SYNOPSIS

ST. JOHNS COLLEGE OF NURSING

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA
ANNEXURE - 2
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
JINI MARY MATHEW (SR.STELLA)
1st YEAR M Sc NURSING
1

NAME OF CANDIDATE AND

ADDRESS

ST. JOHNS COLLEGE OF NURSING

SARJAPURA ROAD,
BANGALORE

NAME OF THE INSTITUTION

ST. JOHNS COLLEGE OF NURSING,

BANGALORE

COURSE OF STUDY

MSc NURSINGs

SUBJECT

MEDICAL SURGICAL NURSING

DATE OF ADMISSION TO COURSE

MAY 02, 2011

TITLE OF THE TOPIC

THE EFFECT OF HOT WATER FOOT

BATH THERAPY ON TEMPERATURE.

6. BRIEF RESUME OF INTENDED WORK

6.1 NEED FOR THE STUDY

Fever has been recognized as a symptom and not a disease. Fever is a natural
response of the body that helps in fighting of foreign substances. Thermoregulatory center
in the hypothalamus regulates body temperature. Once the temperature raises the person
often feels warm, the cellular metabolism increases, oxygen consumption rises, heart rate
and respiratory rate increases to meet the metabolic needs of the body. Increased
metabolism uses energy that produces additional heat1.
During fever, dilation of internal blood vessels and constriction of peripheral
blood vessels occurs2. It weakens the patient and makes him/her uncomfortable and
anxious.

Therefore fever as a symptom and its management is a concern to both

healthcare professionals as well as patients. Providing comfort to patient is a basic and

most important nursing intervention3.
Antipyretic therapy is an effective pharmacological measure to reduce fever.
Along with pharmacological measures there are many non pharmacological measures like
cold sponging, tepid sponging, external cooling, warm water therapy that are found to be
effective in controlling the temperature. There is a controversy regarding the indication
for and the use of the heat and cold therapy4. But many studies have shown that,
hydrothermal therapy is an effective method for treating fever1.
The present healthcare system under National Health Policy has been given a lot
of emphasis on merging of alternative and complimentary therapies along with other
treatments to provide comprehensive healthcare. Hydrothermal therapy is one such
modality shown to be effective in reducing fever. Studies have shown that warm bathing
helps to provide comfort and reduce high temperature. Heat causes the relaxation of the
blood vessels, there by opening the vessels and increasing blood flow to the injured area4.
Hot water foot bath therapy (HWFBT) one of the hydrotherapeutic measure,
which improve warmth, promotes muscle relaxation, relieves pain, dilates blood vessel
and promotes circulation, relaxes the connective tissue and provides a soothing and
healing effect4, 5. HWFBT is said to treat the underlying infection by activating the WBCs
and immune system. Hot application to the skin increases the oxidation of the toxins and
increases the blood flow through the peripheral vessels. It also increases the ability of the

phagocytes to destroy the germs and detoxify the blood. Beneficial effect of increased
blood flow to the tissue includes facilitation of drainage and wash-out effect, purging
the tissue of debris and byproducts of tissue injury. Thus large quantities of bacterial
poison can be eliminated4, 5, 6.
Warm application to the foot causes the congested blood to flow towards distant
parts of the body and is brought to the dilated vessels of the foot and leg. When HWFBT
applied for 15-20 minutes the vessels in the feet starts expanding and gets improved
circulation, neutralizing acid and killing bacteria, and relieving aches, tiredness and fever.
The improved blood circulation

resets the hypothalamic set points by heat transfer from

higher heat area to lower heat area6.

