EXPERIENCES OF FOOT REFLEXOLOGY AS SELF-CARE
Grace Hsiao Thesis, spring 2009 Diaconia University of Applied Sciences Diak South Helsinki, Finland Degree Programme in Nursing Nurse
ABSTRACT Grace Hsiao Experiences of foot reflexology as self-care 44 p., 2 appendices, Language: English. Helsinki, Spring 2009. Diaconia University of Applied Sciences. Degree Programme in Nursing. Degree: Nurse
The aims of the study were to examine eight Chinese-speaking immigrants’ experiences of foot reflexology for their well-being and health; and also to investigate how successfully the eight Chinese-speaking immigrants applied reflexology themselves as self-care to maintain their well-being and health. The purpose of the study was to provide a deeper understanding of people’s experiences of reflexology. Furthermore, it can benefit all nurses, doctors and people who are interested in reflexology as self-care. Moreover, this study can offer people an alternative method of self-care. This research was conducted using a qualitative method and adopted an action research approach. I applied reflexology five times on every participant. Each time lasted forty minutes. After that they were encouraged to practice reflexology at least 6 months by themselves. The data was collected by using half-structured thematic interviews with eight research participants aged from twenty to sixty-five before the first reflexology session, during the five sessions, after the last session, and after participants 6-month self-practice. The research took place in spring 2007 and ended in summer 2008. The theory part of this thesis included Orem’s theory of self-care, complementary medicine and reflexology. The result of this research showed that the eight participants had experienced reflexology in a positive way on their health and well-being. The improvement of their health problems and well-being were appeared to be slight or obvious. After my teaching and their own many-month practice, they were able to apply reflexology by themselves. All participants perceived reflexology as a good form of self-care and showed interest in continuing it by themselves after the study. The conclusion of this research is that reflexology seems a costless and efficient form of self-care to maintain and improve people’s well-being and life quality. It could be worthwhile for the health care professionals and government to promote it to a wider group of people.
Keywords: reflexology, self-care, complementary medicine
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TIIVISTELMÄ Hsiao, Grace. Kokemuksia vyöhyketerapiasta jaloille itsehoidon muodossa. Helsinki, kevät 2009, 44s., 2 liitettä. Kieli: englanti. Diakonia-ammattikorkeakoulu, Diak Etelä Helsinki. Hoitotyön koulutusohjelma, Sairaanhoitaja (AMK).
Tämän opinnäytetyön tarkoituksena on kuvata kahdeksan kiinankielisen maahanmuuttajan kokemuksia vyöhyketerapiasta (refleksologiasta) jaloille. Tässä työssä tarkastellaan myös sitä, miten nämä kahdeksan ovat onnistuneet käyttämään vyöhyketerapiaa oman terveytensä hoidossa ja hyvinvointinsa edistämisessä sen jälkeen kun tutkija opetti heille vyöhyketerapiaa. Opetuskertoja oli viisi.
Tutkimus pyrkii antamaan syvällisen käsityksen, kuinka ihmiset kokivat vyöhyketerapian. Lisäksi se voi hyödyttää sairaanhoitajia, lääkäreitä ja muita henkilöitä, jotka ovat kiinnostuneita vyöhyketerapiasta itsehoidossa. Tutkimus myös tarjoaa ihmisille vaihtoehtoisen keinon itsehoitoon.
Tutkimus on kvalitatiivinen ja tehtiin käyttäen toimintatutkimuksen lähestymistapaa. Annoin viisi kertaa vyöhyketerapiaa jokaiselle osallistujalle ja yksi kerta oli noin 40 minuuttia. Tämän jälkeen heitä kehoitettiin harjoittelemaan vyöhyketerapiaa itsekseen vähintään kuuden kuukauden ajan. Aineisto koottiin käyttämällä puolistrukturoitua haastattelumenetelmää, jossa oli mukana kahdeksan osallistujaa, iältään 20-65 vuotiaita. Haastattelut tehtiin ennen vyöhyketerapian antamista, sen aikana, sen jälkeen ja kuuden kuukauden oman harjoittelun loputtua. Tutkimus alkoi keväällä 2007 ja loppui kesällä 2008. Tutkimuksen teoreettisessa osassa käsitellään Oremin itsehoidon mallia, vaihtoehtoista lääketiedettä ja vyöhyketerapiaa, joka vähentää stressiä ja rentouttaa kehoa.
Tutkimuksen tuloksista ilmenee, että kahdeksan kiinankielistä maahanmuuttajaa on kokenut vyöhyketerapian hyväksi terveydelleen ja hyvinvoinnilleen. He ovat onnistuneet käyttämään vyöhyketerapiaa itsehoidossa sen jälkeen kun tutkija opetti heille vyöhyketerapiaa ja he harjoittelivat sitä itse usean kuukauden ajan. He kaikki kokivat vyöhyketerapian myös hyväksi itsehoidon muodoksi ja halusivat jatkaa sitä tutkimuksen jälkeen.
Tutkimuksen tärkeimpänä johtopäätöksenä voidaan todeta, että vyöhyketerapia on edullinen ja tehokas itsehoidon keino terveyden ja hyvinvoinnin edistämiseksi ja elämän laadun parantamiseksi. Terveydenhuollon henkilökunnan ja yhteiskunnan muiden toimijoiden kannattaisikin suositella vyöhyketerapiaa ihmisille enemmän.
Avainsanat: refleksologia vyöhyketerapia, itsehoito, vaihtoehtoishoito
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TABLE OF CONTENTS 1. INTRODUCTION ........................................................................................................5 2. DOROTHEA E. OREM’S THEORY OF SELF-CARE ..............................................7 3. COMPLEMENTARY MEDICINE ............................................................................11 4. FOOT REFLEXOLOGY ............................................................................................14 4.1 What is reflexology? .............................................................................................14 4.2 The history of reflexology.....................................................................................14 4.3 Reflexology and self-care .....................................................................................18 4.4 Stress, health and reflexology ...............................................................................18 4.5 Reflexology methods ............................................................................................19 4.6 Research and study on reflexology .......................................................................20 4.7 The state of reflexology in Finland .......................................................................22 5. RESEARCH IMPLEMENTATION ..........................................................................23 5.1 The aim of the study..............................................................................................23 5.2 Research method ...................................................................................................23 5.3. Data collection and analysis.................................................................................25 5.3.1 Selection of Participants.................................................................................26 5.3.2 Research procedure ........................................................................................27 5.4 Credibility of the study .........................................................................................28 5.5 Research ethics......................................................................................................29 6. RESEARCH RESULT................................................................................................31 7. CONCLUSIONS AND RECOMMENDATION........................................................39 8. MY PROFESSIONAL GROWTH .............................................................................40 BIBLIOGRAPHY ...........................................................................................................41 APPENDIX 1. .................................................................................................................43 APPENDIX 2 ..................................................................................................................44
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1. INTRODUCTION
The American Medical Association states that 85 % of illness results from stress (Reflexology overview, 2008.) However, it is not easy to avoid stress in life nowadays. It is very important for everyone to know some ways to relax from stress; the accumulated stress left without being well-managed can cause illness. The question of how to reduce stress efficiently, safely and economically has been on my mind; my personal interests and study have made me start searching the answer to that.
My current nursing education of the conventional medicine has trained me to look at health care from different points of view. The theoretical knowledge of nursing was covered during my studies. Dorothea Orem is one of the most important theorists of nursing. Her theory has been one of the most studied and applied theories in nursing. The key prominence of her work emphasizes that self-care plays a very important role in maintenance of health. I am impressed by her self-care theory of nursing and convinced of what she emphasized in her work. Therefore, the Dorothea Orem’s theory of self-care is applied as the theoretical framework for this thesis. In section 2, the theory will be presented in detail.
Moreover, I have been always interested in the topics how to stay healthy with small cost but long-lasting effect. This interest partly originates from my own unsatisfactory experience about the conventional western medicine, partly comes from the belief in a natural way to maintain health. Since being teenaged, I have suffered frequently from headaches, usually turned up into migraine. With age, chest pain, pre-menstrual syndrome, sleeping problems, shoulder stiffness, back pain and urinary tract infections have bothered and annoyed me frequently, but no satisfactory treatment were found from the conventional western medicine practices. Therefore, I turned to the traditional Chinese medicine and the complementary medicine and tried to heal myself with them. Over many years I have great experiences in utilising traditional Chinese medicine and complementary medicine and am convinced of their good effects and impacts on health. For that I decided to start my exploration in finding out more information and understanding about the complementary medicine.
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About twenty-five years ago, I accidently obtained a brochure about foot reflexology, and then started to practice reflexology on myself by following the instruction of that brochure.
From that time being, I have benefited by reflexology and my above
mentioned health conditions have been improved remarkably. I have continued to use it often to relax from the daily stress and to maintain my health and well-being. As a result, reflexology, one of the complementary medicines became one of my favourable interest topics.
I believed that the combination of the conventional medicine and
complementary medicine can be applied for the best interests of the patient. Based on my own experiences and belief, I decided to work on my thesis about how reflexology could be utilized as self-care.
