Definition
Providing back care and massage is a therapeutic nursing intervention that promotes both physical comfort and emotional wellbeing especially for patients who are bedridden, in pain, or recovering from illness.
Purposes
- To relieve muscle tension.
- To promote physical and mental relaxation.
- To relieve insomnia.
- To stimulate blood circulation.
- To assess condition of skin.
- Promote refreshed feeling.
Contraindications
Patients with:
- Rib fracture.
- Burns.
- Immediate postoperative period after coronary artery bypass graft.
- Patients at risk for developing pressure ulcer.
- Spinal injuries.
- Surgeries on back.
Articles
- Lotion or oil or powder.
- Bath towel.
- Bath blanket.
- Soap with soap dish.
- Washcloth-2.
- Warm water in basin.
- Mackintosh and draw sheet.
- Patients’ linen.
- Screen for privacy.
- Kidney tray.
If patient requires hygienic care, it should be provided, followed by massage.
Procedure
| NURSING ACTION | RATIONALE | |
| 1. | Before procedure Explain the procedure and desired position to patient. Determine if patient is comfortable with massage strokes. Assess condition of back- pressure points, redness and breakdown in skin integrity. | Helps in promoting relaxation. |
| 2. | Adjust bed to comfortable height. | Ensures proper body mechanics and prevents strain on back muscles |
| 3. | Adjust light, temperature, and sound within room. | Environmental distractions can prevent patient from relaxing. |
| 4. | Close curtains around bed. | Privacy promotes relaxation. |
| 5 | Lower side rail and help patient assume prone or side-lying (Sim’s) position with back toward you. Assemble all required equipment’s | Position makes it easier to apply necessary pressure to back muscles. |
| 6. | During procedure Expose patient’s back, shoulders, upper arms, and buttocks. Cover rest of the body with bath blanket/top sheet. | Prevents unnecessary exposure of body parts and prevents excess lotion from touching linen. |
| 7. | Using the washcloth make a mitten and dip in the warm water. | |
| 8. | Wet the patients back from neck to buttocks using the mitten. | Helps in easy cleaning. |
| 9. | Apply soap on back from neck to buttocks using circular motion with hand with special attention to back, pressure points, exposed wounds (if any, should not touched). | |
| 10. | Wipe off the soap using another washcloth. | |
| 11. | Dry the skin with bath towel. | |
| 13. | Wash your hands in warm water. | Cold water causes muscle tension. |
| 14. | Inform patient that lotion will feel cool and wet. | Warning patient of what to expect reduces startle response. |
| 15. | Apply hands first to sacral area massaging in circular motion. Stroke upward from buttocks to shoulders. Massage over scapulae with smooth, firm strokes. Continue in one smooth stroke from upper back to arm and laterally alongside of back, down to iliac crests. Do not take the hands off from patient’s back till the end of the procedure. Continue massage pattern for at least 3 minutes (effleurage). | Gentle, firm pressure applied to all muscle groups promotes relaxation. Continuous contact with skin surface is soothing and stimulates circulation to tissues. |
| 16. | knead skin by gently grasping tissue between your thumb and fingers, knead upward along one side of spine from buttocks to shoulders and around nape of the neck, knead downward toward sacrum, repeat along other side of back (Petrissage). | Kneading increases circulation and kneading motion is soothing and relieving. |
| 17. | Perform tapotement (tapping movement with medial aspects of hands-on side of spine from sacral region upward) for 2 minutes. | Provides relaxation to back muscle. |
| 18. | In the end, massage with long, stroking movement for an additional 3 minutes and tell patient you are ending massage. | Long stroking is most soothing. |
| 19. | If lying on side, ask patient to turn to opposite side and massage other hip. | |
| 20. | Apply oil or lubricant to back as required. | Help to reduce friction. |
| 21. | Wipe excess lubricant from patients back with bath towel/ tissues. Re-tie gown or assist with pajamas. Help patient to comfortable position. Raise side rails as needed, lower bed and open curtains. | Excess lotion can act as an irritant and soil sheet. Comfortable position enhances back rub’s effects. |
| 22. | After procedure Dispose off soiled towel and wash hands. | Promotes infection control. |
| 23. | Record response to massage and condition of skin. |
Special Considerations
- For patients with history of hypertension and dysrhythmias, assess pulse and blood pressure as massage may cause stimulation of autonomic nervous system, which increase heartrate and bp.
- Consider cultural preference of patient. some cultures may consider it as an invasion of personal space.
- Do not give massage if any discoloration of skin is present.
- Pressure ulcer risk assessment can be done using Braden O scale. If the total of scores obtained on all subscales is <16, the child is at high risk of developing pressure ulcers. Lesser the score higher is the risk.
- Proper assessment of the stages of pressure ulcers ensures early and appropriate treatment and prevents aggravation.
Stages of pressure ulcer
- Stage 1: Non blanchable erythema of intact skin; warmth; swelling
- Stage 2: Superficial ulcers with loss of epidermis, dermis or both. Appears scrape, such as blister or crater.
- Stage 3: Skin loss to both outer and underlying layers of skin tissue with damage to fascia.
- Stage 4: Skin loss to both outer and underlying layers of skin tissue; increased damage and dead tissue in fascia, muscle, bone, tendon or joint capsule.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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