Some of the non pharmacological measures such as tepid sponging, cold
sponging is also found to be effective in reducing fever. But it may result in rapid cooling
and may cause shivering in the patients, which is a discomfort to the clients 7. A
randomized control trial was conducted in an accident and emergency department with 20
children aged 5months to 5 years with fever equal to or greater than 38.9 oC. Children
were randomly assigned to acetaminophen and acetaminophen + a 15 minutes tepid
sponging bath. Results showed that sponge bath subjects cooled faster during first hour
but there was no significant temperature difference between two study groups. On the
other hand subjects in the sponge bath group had significantly higher discomfort scores
due to shivering as a result of rapid cooling in cold sponging 7. But in case of HWFBT
rapid cooling is not brought about. Temperature is brought down gradually, so that it
allows slow heat loss, thus avoiding rapid cooling and shivering6.
A HWFBT increases nourishment to tissues, calms and relaxes tension. It
important for the nurse to consider the treatment modality, that is effective for the client,
considering all the factors affecting thermoregulation. HWFBT is considered as a non
pharmacological, safe and side effect free, cost effective, easy to administer

3,5

. As

pharmacological measures have reported side effects, it is always better to use non
pharmacological measures to reduce fever8,9. There are very few studies that are
conducted to test and compare the effectiveness of different non pharmacological
measures to reduce the fever.

In the light of above mentioned back ground, coupled with the investigators
experience on management of fever patients, literature reviewed on the effectiveness of
HWFBT and also due to the dearth of studies on effectiveness of HWFBT, it is the
interest of the investigator to evaluate the effect of hot water foot bath therapy on fever.

6.2 REVIEW OF LITERATURE

The review of literature is organized under the following headings:Section 1: Literature related to cause and effect of fever.
Section 2: Literature related to management of fever.

LITERATURE RELATED TO CAUSE AND EFFECT OF FEVER.

Fever is a common illness found among patients due to various causes.

Fever

occurs because heat loss mechanism is unable to keep pace with excess heat production,
resulting in an abnormal rise in body temperature. The level at which fever threatens
health is often a source of disagreement among health care providers. A fever is usually
not harmful if it stays below 102oF 9, 10.
A true fever results from an alteration in the hypothalamic set point. Pyrogen such
as bacteria and virus cause a rise in body temperature. Pyrogen acts as an antigen after
entering into the body and triggers the immune system. More WBCs are produced to fight
against infection. Fever is an important defense mechanism. A mild temperature elevation
up to 1020F enhances bodys immune system and WBC production is stimulated.
Increased temperature reduces the concentration of iron in the blood plasma, suppressing
the growth of bacteria2, 9, 10.
Although fever is beneficial for enhancing host defense, other factors such as the
patients comfort and physiological responses must be considered when fever occurs 10.
Studies have shown that physiological manifestations during fever include increased
oxygen consumption, increased heart rate, increased cardiac output, and elevated serum

levels of catecholamine. Increased cardiovascular and metabolic demands may be poorly

tolerated by persons with minimal cardiopulmonary reserve, such as those with coronary
artery disease or heart failure11.
In another study, found that heart rate was significantly higher in critically ill
patients with temperature greater than 37.80C, than in patients with temperature less than
37.80C. A similar study conducted on cardiovascular responses during fever due to
bacterial and viral causes done among seven patients. The cardiac output was higher
during fever than during afebrile state in the same subjects. This hyper metabolism and
associated increase in energy consumption presents a challenge to patients who are
already experiencing physiological alteration11. Hence immediate treatment for fever is
an important concern for the health care professional to improve the comfort of the
clients11.

LITERATURE RELATED TO MANAGEMENT OF FEVER

There are various pharmacological and non pharmacological measures available
to manage fever. One of the pharmacological management for the fever is the
administration of the paracetamol. The most frequent reason for the administration of
antipyretics by the doctors is to provide immediate comfort to the patients. But
paracetamol toxicity is a concern8, 9.
In a study wherein paracetamol 10-15mg/kg was administered in children with
fever, there were no remarkable advantage in comfort, mood, appetite or fluid intake
from the antipyretics, though there was some improvement in alertness and activity. In
two of three studies in which paracetamol were given prophylatically for pain and fever
after immunization, paracetamol reduced fretfulness but this action can be ascribed to its
potent analgesic properties. These studies have limited relevance to children with viral
infections since pain is an uncommon accompaniment. The use of antipyretics to relieve
discomfort which is not pain is clearly incongruous when large numbers of people derive
pleasure from saunas and jogging in warm weather. When an infection causes pain, such
as head ache of influenza, then analgesics is clearly appropriate 12. Greater antipyretics

