الفهرس 
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Abstract
Anxiety had been reported among the highest prevalent psychological problems experienced by patients receiving HD. Anxiety is a significant clinical problem in geriatric patients undergoing HD that is under-recognized. Non-pharmacological interventions are safer to be used in the management of anxiety among these geriatric patients. In this respect among the most noteworthy non-pharmacological methods are complementary therapies, such as aromatherapy and acupressure. Aromatherapy is one of the main approaches adopted in non-pharmacological interventions for anxiety relief. Also, acupressure has also been shown to effectively relieve anxiety with no complications.
Aim of the study
The present study aimed todetermine the effect of lavender aromatherapy versus acupressure on reducing anxiety levels among elderly patients undergoing hemodialysis.
Materials and method:
A. Materials
Research design: A quasi-experimental research design was used in this study.
Setting: This study was conducted in the Hemodialysis Unit of Damanhur National Medical Institute, El-Beheira Governorate, which is affiliated to the Ministry of Health and Population, Egypt.
Subjects
The study subjects were recruited from ward G&D of the hemodialysis unit using a purposive sampling technique and included (66) geriatric patients and fulfilling the following criteria:
Geriatric patients 60 years and more, treated with hemodialysis for a minimum of 6 months and up to 5 years and undergoing dialysis 3 times a week, 4 hours each session; with no or mild cognitive impairment (based on Short Portable Mental Status Questionnaire), have normal olfactory function based on (Quick Smell Identification Test), and suffer from anxiety based on (Geriatric Anxiety Scale), hemodynamic stable ( heart rate, blood pressure), body weight increase does not exceed 2 KG in each dialysis session and willing to participate in the study.
The researcher included 66 geriatric patients in the present study. These patients were randomly assigned to three equal groups (22 geriatric patients for each group):
group A: included geriatric patients who received lavender oil to inhale.
group B: included geriatric patients selected to acupressure technique.
group C (control group): these geriatric patients received the routine care of the hemodialysis unit.
Tools of the study:
Four tools were used for data collection
Tool I: Quick Smell Identification Test (Q-SIT)
The Q-SIT was developed by Jackman and Doty in 2005 to enable preliminary diagnosis of anosmia and for olfactory impairments using three odors (cloves, coffee, and rose). The score of the Q-Sticks test ranged from 0 (no odor identified) -3(all odors identified); zero means anosmia to and 3 means normal olfactory function. The tool is reliable (r = 0.87).
Tool (II): Short Portable Mental Status Questionnaire (SPMSQ)
This tool was developed by Pfeiffer E (1975) to exclude older adults with moderate and severe cognitive impairment. Items were scored and classified as follows: - 0-2 errors: normal mental functioning, 3-4 errors: mild cognitive impairment, 5-7errors: moderate cognitive impairment, 8 or more errors: severe cognitive impairment. It was translated into Arabic language by Abd Elsalam, (2012). The Arabic version was used in this study.
Tool III: Geriatric Anxiety Scale (GAS)
The GAS was developed by Segal et al., (2010). It is a 30-item self-report rating scale designed to measure anxiety symptoms with older adults. It measures several components of anxiety: somatic (9 items), affective(8 items), and cognitive symptoms (8 items). It is a Likert-type scale that ranges from 0 (not at all) to 3 (all of the time). Total Score = sum of items 1 through 25; Possible total scores range from 0 to 75. The score 0 to less than 24 indicates mild anxiety, from 25 to less than 50 indicate moderate anxiety and more than 50 indicate sever anxiety (Segal et al., 2015).
Tool IV- Hemodialysis geriatric patients’ Socio–Demographic and Clinical Data Structured Interview Schedule: It was developed by the researcher and included two parts;
Part I: Socio- demographic data such as age, sex, level of education, marital status, residence, monthly income and occupation before retirement.
Part II: The clinical data of the studied geriatric patients such as history of ESRD, its onset, start of hemodialysis, number of sessions/week and duration of each session.
Method
The study was executed through (3) three main phases.
I. Preparatory phase:
1- The necessary approvals were obtained from the responsible authorities.
2- Preparation of the study tools (tool I (Quick Smell Identification Test), the Arabic version of tool II (Short Portable Mental Status Questionnaire) and tool III (Geriatric Anxiety Scale and tool IV (Hemodialysis geriatric patients’ Socio–Demographic and Clinical Data Structured Interview Schedule).