In section 3, the complementary medicine will be
introduced and in section 4, reflexology will be explained in specific.
According to the international Council of Nurses Code of Ethics for Nurses (2000) “Nurses have four fundamental responsibilities: to promote health, to prevent illness, to restore health and to alleviate suffering”. (Tschudin 2003,13.)
From my own
experience and opinion, I believe that reflexology could be one of the effective and lowcost ways to achieve those tasks. For this reason, I aimed to bring information about reflexology to a group of people in this research to examine their experience of reflexology and to follow up how successfully they can apply reflexology on themselves as a means of self-care to maintain their well-being and health. The research implementation is reported specifically in section 5.
This study is conducted by a qualitative research and adopted an action research approach. The qualitative research and action research will be explained also in section 5 more why they are suitable for this research.
The research result is shown in section 6. Hopefully this research could create more interest in reflexology among people, and draw more attention from especially decision makers of health policy. Moreover, I hope government in health sector and nursing schools could recommend reflexology as a good means of maintaining health and improving life qualities. The conclusion and recommendation of this study is shown in section 8.
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2. DOROTHEA E. OREM’S THEORY OF SELF-CARE
Self-care is behaviour of mature and maturing persons who have developed the abilities to care for themselves in their environmental situations. Self-care conveys the twofold connotation of “for oneself” and “given by oneself”. Self-care is the operation of activities that persons start and act on their own behalf in maintaining life, health and well-being. Persons who participate in self-care own the necessary action abilities to behave intentionally to control internal and external factors that influence their own operation and growth. (Orem 1995, 103.)
Self-care needs internally directed activities to control behaviors. Self-care also needs externally oriented behaviors to control the environment, to establish contact and communication with others, and to secure and utilize of resources. (Orem 1995, 107.) There are four kinds of externally directed self-care activities: 1) knowledge-seeking activity courses, 2) assistance- and resource-seeking activity courses, 3) expressive interpersonal activities, and 4) activities courses to manage external factors. There are two kinds of internally directed self-care activities: 1) resource-utilizing activity courses to manage internal factors and 2) activities courses to manage oneself (thoughts, feelings, orientation) and consequently manage internal factors or one’s external directions. (Orem1985, 110.)
Comprehending self-care as intentional activity with internal and external directions is important for nurses. This comprehending assists nurses in obtaining, developing, and improving skills required for 1) obtaining valid and reliable information to define the self-care systems of individuals, 2) evaluating information descriptive of self-care and dependent-care systems, and 3) estimating how individuals can and should be assisted concerning carrying out the self-care operations from which a therapeutic self-care requirement is formed. Nurses must understand self-care activities classified concerning their internal or external directions regarding to their relationship to each of the five forms of assisting. (Orem1985, 110.) The five forms of assisting are: 1) acting for or doing for another, 2) advising and directing, 3) supplying physical or mental support, 4)
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supplying and maintaining a surrounding that aids personal development, 5) teaching. (Orem 1995. 15.)
The activities of self-care are acquired according to the religions, habits, and customs that present the cultural form of life of the group to which the person belongs. Self-care needs both acquiring and utilization of knowledge as well as lasting motivation and skill. The acquiring process contains the person’s continuous development of a range of self-care habits and related skills. (Orem 1985, 70-71.)
Self-care behavior is affected by self-concept, by the level of maturity of the individual, by culturally based targets and practices, by the scientifically based health knowledge owned by a person, by placement in the family constellation, and by membership in social groups out of the family, for example, friendship and work groups. Absence of scientifically based knowledge about self-care, disorders of health and malfunctioning, absence of self-care skills, and insufficient habits of self-care limit what a person can do concerning his own self-care or in aiding another person in such things. Self-care needs general knowledge of self-care targets and practices as well as specific knowledge about self, containing health state, and about the physical and social environment. It also needs internalization of perceptions and restrictions and motivation. Learning specific knowledge requires making observations and judgments and leads to comprehending of present self-care requirement as well as the self-care deficit; it may need contact and interactions with workers in the health services. Self-care contains also searching for and taking part in medical care advised by the doctor in the event of health deviations and periodic scientific evaluations of health states. (Orem 1995, 106-107.)
Therefore, there are many factors which affect person’s self-care capability and process. The possibility and ability of individual to acquire the capabilities which self-care requires vary largely. The external affecting factors of self care are such as culture, tradition, education and socioculture orientation. The internal afftecting factors of selfcare are such as age, sex, developmental and health state. The combination of internal and external factors produce individual’s general operation capability of self care, such knowledge, attitude, skills and motive. The following diagram shows the relationship between self-care and affecting factors. ( Sinkkonen 1984, 39.)
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Diagram of individual’s self-care process and affecting factors Level 1 Individual’s internal affecting factors age sex health state developmental state
Individual’s general operation capability (human agency) operation abilities area: cognitive, affective and psychomotor understanding needed: knowledge, skills, values, attitude, belief, experience, motive, self-concept
Individual’s external affecting factors culture, tradition sociocultural orientation patterns of living family system elements health care system elements education system
Individual’s self-care capability (self-care agency): knowledge, attitude, skills, motive
Level 2 Individual’s self-care requirement general self-care requirement
Self-care process
Self-care adquate behavior
Individual’s problem solving and decision making process, where he compares his self-care requirement with self-care ability
when individual’s self-care capability is the same as or biger than his self-care requirements
Self-care deficit and self-care compensatory care demand when individual’s self-care capability is smaller than selfcare requirement
Self-care compensatory system
Level 3 family friends colleagues
official health care system nursing as part of it
un-official health care system such as volunteer organization, other professionals outside of health care system
Self-care actions compatible with an individual’s goals and values are probably to be viewed as beneficial. Their application, however, is based on the individual’s estimate of whether he /she can conduct the action. The first action in the application of self-care is answering these questions: Is it useful for me? Am I able to do it? (Orem 1980, 71.)
According to Orem’s theory of self-care, I first motivated people by providing reflexology knowledge in a health seminar and telling them my own good experience of
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reflexology. I also demonstrated how to apply reflexology to feet, let them experience how it felt in the seminar. The purpose of that seminar was to inform them that there is a costless and effective form of self-care to maintain and promote health and well-being which can be performed at home at any time. After the seminar I chose some people as research participants whose age, physical and mental development were suitable for performing self-care. Moreover, they had been suffering some health problems and want to improve them, but they had not obtained satisfactory treatments from “western medicine” in Finland for those health problems partly because of foreign language and partly because of Finnish different health care system from their original countries’. According to their opinions it was not so easy to see a doctor in Finland as in their own original countries. In other words, they have their own motivation to learn reflexology as self-care to take care of themselves in the immigrant country – Finland. In the study I taught reflexology to them five times so that they experienced it first and obtained some benefit of health improvement from it. In other words, I made it possible for them to think that it was useful for them and it was possible for them to do it themselves. When they met problems in applying reflexology, I helped them to find solutions by demonstrating more skills and by providing more knowledge about physiology and their health problems. With strong motivation of solving their health problems and my help, they followed my instructions to practice reflexology as often as they could.
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3. COMPLEMENTARY MEDICINE
What is complementary medicine?
First, the terms complementary and alternative
should be clarified. Before the term alternative medicine was used mostly, after years, in order to emphasize that the alternative medicine is proposed to run side by side with the orthodox medicine, instead of the opposition to it, the word complementary medicine took the place and became more frequently used term, particularly in the UK and Europe, but in the USA the term alternative medicine is still used commonly. To avoid the confusion, doctors, researchers and practitioners decided to apply the term complementary and alternative medicines to describe those therapies which are classified as non-mainstream medical care. The definition of complementary medicine is not specific. According to the House of Lords Select committee on Science and Technology’s Sixth Report on Complementary and Alternative,
it reads
‘Complementary and Alternative Medicine (CAM) is a title used to refer to a diverse group of health-related therapies and disciplines which are not considered to be a part of mainstream medical care.’ The other definition reads treatment employed by registered doctors is orthodox and others are complementary.
This definition is also not
satisfactory and even causes problems, because some registered doctors perform the CAM, too, in their practice. (Murcott 2005,13.)
The mainstream medical care is the so-called ‘western’, ‘scientific’, ‘orthodox’ ‘conventional’ or ‘allopathic” treatments or therapies which are studied mostly in university and vocational schools. What treatments or therapies are categorized into the group non-mainstream medical care, the complementary medicines? The list of those therapies is big and growing and there are many ways of classifying those therapies. They can be split up to physical techniques, for example, osteopathy or massage belong to this group; qi (or chi) energy-based, for example, shiatsu and reflexology belong to this group; mind-based, for example, hypnotherapy and neurolinguistic programming belong to this group; or geomancy, for example, crystal healing belongs to this group. The therapies can be classified by their origins as well. For example, acupuncture and shiatsu are derived from energy meridians concept of the Traditional Chinese Medicine.
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However, none of these classifications is specially convincing, because there is repeated crossover of concept from one to another. (Murcott 2005, 14.)