efficacy has been shown to occur in children given the combination compare with either
drug alone. However there are potentially complicating problem, that make such a
practice inadvisable is due to its side effects that is hepatotoxicity12.
A variety of non pharmacological measures which is used to reduce fever include
sponging with various solution, tepid water, alcohol, application of ice packs, or cooling
blankets, exposure to circulating fans, hot water foot bath therapy. A more recent study
showed that ice packs placed on the neck, axilla, and groin are ineffective in the treatment
of hyperthermia. Article also emphasized that warm or cool water can be useful in
controlling body temperature of a feverish person13, 14.
A prospective comparative study was done in Netherlands, to compare the
efficacy of different cooling methods to reduce fever. Fifty ICU patients with fever were
enrolled in the study and were assigned to five groups. Group-1 conventional cooling,
group-2 cooling with air circulating blankets, group-3 water circulating gel coated pads,
group-4 intravascular heat exchange system, and group-5 water circulating blankets.
Temperature decline was significantly higher in cooling with water circulating blankets,
gel pads and intravascular cooling, when compared to conventional cooling and air
circulating blankets. No adverse events are noted. However the absence of this can be due
to small sample sizes15.
A comparative randomized control trial was conducted in CMC Vellore, to assess
the effectiveness of tepid sponging and antipyretic drug versus only antipyretic drug in
the management of fever among children. Hundred and fifty samples with temperature
>1010F were selected and assigned into two groups. After the intervention, temperature
was checked at every 30, 45, 60, 90 and 120 minutes. The results showed, apart from the
initial rapid temperature reduction, addition of tepid sponging to antipyretic
administration does not offer any advantage in ultimate reduction of temperature and may
result in additional discomfort such as shivering16.
Hydro-thermal therapy is another non pharmacological method used to reduce
fever. It is not a new concept. It has been used since 5 th century to stimulate the immune
response. Roman physician Galen and Celsus wrote of treating patients with warm and
cold bath to prevent disease15. In 19thcentury Sebastian Kneip a Baverian priest and

proponent of water healing, began treating his parishioner with warm water application
after he himself cured of TB, through the same method, and opened many hydrotherapy
clinics. Hydrotherapy can soothe sore or inflamed muscle and joints, rehabilitate injured
limbs, reduce fever, soothe headache, promote relaxation, treat burns and frost bite, ease
labor pain and clear up skin problems17.
A most versatile and helpful true remedy to treat fever is the hot foot bath, which
reduces fever by increasing the number of circulating white blood cells. Hot foot bath
gives relaxation to entire body if you are tired and also helpful in eliminating toxins from
the body. It is an effective means of reducing congestion of blood or water in upper part
of the body19. This helps to remove the toxins that caused the fever, restoring the body's
thermostat to normal. The hot foot bath can increase the body temperature by one to two
degrees, producing profuse sweating. This is a very desirable reaction, as it removes
toxins and wastes19.
A study was done in Coimbatore to assess the effect of hot water foot bath therapy
on patients with fever. Thirty patients with temperature ranging from 99 oF 103oF were
selected for the study by using purposive sampling technique. A quasi experimental one
group pre test post test design was used in this study. The HWFBT was administered after
checking the temperature of the patient. After 20 minutes of administration the
temperature was again assessed. Pairedt test was done to find out significant difference
in temperature before and after intervention. The average post test temperature was less
than the mean pretest temperature. There was a significant reduction in temperature of
patient after the intervention at 0.05 level6.
Thus the literature review has thrown light on the effectiveness of HWFBT in
management of fever.

6.3 PROBLEM STATEMENT

A study to assess the effect of hot water foot bath therapy on temperature among patients
with fever in a tertiary care hospital, Bangalore.

6.4 OBJECTIVES OF THE STUDY

1. To assess the temperature of the patient before and after hot water foot bath
therapy in both experimental and control group.
2. To compare the changes in the temperature in experimental and control group
after hot water foot bath therapy.
3. To determine the association of changes in temperature with selected base line
variables.