3- A pilot study was carried out on 7 geriatric patients undergoing hemodialysis from the same mentioned setting before starting data collection to assess the clarity as well as the applicability of the study tools.
4- The researcher attended a training course on the basic concepts and techniques of acupressure at physical fitness unit, Faculty of sport education, Alexandria University. (AppendixVIII).
5- The researcher assessed individually each geriatric patient in the three groups in order to collect the baseline data about their socio-demographic characteristics and clinical data using (tool IV).
6- The researcher prepared the needed equipment and environment and the geriatric patient.
II. Implementation phase:
• Every geriatric patient in the three groups was interviewed individually to collect the necessary data.
• The researcher checked the vital signs of the patients (temperature – pulse - respiration - blood pressure) from the patient’s record in the unit to assure the stability of the hemodynamic status of the patients.
- group A received lavender aromatherapy, each of the geriatric patients was given the lavender oil to inhale, after one hour from starting the hemodialysis session for 20 minutes (using stopwatch), 3 times a week on Saturday, Monday and Wednesday during the morning and evening shifts for one month.
- group Bwere selected to acupressure technique, Pressure was applied to three selected acupointsof each geriatric patient (GV 29, HT 7 and KI 3). Each session lasted 15 minutes on Sunday, Tuesday, and Thursday during the morning and evening shifts for three sessions a week for one month.
III. Evaluation phase
• At the end of the 4th week, each patient in the three groups was re-assessed for the effectiveness of the interventions using tool III (Geriatric Anxiety Scale) (Post-test).
• Comparison was done between the three groups using proper statistical analysis to identify which intervention is the most effective in reducing anxiety among geriatric patients undergoing HD.
• The data collection started on the first ofMay 2021 to the end of July 2021.
• The statistical Package for social science (SPSS) was used for data analysis and tabulation. The level of significance for this study was less than or equal to 0.05.
Ethical consideration: an informed oral consent was obtained from each study subject after being informed about the purpose of the study. Geriatric patients were assured that all data taken by the researcher will be used only for the purpose of the study and will not be available for others. Anonymity and privacy of the study subjects was maintained, and confidentiality of the collected data was assured. The desire of the study subjects to withdraw from the study at any time was respected.
Results:
- The age of the geriatric patients ranged from 60 to 85 years old, with a mean 69.4 ± 9.8 years. Males constituted 56.1 %, while 43.9 % were females.
- The main chronic diseases reported were hypertension accounting for the majority (95.1%), diabetes mellitus (37.7%), and cardiovascular diseases (18%).
- Nearly the majority of the geriatric patients (81.8%) began hemodialysis from 3 to less than 5 years. For the majority in the three groups (93.9 %) arteriovenous fistulas as a vascular access was used.
- Prior the intervention, geriatric patients in the three groups reported moderate levels of anxiety i.e. 86.4% for patients in group A, 72.7% for those in group B, and 59.1% for group C), while post-intervention, revealed that most of the geriatric patients in groups A, B (the same percent 81.8%), and C (72.7 %) encountered mild anxiety.
- The differences in anxiety levels between the lavender aromatherapy and acupressure groups were highly statistically significant (p= 0.001). Conversely, no statistically significant differences were observed in the anxiety level pre and post evaluation in the control group (p=0.054).
- The overall mean anxiety scores in the intervention groups A (lavender inhalation group) and B (acupressure group) were lower post-intervention (19.73± 5.34 &18.32± 6.42) than before (29.77 ± 4.96 &27.14± 3.59), with a highly statistically significant difference (p=0.001).
- Lavender aromatherapy had a high effect on reducing anxiety (0.95), while acupressure had an intermediate effect size (0.73).
Conclusion:
According to the findings of the present study, implementation of either lavender aromatherapy or acupressure was effective in reducing anxiety level among geriatric patients undergoing hemodialysis. While the effect of lavender aromatherapy on reducing anxiety is higher than that of acupressure.
Recommendations:
1) Assessing the psychological status of each geriatric patient should be an integral part of a multidisciplinary geriatric assessment using valid and reliable tools for early identification of those at risk for psychological problems including anxiety.
2) In-service training programs to be planned by the faculty members of the Gerontological nursing department and offered on regular basis to the nurses at the various hemodialysis units.