Complementary and conventional medicines approach differently toward the definition and treatment of illness. Conventional medicine is based on diagnosis: doctors utilize symptoms and medical tests to evaluate the problem, and advise treatment accordingly. In contrast, complementary practitioners intend to treat the patient as a whole: for them illness means a disorder of physical and mental well-being. Treatment aims to activate the natural self healing and self regulating capabilities in the body. Obviously the body posses some ability to heal itself, for example, wound restore and the renewal of cells. This shows that there is a recurring process of disintegration and growth in the body. For complementary practitioners, all recovery and cure comes from the self healing of the body and treatment solely activate the own resources of the body. Complementary therapies and treatment attempt to activate self healing process in the body to bring back the harmonious functions of the physical and biochemical elements of the body, and of the mind and emotions. Those therapies obviously meet the health requirement of people, therefore the popularity of complementary therapies increased rapidly in the 1980s and 1990s. Complementary therapies are considered as suitable for over 200 health conditions. (Woodham and Peters 1997, 8-9,12.)
Nowadays complementary medicine is a powerful force in health care and has become a division of health care. For example, complementary health practices have newly and increasingly been applied to palliative care.
The money of the world spend on
complementary medicines is yearly USA dollar 60 billion and the figure is increasing all the time. There are many explanations about the increasing popularity of complementary medicine. One reason is that complementary medicine has been defined as the patient-based type of health care.
It is applied mostly for chronic health
conditions such as lower back pain, eczema, stress or arthritis, which do not threaten life but are annoying problems by which conventional medicine is frequently perplexed. Other reason is that people are not satisfied with the conventional medicine and instinctively search for other healing solution. Most specially, complementary medicines are typically holistic; they aim to treat the whole person, not solely the specific symptoms of organs with the need to restore. Many of the complementary therapies have been researched to their effectiveness and they have being applied in 12
large number by conventional doctors in conventional medical practice. These therapies contain chiropractic, osteopathy, acupuncture, homeopathy, Bowen technique, psychotherapy, shiatsu and reflexology. (Murcott 2005, 16.)
Health and well-being are usually compared to a three-legged stool: one leg is pharmaceuticals; the second is surgery and procedure; and the third leg is self-care. Self-care is one of the cornerstones of complementary medicine.” (Woodham and Peters 1997, 12.) As mentioned many times in above statements, reflexology falls into the field of complementary medicine. In the next section, reflexology will be described specifically.
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4. FOOT REFLEXOLOGY In this research reflexology means foot reflexology, instead of hand reflexology or others.
4.1 What is reflexology? Reflexology is a method of activating the healing powers of the body. In this method pressure is applied to the feet. Reflexology states that, the feet are a mirror of the body. By applying a certain degree of pressure on specific reflex point on the feet, the corresponding areas of the body can healed and the feeling of well-being can be promoted. When all parts of the feet are pressured properly, as a result, the body is treated as a whole. It is believed that granular accumulations of waste material of the body concentrate around reflex points in the feet, in the form of uric acid and calcium crystals which cause the reflex point tender to touch. The greater the tender felt by the receiver of reflexology, the greater the disorder is assumed. By breaking down those uric acid and calcium crystals, the energy flow will be freed along the zones, blocked nerve pathways are opened and consequently the blood supply is improved to take away waste products out of the body. According to medical opinion, there are 7,200 nerves ends in each food, and many doctors are convinced that pressure performed on these probably elevate the feelings of deep relaxation created by reflexology. Besides, doctor conceded that massaging tense from foot muscle by reflexology may cause blood to circulate more freely, distributing nutrients and oxygen all over the body and taking away waste products. Reflexology is harmless to any symptoms of illness, and the relaxation it induces may be beneficial. (Woodham and Peters 1997, 66.)
4.2 The history of reflexology It has been known that the early Chinese, Japanese, Indians, Russians and Egyptians massaged the feet to promote health and well-being. There are several theories about the origin of reflexology. One widely believed theory states that reflexology started in China over five thousand years ago. Although no concrete evidence is found, many esteemed reflexology practitioners believed in this theory.
They believed that
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reflexology stemmed from on the ancient Chinese concept of health and the flow of energy in the body. The flow of energy is described as qi (or chi). The traditional Chinese medical care was founded on the concept of man as a whole being.
Other
theory is that reflexology originated in Egypt, because the oldest documentation of reflexology was founded in Egypt. The evidence is a painting showing men massaging the feet and hands of others. This painting was dated about 2500-2330 B.C. and was found in the tomb of an Egyptian physician, Ankmohor at Saqqara. The third theory asserts that reflexology had its origin from the Native Americans by the Incas, but no exact evidence supports this theory. In spite of that, the application of reflex pressure to the feet as a healing treatment has been done by the North American local people for generations. (Dougans 1996, 50.) In Europe a similar type of reflexology was practiced in the 14th century. The evidence to it is a book called Zone therapy written by Harry Band Bressler. The book stated that “pressure therapy was well known in the middle countries of Europe and was practised by the working classes of those countries as well as by those who catered to the diseases of royalty and the upper class.” The other evidence is the other book written by Dr. Adamus and Dr. A’tatis about the subject of zone therapy. That book was published in 1582. Later in 1890s, Sir Henry Head (1861-1940) of London conducted neurological research, where the scientific basis of the reflex study began. In 1989 he discovered zones on the skin that turned out to be very tender to pressure when an organ connected by nerves to this area was diseased.
Years later after his clinical research was
conducted, he established the theory of “Head’s Zones” or “zones of hyperalgesia.” (Dougans 1996, 50.)
In Russia the work on reflexes started from a psychological point of view by the founder of Russian physiology, Ivan Sechenov. He found out the cerebral inhibition of spinal reflexes and issued in 1870 a paper about it. By inspired by the book of Ivan Sechenov Reflexes of the Brain, Ivan Pavlov developed a theory of conditioned reflexes in 1870. The theory states that “there is a simple and direct relationship between a stimulus and a response.” He discovered that “any stimulus can act a conditioning stimulus to produce a corresponding conditioned response”. The study of reflexology continues in Russia nowadays. They have conducted scientific tests on the effect of reflex therapy and have discovered that reflexology is an effective complement to 15
orthodox medicine. In Germany, Dr. Alfons Cornelius may be the first German to apply massage to “reflex zones.” He himself had benefited from the massage applied to the reflex zones. Then he started to use the pressure to the reflex zones in his own medical practice and published a book called Pressure points, the origin and significance in 1902. Based on the researches of the above people, the European continued the study of reflexology. (Dougans 1996, 50.)
In the USA, Dr William H. Fitzgerald (1872-1942), an ear, nose and throat specialist introduced the zone therapy in 1915. Therefore, he is generally known as the founder of zone therapy. When he worked in Vienna, he started the contact with the work of Dr. H. Bressler who had been researched the possibility of healing organs with pressure points. By means of his experience in Europe and his own investigation, Dr. Fitzgerald discovered that if the pressure used on the fingers, it would cause a local anaesthetic impact on the hand, arm, and shoulder, up to the jaw, face, ear, and nose. He used pressure by way of tight hands of elastic on the middle area of every finger, or by way of small clamps on the tips. Only by means of this pressure technique, he was capable of performing minor surgical operation without anaesthesia.
Dr. Fitzgerald split the
body into ten equal longitudinal zones from the head to the toes; he applied those ten zones for his anaesthetic effect. The number of ten correlates to the fingers and toes. Every finger and toe falls into one zone. The idea is that organs of the body within a certain zone will be connected to one anther by the energy flow and thus organ of the body is able to influence one another. Dr. Fitzgerald published a book Zone Therapy as a result of his discovery.
He and his colleague Dr. Edwin Bowers continued
enthusiastically the development of theory of zone therapy. Dr. Joseph Shelby Riley, a physician, accepted their theory seriously by using it in his work for many years. Dr. Riley improved the techniques of Dr. Fitzgerald and finished the first detailed diagrams and drawings of the reflex points located in the feet. He also increased his discovery of eight horizontal divisions to Dr. Fitzgerald’s longitudinal zones.
As a result, he
published in 1919 his first book Zone Therapy Simplified. (Dougans 1996, 51-52.)
In addition to Dr. Fitzgerald, Dr. Bowers and Dr. Riley, Eunice Ingham (1897-1974) was considered as the most important person to contribute the foundation of modern reflexology. It is said that she should be named as the Mother of Modern Reflexology, because she split up the work on the reflexes of the feet from zone therapy and 16
developed the zone therapy into what is now known as reflexology. (Dougans 1996, 53.)
In the 1930s, Eunice Ingham was a physiotherapist and the assistant to Dr. Riley.
Besides, she was a student and promoter of the theory of zone therapy and applied it to her patients; she came to the conclusion that some parts of body probably were more reachable and effective than others, because the zones went all over the body and was able to be reach anywhere. She believed that the feet should be particular targets for therapy, because the feet are extremely sensitive in nature. Finally she charted the whole body in the feet and found that rotating pressure on the different area in the feet had healing effects significantly over the limitation of zone therapy which had been applied specifically to reduce pain. In this way the modern reflexology was established. (Norman 1989, 17.)