6.5 OPERATIONAL DEFINITIONS

Hot water foot bath therapy
According to the Herald of Health, April 1998, hot water foot bath therapy is a local
immersion bath covering the feet and ankles at a temperature ranging from 1000 to 1100F.
In this study hot water foot bath therapy refers to the immersing of the both the feet in hot
water with a temperature of 100o- 110o F for a period of 20 minutes administered by the
investigator.
Fever
According to Donalds pocket medical dictionary, Fever is referred to as elevation of
body temperature above normal.
In this study fever refers to rise in body temperature of patient ranging from 100 0 F and
above.

Patients

According to Tabers cyclopedic medical dictionary, Patient refers to a person who is sick
with or being treated for, an illness or injury.
In this study patient refers to all the adult in patients admitted with fever or who had
developed fever during their period of hospitalization in the wards of St. Johns medical
college hospital with a temperature of 1000 F and above.

Effect
According to Dorlands pocket medical dictionary, effect means the desired result
produced by an action.
In this study effect refers to the ability of hot water foot bath therapy to bring about a
change in temperature as measured by the investigator using a clinical thermometer.

6.6

ASSUMPTIONS

Fever may be a result of several causes and it can be controlled by treating the
underlying infection.

Hot water application causes vasodilatation and there by enhances the immune
system to reduce infection.

6.7

Hot water application may have some effect on temperature.

DELIMITATION

The study is limited to patients admitted in inpatient departments of SJMCH.

6.8

PROJECTED OUTCOME

Finding of the study will reveal the effect of hot water foot bath therapy on temperature
which can contribute to the evidence base and can be implemented as a nurse led
intervention in the management of fever.

6.9

HYPOTHESIS

H1 There will be a significant difference in the temperature between experimental and

control group after hot water foot bath therapy at 0.05 level of significance.
H2 There will be a significant association of changes in temperature of patients with
selected base line variables at 0.05 level of significance.

7. MATERIALS AND METHOD

7.1 SOURCE OF DATA
7.1.1 RESEARCH DESIGN.
Pre test post test control group design.

7.1.2 SETTING
Setting of the present study will be the inpatient unit of SJMCH. SJMCH is 1250 bedded
multidisciplinary tertiary care hospital with 80%-85% bed occupancy. On an average
there are almost 50% of the patients suffering from fever either at the time of admission
or during the course of illness.

7.1.3 POPULATION

Population in this study refers to patients with fever.

7.2 METHOD OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE
Sampling procedure used will be purposive sampling.

7.2.2 SAMPLING SIZE

The sample size will be 100 (experimental and control groups will have 50 each).

7.2.3 INCLUSION CRITERIA FOR SAMPLING

Patients whose temperature is above 100oF.

7.2.4 EXCLUSION CRITERIA FOR SAMPLING.

Patients who are admitted with:
1) Peripheral vascular disorder.
2) Loss of sensation in the legs.
3) Unconsciousness.
4) Those who cant assume sitting position.
5) Peripheral neuropathy.

6) Ulcer, lesion, or allergy in the leg.

7) Chronic organ damage.

7.2.5 INSTRUMENT USED

Section A: Interview schedule to elicit demographic variables.
Section B: Clinical thermometer to check temperature of the patients.
Lotion thermometer to check the temperature of water.
Section C: Table to record temperature.

7.2.6 DATA COLLECTION METHOD

After obtaining administrative permission from the SJMCH, the subjects will be
identified,

according to the inclusion and exclusion criteria, by purposive sampling

technique. The purpose of the study will be explained to the participants and informed
consent will be obtained. Then the samples will be randomly allocated into two groups,
experimental and control group by flipping a coin. Control group will receive standard
treatment. Experimental group will receive hot water foot bath therapy along with
standard treatment. Investigator will use an interview schedule to elicit the demographic
proforma. The temperature will be assessed before the intervention in both the groups.
Hot water foot bath therapy will be administered for 20 minutes by the investigator. After
20 minutes, temperature will be measured in both experimental and control groups by
using clinical thermometer.

7.2.7 DATA ANALYSIS PLAN

The data analysis will be done by using descriptive and inferential statistics.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION

TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS? IF
SO PLEASE DESCRIBE BRIEFLY.
Yes. This study requires an intervention to be conducted with hot water foot bath therapy.