According to Kevin Kunz, a writer of many reflexology books, the term reflexology was not created by Eunice Ingham. It was invented by Dr. Bechterev in 1917 to define the actions of reflexes. The original definitions reads: “Reflexology is behavior according to the reflexes.” in older dictionaries. Eunice Ingham loaned the term to report her work. This is the reason why the term reflexology is not common used in many countries. (Kunz 2007)
Eunice Ingham enthusiastically taught her theories to the non-professional people, because she believed that they could learn the correct reflexology skills to take care of themselves, their families, and friends. As a result of her work, she published two wellknown books about reflexology Stories The Feet Can Tell (1938) and Stories The Feet have Told (1963). (Dougans 1999, 53.)
In the 1960s Doreen Bayley, one of Eunice Ingham’s student, introduced reflexology into the UK and evolve many charts which are applied nowadays. After that reflexology become widespread in the UK, Europe, Australia and New Zealand. It is applied in pain clinics, caner centers and special-care baby units.
In the USA, application of
reflexology in institutions is limited; however, it has applied to treat cardiac and braininjured patients. (Woodham and Peters 1997, 66.)
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4.3 Reflexology and self-care The Mother of Modern Reflexology Eunice Ingham believed that the ordinary people could learn the correct reflexology skills to take care of themselves, their families, and friends; therefore she promoted reflexology enthusiastically. (Dougans 1999, 53.) Besides, many reflexology practitioners after her also recommend that reflexology is suitable for self-care. With the proper knowledge and careful teaching, people can learn reflexology to help themselves to maintain their health. There are many books that illustrate comprehensively how to learn reflexology correctly for self-care. Most of books are easy to buy from shops and internet, or to borrow from library; in other words, it not difficult for people to access them.
What is the difference between reflexology performed by people themselves and practiced by a professional? According to reflexology practitioner Rosalind Oxenford, the difference depends on the practitioner’s philosophy and principles of reflexology, the knowledge of anatomy, physiology, pathology and the reaction of body to health problems. The ability to apply the right reflexes and energy pathways for special conditions is the key difference between a professional person and a non-professional one. (Oxenford 1996, 54.)
4.4 Stress, health and reflexology The American Medical Association states that 85 % of illness is resulted from stress (Reflexology overview, 2008.) First, let us inspect what really happens in the body when we are stressed. The stress response is a primitive reaction to a threatening situation. When we face a threatening situation, our thoughts activate the sympathetic and parasympathetic systems. The sympathetic nervous system starts involuntary responses designed to switch on all the major systems of the body. Firstly a flood of hormone secretes, and then the hypothalamus activates the pituitary gland. The gland discharges hormones that induce the adrenal gland to increase the secretion of adrenalin and noradrenalin into the bloodstream. The body supplied more blood to the brain. The heart accelerates, more blood is sent to muscles and more energy is discharged into bloodstream. As a result, blood pressure increases. At the same time adrenalin induces vascular constriction, which decreases the flow of blood to the stomach and intestine. 18
Blood vessels dilate in some areas and constrict in others.
Long-term adrenal
stimulation with no discharges of energy will exhaust minerals and vitamins from the body. Further, long-term adrenal accumulation can affect blood pressure and induce accumulation of fatty substances on blood vessel and damage the function of digestion system. When an organism confronts a continual stress, the response system comes into a chronic phase, where the body’s normal resistance decrease and becomes exhausted. As a result, several illnesses appear in this phase. Moreover, the ability of body to defence infection and cancer declines. (Dougans, 1999, 22.)
Nowadays stress is not easy to avoid, people meet it and live with it everyday. How to manage the stress well is very important for every person to maintain good health. The stress that is not managed well will damage badly the health when the defence of body collapses. Reflexology reduces stress by creating deep and peaceful relaxation. The deep relaxation and peace assist the body to balance itself and stimulate healing energy to flow in the body smoothly. In addition, over seven thousand of nerves are stimulated during reflexology session, and consequently neural pathways are open and clear to function normally. Pains are relieved. Muscles are relaxed. Furthermore, the cardiovascular vessels conduct the flow of blood easily as well. As a result, the toxins and waste product are easy to eliminate out of the body. Every organ, cell and tissue of the body receives adequate nutrition due to the smoothness of blood flow. Under this circumstance, people feel well. (Norman, 1989, 17-19.)
4.5 Reflexology methods Since reflexology has its long history and ancient origins, different methods and approaches have been developed, for example, the Ingham method, new approaches and the Father Joseph method.
The Ingham Method was developed by Eunice Ingham and the modern reflexology was established on this method. The method is the most widespread of reflexology methods practised all over the world nowasdays.
According to this method pressure is
performed by “thumbwalking”, in this way the thumb (or finger) curves and straightens to maintain a constant pressure over the area of the foot being worked. How much 19
pressure should be used to the foot depends on the pain tolerance of the patient. The focuse of this method is to relax and balance the body systems. All of the reflexes will be pressed in the one-hour session by the method, so it is always holistic. (Differing methods and techniques, 2008)
New Approaches and techniques was born and rapidly spread
when therapists of
complementary medicine all over the world evolve and share their experiences and clinical discoverings. This method is performed by mixing acupressure points and concepts of energy therapies within a reflexology session. (Differing methods and techniques, 2008)
The Father Josef method was used in this research. The method was originated from Switzerland and developed in Taiwan by Father Josef Eugster, a Swiss catholic priest worked in Taiwan. Father Josef Eugster had suffered the Rheumatoid Arthritis in his knee for a long time and in 1980s he received a book about reflexology from his friend who believed it probably would help Father Eugster with his illness. Father Eusgter learned reflexology from that book by himself, applied it to himself and consequently his Rheumatoid Arthritis was healed. He was very happy about this surprising result and started to apply reflexology to his friends and parishioners. Similarly, the outcome was satisfactory.
Father Eugster enthusiastically promoted his method in Taiwan,
China, Japan, Korea, Malaysia, Singapore, Hong Kong and Bolivia. (Chen 1999, 3537.) This method combines thumb-sliding and pressure skill, and a small, wooden stick is used as an assistant tool sometimes. The pressure is usually hard and cream is used in order to create a smooth and efficient motion. The method mainly concentrates to stimulate the body and less to relax. A session of this method lasts 30 - 40 minutes (Differing methods and techniques, 2008)
4.6 Research and study on reflexology It is asserted that more than 100 illness benefit from reflexology. There are more than 300 outcome studies about the effectiveness of reflexology around the world. (Oleson & Flocco, 2008)
20
Most of research studies show the effectiveness of reflexology for various conditions. Particularly, there are several well-designed studies, financed by the National Cancer Institute of USA and the National Institutes of Health of USA, those studies show the promise of reflexology as an intervention to relieve pain and improve relaxation, sleep, and the decrease of psychological symptoms, for example, anxiety and depression. Furthermore, Chinese research literature on reflexology consists of more than 300 studies that indicate its effectiveness in 95% of over 18,000 cases including 64 different illnesses. (Teagarden, 2007)
According to Kunz’s reflexology research project, there are 69 controlled studies which were conducted for the effectiveness of reflexology. Among those studies, there are some studies focused on those health conditions that are related to stress symptoms, such as anxiety, constipation, dyspepsia, fatigue, headache, shoulder pain and nervous exhaustion. The results of those studies indicate that reflexology is effective to relieve those stress symptoms to some extend and improve general health and well-being. (Kunz & Kunz, 2009)
A report made by Leila Eriksen about reflexology: Research and Effect Evaluation in Denmark, Danish Reflexologists Association, Denmark, August 1995 showed a very interesting controlled case study in Denmark. It reported that reflexology saved a Danish employer US$3,300 a month due to fewer sick days of employees and improved also the work environment.
Reflexology has been applied to assist the staff of
Scandinavian Airline’s Cargo Department. Here is a statement from the employees:
“Our work is one through computers and people spending many hours in a chair doing their work, resulting in aching shoulders and back. Since we employed our reflecologist … we have experienced a substantial decrease of people being ill and away from work. The approximate amount is 20,000 Danish kroner a month (US$3,300). It has not only a physical effect, but also a psychological effect. There is much better atmosphere in the department, because the employees feel there is something being done about their problems… Before we used to stay at home when ill, now we see the staff go to work anyway because they know they can get a treatment and feel better.” (Kunz & Kunz, 2009) 21
A study of the effect of reflexology treatment conducted by Hanne Terp reported another interesting case of company reflexology in Denmark. This case involved 52 women employees. The report stated the reflexology had positive effects on the primary ailments of 97.5% employees and on the secondary problems of 77.5% employees. Medicine taking of 27.5% employees was reduced. The sick leave days of employees were decreased 65.9%. (Kunz & Kunz, 2009)
4.7 The state of reflexology in Finland Reflexology is translated into two different Finnish words refleksologia or vyöhyketerapia which is derived from the zone therapy discovered by Dr. Fitzgerald. The word vyöhyketerapia is used more commonly in Finland than refleksologia.
There are three zone therapy organizations in Finland, which are Association of Finnish Reflexologists, Finnish Association of Natural Therapies and Medika Nova (Association of Reflexologists, 2009). The education of zone therapy in Finland has started since year 1970.
Modern zone therapy education is provided by
Lountaislääketieteen Institute Kairon, classical zone therapy education is provided by Frantsilan koulutuskeskus, and the education of reflexology are provided by Medika Nova lountaisterapiakeskus. (Luonnonlääketieteen keskusliitto, 2009)
In Finland there is no legal regulation for complementary medicine. Everyone has the freedom to work independently in a professional way. There are six private institutes educating reflexology in Finland. The number of reflexology practitioner with certificate is about 2000. Those six private institutes have negotiated common criteria for the certificate. Reflexology has obtained plenty of publicity in the past years. The media wrote about complementary treatments and informed facts of reflexology. Further, the public health sector has been interested in reflexology according to the Association of Finnish Natural Health Therapists and Medika Nova / Finnish Institute for Reflexology. (Reflexology in Europe Network, 2008)
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5. RESEARCH IMPLEMENTATION
5.1 The aim of the study The aims of the study are: to examine eight Chinese-speaking immigrants’ experiences of reflexology applied by me and by themselves for their well-being and health; and also to investigate how successfully the eight Chinese-speaking immigrants apply reflexology as self-care to maintain their well-being and health after my teaching. The research questions are:
1. How do eight Chinese-speaking immigrants experience reflexology applied by me and themselves for their well-being and health? 2. How do the eight Chinese-speaking immigrants succeed in applying reflexology as self-care to maintain their well-being and health?
5.2 Research method In this study the research adopted the qualitative research method and action research approach, because the method is suitable for this research purpose of investigating people’s experience.
First the definition of qualitative research and action research has to be explained. Actually, to define a qualitative research specifically is not easy. For example, Strauss and Corbin (1998) described qualitative research as any research not fundamentally constructed on calculation or quantification of empirical material. However, most of researchers agree that the qualitative research should possess some specific essences. About the standpoint of the researcher and the researched, the standpoint of the people should be investigated by entering their structures of meaning. The social life should be observed in process instead of static situation.
A whole point of view should be
provided within described contexts. The empathic neutrality should be maintained by means of a non-judgement approach when the investigator’s personal view is used. Regarding the nature of the research outline, a flexible research plan should be adopted. Naturalistic inquiry should be conducted in real-world instead of experimental of
23
manipulated environments. As to the nature of data production, flexible and sensitive methods to the social surrounding where the data are generated should be applied. The methods involving close contact between the researcher and the researched should be used. Concerning the nature of research methods, the primary qualitative methods contain observation, in-depth individual interviews, target groups, biographical methods which read like life histories and narratives and analysis of documents and texts. With respect to analysis or interpretation of data, the methods which display the complexity, detail and context of the data should be used. Apparent categories and theories should be picked out from the data. The particularity of each case should be respected and cross-case analysis should be carried. The explanations at the level of meaning instead of cause should be developed. Referring to the nature of result, detailed descriptions should be produced. Meaning, processes and contexts should be mapped. The result should answer ‘what is’, ‘how’, and ‘why’ questions. The influence of the investigator’s standpoint should be considered in the result. (Richie and Lewis 2004, 3-4)
Action research is one type of major analytical tools of qualitative inquiry methods. The purpose of action research attempts to solve a specific problem within a program, organization, or community. Action research clearly and resolutely becomes part of the change process by making the people participate in the program or organization to investigate their own problems for the purpose of solving those problems. Consequently the differentiation between the investigator and action becomes obscure and the research methods are inclined to be less systematic, more informal, and quite specific to the problem, people, and organization for which the research is conducted. The focus of action research is put on specific programs at specific time. There is no intention to generalize beyond those specific environments. (Patton 1990, 157.) Action research is combined, pooled, self-reflective, judgemental, and done by the participants of the inquiry. Besides, action research is a contemplating investigation of a personal curiosity, problem or challenge. The process starts with the development of questions, which would probably be answered by the collection of data. Action signifies that the investigator will be conducting himself as the collector of data, the analyst, and the interpreter of results. (Action research, 2008)
In large amount of action research, the process is the product, for that reason no evaluation will be produced. On the other hand, some action research attempts are set 24
about to examine an organizational or community development theory and for that reason the action research requires quite formal reports and the publications. Action research attempted by a group of people to solve a specific problem probably requires the group to participate the analysis process for the purpose of creating a mutually understood and acceptable solution. For this reason no permanent, written record of the analysis is required. (Patton 1990, 374.)
5.3. Data collection and analysis According to the qualitative research method, I planed the study and selected a group of people who are interested in reflexology and self-care as the research group. Then, I demonstrated the participants how to practice reflexology and ensure the participants’ capability of the basic skills for practicing reflexology. The research data are collected from the interviews before the first session, during sessions, after the fifth session and after one year face by face and on phone as well. I took field notes on every interview, what health conditions the research participants have, which area in the feet should be pressed and how participants felt during the reflexology sessions received from me.
The essential job in qualitative analysis is description. The descriptive analysis answers basic questions. To evaluate the programme these basic descriptive questions contain the following: what are the aims of the programme? What are the essential activities of the research? What occurs to people in the research? What are the influences of the program on participants? Description must be attentively split up from interpretation. Interpretation includes the explanation of the findings, answering “why” question, the ascription of significance to particular results, and the formulation of patterns into an analytic structure.
The authority and accuracy of qualitative analysis rely on the
presentation of well described data, what is often called “thick description”, in such a way that readers of the results are able to comprehend and make their own interpretations.
The focus of qualitative data analysis comes from the evaluation
research questions. (Patton 1990, 374-375.)
Description and quotation are the essential elements of qualitative inquiry. Sufficient description and direct quotations should be contained to enable the reader to gain access to the situation and thoughts of the people represented in the report. Description is 25
counterbalanced by analysis and interpretation. The purpose of analysis is to arrange the description in such a way that it is easy to manage. Description is counterbalanced by analysis and induces interpretation.
An interesting and readable report presents
sufficient description to enable the reader to comprehend the basis for an interpretation, and sufficient interpretation to enable the reader to comprehend the description. (Patton 1990, 430.)
5.3.1 Selection of Participants To assure that the data is collected without any language problem, I chose Chinese as the research language, because Chinese is my mother tongue. The participants of the study are Chinese speaking immigrants living in Finland.
Before the study began, I arranged a seminar introducing reflexology to the audiences in a Chinese-speaking congregation in Helsinki. There were about twenty-two persons (men and women) attending the seminar.
In the seminar fifteen volunteers were
requested to experience a very short reflexology performed by me.
After the seminar I contacted by email all twenty-two persons who attended the seminar and informed them of the purpose of the study, the use of collected data and their anonymous identification in the study. Eight of them replied and agreed to join this research voluntarily.
The total of eight participants is suitable for this qualitative
research. Participants were selected on their Chinese speaking background and good rapport with me. More importantly, the participants and I are members of the same Chinese speaking church in Helsinki. The regular meetings between participants and I are at least once per week. Thus, I am able to follow up how the participants to practice reflexology by themselves.
The ages of participants are from twenty to sixty-five. Among the participants, only one is man and the other seven are women. Six participants have at least a university education except that two others have only high school education. Only one is not married, all others are married. The occupations of the participants are student, software designer, art designer, kitchen-worker and researcher. The origin countries of participants are China, Hong Kong and Taiwan, respectively. The years of participants’ 26
immigration to Finland are from seven years to twenty-two years. They live in Espoo and Helsinki, respectively. Seven of the participants have never heard reflexology before the study, only one of them has heard and experienced reflexology before. Table 1 below shows in detail the background information of participants
TABLE 1. Background information of Participants case 1
case 2
case 3
case 4
case 5
case 6
case 7
case 8
age
20
31
34
43
48
52
54
65
sex
woman
woman
man
woman
woman
university
occupation marriage status country of origin mother tougue years of immigration residence area familiarity of reflexology experience of reflexology
student
university art designer
university software designer
university software designer
woman high school factory worker
woman
education
woman high school kitchen worker
pastor
researcher
single
married
married
married
married
married
married
married
Finland
China
China
China
China
China
Taiwan
China
Chinese
Chinese
Chinese
Chinese
Chinese
Chinese
Chinese
Chinese
20
8
7
10
21
22
15
20
Helsinki
Espoo
Espoo
Espoo
Helsinki
Helsinki
Helsinki
Helsinki
no
no
no
no
no
no
yes
no
no
no
no
no
no
no
yes
no
university university
5.3.2 Research procedure The research started in the spring of 2007 and ended in the summer of 2008. Reflexology was performed by me one by one. Appendix 1 shows when and where I performed reflexology. Before the first session started, I conducted the first interview to obtain information about the health conditions of the participants. I took field notes during the interviews. Each participant received five sessions of reflexology. Each session lasted about forty minutes. After each session the participants were encouraged to practice reflexology to themselves according to my instruction as often as they could until the next session. I interviewed them again before the new session was performed to obtain the information about their experience of reflexology during the period from the previous session to the current session. This procedure repeated until the fifth
27
session is performed. The completion of the five sessions took at least three month on average.