7.4

HAS

ETHICAL

CLEARANCE

BEEN

OBTAINED

FROM

YOUR

INSTITUTION IN CASE OF 7.3?

Yes. The administrative permission with regard to the study will be obtained from the
research committee of the St. Johns Medical college Hospital, Bangalore prior to the
study.

REFERENCES

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among pediatric Nurses In three regional acute hospitalsin Hongkong. Macau
Journal of Nursing. 2008;7(1)
2. Potter and Perry. Fundamentals of nursing, concept, process and practice. 6thed.
Mosby publication; 1985:196-206.
3. Hydrotherapy holistic online.com; http://www.info@ holistic online.
4. Dan Wnorowski. Heat and cold therapy. www. genufix. com/heat and cold
therapy. htm.
5. http://www. greek medicine. net/therapies/The_water_use.html.
6. R. Selvakumari. Hot Water Foot Bath Therapy for patient with fever. Nightingale
Nursing Times. 2011 March; 6(12)
7. Judith O Donnell, Peter Axelrod, Carley Fisher, Bennett Lorber. Use and
effectiveness of hypothermia blankets for febrile patients in the ICU. Clinical
Infectious Disease. 1997 June: 1208-1213.
8. Karen I Plaisance, Philip A Mackowiak. Antipyretic therapy. Physiologic
rationale, Diagnostic Implications, and clinical consequences. Arch Interim Med.
2000; 160: 449-456.
9. Alan K Done. Treatment of fever in 1982: A Review. The American Journal of
Medicine. 1983 June: 27-33.
10. Aurthur. C. Guyton, John E Hall. Text book of medical physiology.11 thed.
Saunders publication; 2006: 889-900.
11. Richard Henker. Evidence based practice Fever related interventions. American
Journal of critical care. 1999.8: 481-487.

12. Blumenthal. Fever concepts old and new. Journal of the Royal society of
Medicine. 1997 July; Vol 90: 391 394
13. Peter Axelrod. External cooling in the management of fever. Clinical Infectious
Disease.2000; 31: 524-528.
14. Paula Anne Ford. Basis of Hydrotherapy. Herald of health. 2004. (95): 4-8.
15. Cornelia W Hoedemaekers, Mustapha Ezzahti, Aico Gerritsen and Johannes G der
Hoeven. Comparison of cooling methods to induce and maintain normo and
hypothermia in intensive care unit patients: A prospective intervention study.
http://ccforum. Com/content/11/4/R91.
16. S Thomas, C Vijayakumar, R Naik,PD Moses and B Antoniasamy. Comparative
effectiveness of tepid sponging and antipyretic drug Versus Only Antipyretic Drug
in the Management of Fever Among Children: A Randomised controlled Trial.
Child3@cmcvellore.ac.in.
17. William Bierman. The history of fever therapy in the treatment of disease. The
bulletin. 1942 Jan: 65-75.
18. Nick Mutt. Hot Foot Bath Good for Health. Bush law firm. Friendly, prompt,
informative.
19. Agathathrash. Fever management, Hot Water Foot Bath Therapy. USA. Albama.
2008.

8.

SIGNATURE OF THE CANDIDATE:

___________________________

9.

REMARKS OF THE GUIDE:

10.

NAME AND DESIGNATION OF

Mrs. BINDHU MATHEW,

10.1 GUIDE:

ASSOCIATE PROFESSOR,
MEDICAL SURGICAL NURSING DEPARTMENT,
ST.JOHNS COLLEGE OF NURSING,
BANGALORE.

10.2 SIGNATURE:
10.3 CO-GUIDE:

Dr. JYOTHI IDICULLA,

ASSOCIATE PROFESSOR,
ST.JOHNS MEDICAL COLLEGE.
BANGALORE.
_________________________

10.4 SIGNATURE:
11.

11.1 HEAD OF THE DEPARTMENT:

MRS. MADONNA BRITTO,

PROFESSO AND H.O.D
SURGICAL NURSING,

11.2 SIGNATURE:

12
.

ST. JOHNS COLLEGE OF NURSING

12.1 REMARKS OF THE CHAIRMAN AND

PRINCIPAL:
12.2 SIGNATURE:

MEDICAL

_________________________