After that the participants was encouraged to practice reflexology to
themselves for at least six months until the final interviews. I followed up the progress of the research.
The procedure of the research lasted about one year.
Finally I
interviewed them on phone to check how they succeed with reflexology practiced by themselves. Appendice 2 shows all the interview questions.
5.4 Credibility of the study The credibility of qualitative research relies on three separate but related research elements: 1) strict techniques and methods for collecting high-quality data that is attentively analyzed, with validity, reliability, and triangulations; 2) the credibility of the researcher, which depends on training, experience, track record, status, and presentation of self; and 3) theoretical conviction in the naturalistic methods, qualitative methods, inductive analysis, and whole thinking. (Patton 1990, 461.)
The authority and accuracy of qualitative analysis rely on the presentation of well described data, what is often called “thick description”, in such a way that readers of the results are able to comprehend and make their own interpretations. (Patton 1990, 375.)
I have been interested in reflexology for more than twenty-five years, and have experienced the improvement of health and well-being by means of reflexology as selfcare. I have learned reflexology from a book written by Father Joseph Eugster. That book is a guidebook of reflexology as self-care. Following the instructions in that book, I demonstrated how to practice reflexology to the participants. The participants were aware of the fact that I am not a professional reflexology practitioner.
This research is my first research, the training and experience of conducting a qualitative research was not much.
Moreover, my techniques and methods for
collecting and describing data were not sufficiently skilful. Furthermore, my teaching skill and reflexology knowledge possibly affected the research result. Additionally, the interviews were not tape recorded and the final interview was conducted on phone; all these factors limited the wholeness of information collected from the participants. Finally my many-year acquaintance with the participants possibly affected the result. 28
As to the measure terms (improved slightly, moderately or remarkably) of describing health improvement comparison, they were purely participants’ subjective expressions, which were not scientifically and medically measurable. Therefore, the research has its limit.
However, I decided to trust all the participants because it was impossible for me to have the accurate information about how often or whether the participants practiced reflexology. I believed what they told about their experience of reflexology. Based on my belief in human goods, the data collected from the participants were trustful because I have known the participants for five to seven years.
5.5 Research ethics The ethical principles for doing research on human being include informed consent, respecting the rights of participants to confidentiality, anonymity, privacy and protection from harm. However, there is no model as to how these principles should be implemented practically. It rather depends on the researchers acting in an ethically reasonable way, taking proper account of the research objectives, the situation about which the research is being set, and the values and interests of the people involved. The ethical decisions nurse researchers finally make are a matter of judgement and open to challenge. It is generally agreed that participants should be informed about the study in a comprehensive way and consent freely to be studied. (Latimer 2003, 86-87.)
The ethical principles provide conventions for the relationship between researchers and suppliers of information and participants in scientific studies. They smooth the relationship between research claim and the claim for individual protections. When interviews are conducted for research, the use of interviews must be constructed on confidence and trust between the researcher and the person who provides the information. The participants must be enquired whether they will permit the data arising from their participations to be used for research purposes. If they give their consent, they shall know that their identity will be protected. (Hallberg 2002, 118-119.)
29
During the planning of this study, I have consulted the instructors of this study about the informed consent. Their opinion was that no official consent to this study is required; however, at least the consent verbally of participants to join this study is required. I informed all participants of the purpose of the study, the use of collected data and their anonymous identification in the study. All of participants consented o participate this research voluntarily.
30
6. RESEARCH RESULT
Research questions are: 1. How do the eight Chinese-speaking immigrants experience reflexology applied by me and themselves for their well-being and health? 2. How do the eight Chinese-speaking immigrants succeed in applying reflexology as self-care to maintain their well-being and health?
The first interview questions were: Have you ever heard reflexology before? Have you had ever experienced reflexology before? What health problems have you had? What do you expect from reflexology?
Only one of the eight participants has heard and
experienced reflexology performed by other person. All of participants expected that reflexology would improve their health or well-being.
As to the health problems, most of participants’ health conditions are related to stress symptom, such as sleeping problems from which seven of eight participants suffered, nervousness five of eight suffered, fatigue five of eight suffered, digestive problems five of eight suffered, anxiousness four of eight suffered, shoulder stiffness three of eight suffered, constipation two of eight suffered, back pain two of eight suffered, headaches one of eight suffered, high blood pressure one of eight suffered. Other problems are such as allergy three of eight suffered, hepatitis one of eight suffered, and menstrual disorders one of eight suffered. From the information of participants’ health problems, I observed that the participant age from forty to fifty suffered more from the stress symptoms as other ages. Table 2 shows the detailed information of health problems of each participant.
TABLE 2. Health Problems of Participants
Health Problems sleeping problems, wake up during night and difficulty falling in sleep again
case 1 case 2 case 3 case 4 case 5 case 6 case 7 case 8 V
V
V
V
V
V
V
31
sleep not deeply, wake up easily
V
V
V
nervousness
V
V
V
V
anxiousness
V
V
V
V
V
V
fatigue
V
V
tension headaches V
digestive problems
V
back pain
V V
V
V
V
V
V
V
shoulder stiffness
V
high blood pressure allergy
V
V
constipation
menstrual disorders
V
V
V
V V
V
V
hepatitis
V
Based on the information obtained from the first interview, I decided the areas of reflex to press to meet their health conditions. The participants’ pressed areas vary depending on the participant’s health conditions.
During the sessions the interview questions were: How do you feel during the session? How do you experience after the reflexology session? What do you think of doing it to yourself? What kind of problems have you met during the previous session to the current session, when you do it to yourself? How often do you practice reflexology to yourself? I took field notes based on the questions.
According to my field notes, all of participants said that their feet felt very tender and sensitive during the sessions, after the first two sessions they felt very tired and sleepy. After all sessions they felt relaxed and slept better in night. One participant described her experience as follows:
“a current, sour and sweet, rise to the leg, then want to sleep. In the whole route back home, I was sleepy. Yesterday before sleeping, I massaged again, mainly concentrate on the head parts. The same feeling occurred
32
and I immediately went to bed. I have waked up two times in the early morning, but not long sleep again twice (proved by dreams).” ”reflexology is the saving star for my stressful period”.
As to the problems they met, most of them said that the problem came from how much pressure they should press to themselves, and the areas where they should press. For them it was not easy sometimes to press some area in the feet by themselves due to the body position. They had little confidence to do it to themselves after the first three sessions. Regarding to the frequency of practicing reflexology, three of participants practiced every day; three of them very often, three or four times a week; only one did once a week.
Before the second interview on the fifth session, one participant stopped the participation of the study, because she became pregnant after the third session. According to many experienced reflexology practitioners, reflexology would not cause any harm to a pregnant person. However, she wanted to stop to secure her pregnancy because she had miscarriage before. After her stop, the participants of the study were seven in number. They continued to the end of the study.
The second interviews questions were: How did you feel about reflexology? How has reflexology influenced your health so far? What kind of difficulties have you had when you practiced reflexology to yourself?
How often do you practice reflexology to
yourself? I took field notes based on those questions.
According to my field notes of the second interviews, the participants had more to say about the influence of reflexology to them after the five reflexology sessions. Here are the direct quotations from the participants:
“Slept deeper and sounder” “Wake-up during night happened still, but easier to sleep again after that” “Warm flow run in the body after reflexology” “A calling from the feet to press when tired” “Felt more energised”
33
“Digestion improved, less stomach acid came when eat something that causes stomach acid before” “Tension headache happened less than before” “High blood pressure has gone down to normal level” “Days of menstrual pain became less, seven days down to three days” “Constipation disappeared, bowl worked well” “Allergy symptoms went over earlier than before.”
As to the problems they met, they had fewer problems after many practices during the five sessions. Some mentioned that one problem came from the tiredness of hands; the other was that to press some certain area by themselves was difficult to adjust body position. Concerning to the frequency of practicing reflexology, the answers remained almost the same as before. Three of participants practiced every day; three of them very often, three or four times a week; only one did once a week.
The final interviews were conducted on phone. The questions were: How has your reflexology practicing been going on? How often do you practice reflexology to yourself? What kind of health improvements have you experienced during the last year? What do you think reflexology as self care to maintain your health and your wellbeing? How would you like to continue reflexology? Every interview lasted between ten to twenty minutes. I took notes based on those questions.
According to my field notes of the final interviews, participants have practiced reflexology to themselves as often as they need. Some of them said that they felt well, so they stopped the practicing after 6 months as the study’s schedule. As to the health improvement after the five sessions until the final interview, except one, all others have experienced the improvement of health in some extent.
During the sessions performed by me, participants have already experienced some kind of health improvement. Sleeping quality improvement was one of the remarkable affects which participants benefited from reflexology.
Those participants who suffered
sleeping problems slept better, some of them said that the improvement happened right after the first session. Other stress symptoms such fatigue, nervousness, shoulder stiffness, digestive problem, constipation were improved to slightly or moderately or 34
remarkably during and after five sessions. Allergy problems and menstrual disorders were also improved slightly or moderately after one year.
After many-month practice, the participants were able to practice reflexology to themselves with fewer problems. All participants in this research experienced the improvements of health problems slightly or moderately or remarkably. The following paragraphs describe specifically reflexology frequency and health improvement of each participant.
Case 1 practiced reflexology three times a week until the end of five sessions, after that one or two time a week for a period of time and stopped because of laziness. The health improvements of case 1 were:
1) temporary sleeping problems were improved
remarkably after one session; 2) menstrual disorders were improved slightly during sessions and moderately after five sessions and after one year; 3) allergy problem was improved slightly after the five sessions and after one year.
Case 2 practiced reflexology four or five times a week until the end of five sessions, after that, as often as needed depending on health conditions. The health improvements of case 2 were: 1) sleeping problems were improved moderately during sessions and remarkably after five sessions and after one year; 2) fatigue was improved slightly during the five sessions and moderately after five sessions and after one year; 3) allergy was improved moderately after one year.
Case 3 practiced reflexology four or five times a week until the end of five sessions, after that, as often as needed depending on health conditions. The health improvements of case 3 were: 1) sleeping problems and fatigue were improved moderately during sessions and after five sessions and remarkably after one year; 2) nervousness was improved slightly after one year; 3) shoulder stiffness was improved slightly during sessions and after five sessions and remarkably after one year; 4) allergy was improved remarkably after one year.
Case 4 practiced reflexology two or three times a week. The participant stopped after 3 sessions the participation of the study due to the pregnancy. The health improvements of case 4 were: 1) sleeping problems were improved remarkably during 3 sessions; 2) 35
nervousness was improved moderately during 3 sessions. Constipation remained unchanged during 3 sessions. According to the participant, her constipation has long history and started since teenaged. The long-history constipation needs frequency of reflexology and longer time until an improvement can occur.
Case 5 practiced reflexology every day or every other day until the end of five sessions, after that, several times a week for a period of time and then as often as needed. The health improvements of case 5 were: 1) sleeping problems, nervousness, anxiousness, fatigue, tension headache and high blood pressure were improved remarkably during sessions and after five sessions and after one year; 2) digestive problems were improved moderately during sessions and remarkably after five sessions and after one year.
Case 6 practiced reflexology every day or every other day until the end of five sessions, after that, several times a week. The health improvements of case 6 were: 1) sleeping problems were improved moderately during sessions and remarkably after five sessions and after one year. Fatigue, digestive problems, shoulder stiffness were improved slightly during sessions and remarkably after five session and after one year; 2) back pain was improved slightly during sessions and after five sessions and after one year; 3) constipation was improved remarkably during sessions and after five session and after one year.
Case 7 practiced reflexology one or two times a week until the end of five sessions, after that, one or two times a month. The health improvements of case 7 were: sleeping problems and digestive problems were improved slightly during sessions and remarkably after five sessions. As to hepatitis, the participant has suffered it since long time ago, it was impossible for the participant to estimate the improvement, because it required medical test. After the five sessions, the participant practiced reflexology seldom; therefore, her health improvements were difficult to say after one year.
Case 8 practiced reflexology every day or every other day until the end of five sessions, after that, several times a week for a period of time, then as often as needed. The health improvements of case 8 were: 1) sleeping problems were improved remarkably during sessions and after five sessions and after one year; 2) fatigue and digestive problems were improved slightly during sessions and moderately after the five sessions and 36
remarkably after one year; 3) shoulder stiffness was improved slightly during sessions, after five sessions and after one year.
From above descriptions of participants’ health improvements, I observed that the frequency of applying reflexology had obviously an important role in their health improvement. For example, case 5, case 6 and case 8 practiced reflexology most frequently; as a result, some of their health problems were improved faster and more obviously. Below Table 3 shows the detailed result of health improvement comparison during sessions, after five sessions and after one year. As to the measuring terms (improved slightly, moderately or remarkably) of describing health improvement comparison, they were purely subjective expressions of participants, not scientifically or medically measurable. TABLE 3. Result of Health Improvement Comparison Health Problems sleeping problems menstrual disorders allergy
Improved during sessions remarkably
Improved after 5 sessions remarkably
Improved after one year remarkably
slightly not
moderately slightly
slightly
case 2
sleeping problems fatigue allergy
moderately slightly not
moderately moderately not
remarkably moderately moderately
case 3
sleeping problems nervousness fatigue shoulder stiffness allergy
moderately slightly moderately slightly not
moderately slightly moderately slightly not
remarkably slightly remarkably remarkably remarkably
case 4
sleeping problems nervousness constipation
remarkably moderately not
stopped after 3 sessions stopped after 3 sessions stopped after 3 sessions
unknown unknown unknown
case 5
sleeping problems nervousness anxiousness fatigue tension headache high blood pressure digestive problems
remarkably remarkably remarkably remarkably remarkably remarkably
remarkably remarkably remarkably remarkably remarkably remarkably
remarkably remarkably remarkably remarkably remarkably remarkably
moderately
remarkably
remarkably
sleeping problems fatigue digestive problems
moderately slightly slightly
remarkably remarkably remarkably
remarkably remarkably remarkably
case 1
case 6
37
back pain shoulder stiffness constipation
slightly slightly remarkably
slightly remarkably remarkably
slightly remarkably remarkably
case 7
sleeping problems digestive problems hepatitis
slightly slightly unknown
remarkably remarkably unknown
unknown unknown unknown
case 8
sleeping problems fatigue digestive problems shoulder stiffness
remarkably slightly slightly slightly
remarkably moderately moderately slightly
remarkably remarkably remarkably slightly
From the table 3, I observed that except hepatitis, all other health problems of the research participants have been improved by reflexology slightly or moderately or remarkably during the study. According to reflexology practitioners, reflexology has also good effect on hepatitis, but it may need longer time and more frequency of applying it. In this study, case 7 practiced reflexology seldom, one or two times a month during 6 months.
To answer the second research question, how do the eight Chinese-speaking immigrants succeed in applying reflexology as self-care, I asked the eight participants two questions: What do you think reflexology as self-care? How would you like continue to it? The following quotations from the participants gave answers.
case 1: ”A good form to maintain health.”
”I would continue it.”
case 2: ”It’s good form, very convenient and effective.” ”I would continue it.” case 3: ”Very good!”
”definitely continue it”
case 4: ”I think it’s good.” case 5: ”Very good, if I insist on doing it.”
”I would continue it every day.”
case 6: ”Very good, specially good for training will to continue it.” ”I would continue it every day or every other day.” case 7: ”Very good, if I have time and a good tool to do it.” case 8: ”Very good, especially for relaxing, when I have a lot of stress.” ”I would continue it, maybe twice a week.”
From the above answers, I summarised that all the participants had succeed in applying reflexology as self-care. They thought reflexology of a good form to maintain their health and they would like to continue it after the study. 38
7. CONCLUSIONS AND RECOMMENDATION
According to the Orem’s self-care theory, self-care is a learned behaviour. By the means of proper education, every person can take the responsibility to take care of themselves to maintain their health and well-being. The research result showed that Orem’s self care theory is implementable practically. It also showed that reflexology has positive effects to reduce stress symptom and improve health problems and well-being. By means of appropriate teaching, careful instructions and regular follow-up from reflexology well-experienced persons, people can apply reflexology to themselves for maintaining their health and well-being.
All of the eight participants agreed that reflexology was a good form as self-care to maintain their health and well-being. However, participants’ ethnic background might affect the research result, because self-care is common and a massage is one of the selfcare forms to maintain well-being in their culture, reflexology for them is similar to foot massage. In other words, these Chinese speaking participants might easily accept the concept of reflexology.
The study provides a deeper understanding of people’s experiences of reflexology. Furthermore, it can benefit all nurses, doctors and people who are interested in reflexology as self care.
Moreover, this study can offer the people an alternative
method of self care.
I suggest that further researches conclude non-Chinese-speaking people. How those participants continue reflexology after the study would be also a topic of further research. Moreover, I suggest that people pay more attention to researches and studies on reflexology, because reflexology can be one of the costless and efficient forms of self-care. Additionally, nursing education might introduce reflexology to teachers and students. Through educational system and public policy, reflexology can be accepted effectively and commonly. Most importantly, in order to improve health and well-being with a fixed budget of public health care, reflexology as self-care should be promoted by government, schools and families.
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8. MY PROFESSIONAL GROWTH
From this study I have grown professionally as a nurse. The study took quite long time from the decision of research topic to the end of writing the whole work. During the time of the study I had been thinking how to combine what I had learned from my professional education and own experience of self-care to produce a meaningful work for the people who I am going to serve as a nurse. It was quite hard for me to produce this thesis in a professional way, because this was my first formal research work. Due to the fact that the Finnish language is my third foreign language, the instructions of doing thesis conducted in Finnish were required more times than usual. The interactions with the thesis instructors were also new learning experience for me.
Fortunately, the
patience and profession of the thesis instructors were sufficiently adequate for a foreign student with broken Finnish. Their efforts to assist me with completing this thesis were highly appreciated.
As to the research implementation, many skills which I had never had before this study were required. For examples, how to make the research questions, how to teach reflexology to the participants who had no knowledge of anatomy, physiology and pathology. The most challenging was how to put all scattered information into a logical order and how to describe the collected data specifically to present a meaningful work. I had learned them by doing them first. Moreover, by the means of doing the study, some important concepts of Orem’s self-care theory, concepts of qualitative research and action research became clearer and were deepened in my mind. This deepening of theoretical concepts would help me in the future with being a professional nurse.
This study was conducted in three languages, Chinese for the research process, English for writing and Finnish for getting instructions from the instructors, it was also a new challenge and learning experience for me. At the end of the work, I could proudly say that nothing was impossible. After all, the learning process of this study was productive and valuable to me to become a mature nurse.
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BIBLIOGRAPHY Association of Reflexologists. The home of Reflexology. Retrieved January 29, 2009 from http://www.reflexology.org/reflinks.htm Action research. Retrieved July 17, 2008, from http://www.emtech.net/actionresearch.htm Bruce, E., Gagnon, C., Gendron, N., Puteris, L. and Tamblyn, A. 2007. Dorothea Orem’s theory of self-care. Retrieved January 4, 2009, from http://www.slideshare.net/jben501/dorothea-orem-theory Chen, K. 1999. What is the right way to practice foot reflexology (in Chinese). Taiwan: Yuhe Culture. Chen, M. 2004. Foot massage illustrated version (in Chinese). Taiwan: Suncolor Chinn, P. L. and Kramer, M. K. 1999. Theory and nursing: integrated knowledge development, fifth edition. St. Louis: Mosby. Dougans, I. 1996. The complete illustrated guide to reflexology: Therapeutic foot massage for health and well-being. Great Britain: Mustard. Differing methods and techniques. Retrieved October 19, 2008, from http://reflexology.org.au/1/modules.php?op=modload&name=Reflexology &file=methods Hallberg, L. R-M. 2002. Qualitative methods in public health research. Sweden: Studentlitteratur. Kunz, K. 2007. Respond to History of reflexology. Retrieved January 12, 2009, from http://www.homereflexology.co.uk/reflexology/history-of-reflexology Kunz, B & Kunz, K. 2009. Reflexology research project. Brief description: reflexology research and case studies. Retrieved January 28, 2009 from http://www.reflexology-research.com/abstracts.htm Latimer, J. 2003. Advanced qualitative research for nursing. Oxford: Blackwell. Lee, S. 1992. How to practice foot reflexology correctly and efficiently (in Chinese). Taiwan: Wuen Kin Sher. Luonnonlääketieteen keskusliitto LKL RY. 2009. Vyöhykehoidot. Retrieved January 28, 2009 from http://www.lkl.fi/index.php?page=1081 Meleis, A.I. 2007. Theoretical nursing: development & progress. Philadelphia: Lippincott Williams & Wilkins. Mclaughlin, C. & Hall, N. 2001. Secret of reflexology. Dorling Kindersley
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Murcott, T. 2005. The whole story. New York: Macmillan Norman, L. 1989. The reflexology handbook: A complete guide. London: Piatkus. Oleson, T. & Flocco, B. Reflexology research: Why we conducted the reflexology research study. Retrieved August 16, 2008, from http://www.reflexologyresearch.net/300StudiesCover.shtml Orem, D. E. 1979. Concept formalization in nursing process and product. Boston: Little, Brown Company. Orem, D. E. 1980. Nursing concepts of practice, second edition. New York: McGrawHill Book Company Orem, D. E. 1985. Nursing concepts of practice, third edition. New York: McGraw-Hill Book Company Orem, D. E. 1995. Nursing concepts of practice, fifth edition. St. Louis: Mosby-Year Book, Inc. Oxenford, R. 1996. Healing with Reflexology. Dublin: Gill & Macmillan. Patton, M. Q. 1990. Qualitative evaluation and research methods. Newbury Park: SAGE Reflexology in Europe Network, Finland 2008. Retrieved October 19, 2008, from http://www.reflexeurope.org/countries%20pages/Finland.html Reflexology overview. Retrieved August 12, 2008, from http://www.focusonhealing.com/overview.htm Ritchie, J. and Lewis, J. 2004. Qualitative research practice: A guide for social science students and researchers. London: SAGE. Silverman, D. 2005. Interpreting qualitative data: Methods for analysing talk, text and interaction. Lond: SAGE Sinkkonen, S. (toim.) 1984. Hoitotiede. Kuopio: Kustannuskiila Teagarden, K. 2007. What does the research say? Retrieved October 19, 2008, from http://takingcharge.csh.umn.edu/therapies/reflex/research Tschudin, V. 2003. Approaches to Ethics, nursing beyond boundaries. Edinburgh: Butterworth Heinemann. Wu. J. & Cheng, Y. 2001. New foot reflexology of Father Wu (in Chinese). Taiwan: Wuen Kin Sher. Woodham, A. and Dr. Peters, D. 1997. Encyclopedia of complementary medicine: The definitive guide of the best treatment options for 200 health problems Yasuhiko, I. 2004. Reflexology Taizen (in Chinese). Taiwan: Rising Books
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APPENDIX 1. Timetable of Five Sessions and Interviews case 1 session 1 session 2 session 3 session 4 session 5 date: 6.6. 07 date: 20.6. 07 date: 1.8. 07 date: 8. 8. 07 date: 31. 8. 07 place: her home place: her home place: her home place: home place: home First interview: 6.6.07; second interview: 31.8.07; final interview date: 23. 6. 08, on phone case 2 session 1 session 2 session 3 session 4 session 5 date: 17.4 07 date: 24.4. 07 date: 5.7. 07 date: 19. 7. 07 date: 14. 8. 07 place: her home place: her home place: her home place: home place: home First interview: 17.4.07; second interview: 14.8.07; final interview date: 1. 7. 08, on phone case 3 session 1 session 2 session 3 session 4 session 5 date: 10.4. 07 date: 17.4. 07 date: 24.4. 07 date: 5. 7. 07 date: 19. 7. 07 place: church place: church place: church place: his home place: his home First interview: 10.4.07; second interview: 19.7.09; final interview date: 2. 7. 08, on phone case 4 session 1 session 2 session 3 session 4 date: 25.5. 07 date: 31.5. 07 date: 11.6. 07 stopped due to place: church place: church place: her home pregnancy First interview: 25.5.07; final interview date: 1. 7. 08, on phone
session 5 stopped due to pregnancy
case 5 session 1 session 2 session 3 session 4 session 5 date: 12.4. 07 date: 18.4. 07 date: 25.5. 07 date: 30. 5. 07 date: 6. 6. 07 place: church place: church place: church place: church place: her home First interview: 12.4.07; second interview: 6.6.07; final interview date: 23. 6. 08, on phone case 6 session 1 session 2 session 3 session 4 session 5 date: 24.4. 07 date: 12.6. 07 date: 28.6. 07 date: 7. 7. 07 date: 2. 8. 07 place: church place: her home place: her home place: her home place: her home First interview: 24.4.07; second interview: 2.8.07; final interview date: 23. 6. 08, on phone case 7 session 1 session 2 session 3 session 4 session 5 date: 23. 4. 07 date: 11. 6. 07 date: 4. 7. 07 date: 12. 7. 07 date: 18. 7. 07 place: church place: her office place: her office place: her office place: her office First interview: 23.4.07; second interview: 18.7.07; final interview date: 23. 6. 08, on phone case 8 session 1 session 2 session 3 session 4 session 5 date: 11 .4. 07 date: 16. 4. 07 date: 25. 4. 07 date: 30. 5. 07 date: 6. 6. 07 place: her home place: church place: church place: church place: her home First interview: 11.4.07; second interview: 6.6.07; final interview date: 23. 6. 08, on phone
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APPENDIX 2. Interview and Follow-up Questions
First interview (done face to face) 1. Have you heard reflexology before my seminar? 2. Have you ever experienced reflexology before? 3. What kind of health problems do you have? 4. What do you expect from reflexology?
During the sessions (done face to face) 1. How do you feel? 2. How do you experience after reflexology session? 3. What do you think of doing it to yourself? 4. What kind of problem have you met since the last session till now?
Second interview (done face to face) 1. How have you felt about reflexology? 2. How has reflexology affected your health so far? 3. What kind of difficulties have you met, when you do it by yourself?
Follow-up (done face to face) 1. How has your reflexology practicing been going on? 2. What kind of problems you have met with it?
Final interview (done on phone) 1. How has your reflexology practicing been going on during the past year? 2. How has reflexology influenced your health during the past year? 3. How often have you practiced it? 4. What do you think reflexology as self care to maintain your health and wellbeing? 5. How would you like to continue reflexology?
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