Discussion
fatigue, muscular stress, anxiety, pain
STRESSFUL EVENTS, COMPLICATIONS
With stressful events and interventions like CA, the level of anxiety may increase, resulting in physiological and psychological complications. Nurses have an essential role in decreasing patients’ fear and anxiety. The results of this study illustrated that a significant difference was found between the study and control groups after implementing the reflexology program. Moderate and severe anxiety scores were lower in the study group in all evaluation periods after the intervention than in the control group. It could be due to massage and nerve stimulation during reflexology, which results in relaxation, alleviate stress, improve blood circulation, and restore body balance. In addition, touching the patient’s skin during reflexology stimulates the release of endogenous endorphins, which reduce anxiety, stress, and pain [This finding is consistent with Kahraman, 2019 [The current study results illustrated that the pain severity was significantly reduced in the study group after 2 h and three days of hand reflexology intervention compared to the control group. This finding can be rationalized in accordance with gate control theory, as reflexology is a standard method of massage that stimulates the large nerve fibers, resulting in blockage of pain signal transmission and inhibiting the central nervous system from receiving it. In addition, reflexology and massage efficiently reduce pain because the muscles are relaxed, the blood flow is increased, and metabolic waste products are removed.This finding is consistent with the findings of Kardan et al., 2020 [The results of this study provide additional evidence supporting the potential of reflexology to decrease fatigue in patients undergoing medical procedures effectively. The current study results showed a statistically significant decline in the level of fatigue, especially moderate and severe fatigue levels, in the study group compared with the control group. It may be due to the physiological changes caused by reflexology, which increase the patient's sense of well-being and comfort. Furthermore, massage and pressure during reflexology intervention enhance blood circulation, which removes accumulated lactic acid from the muscles, reducing muscular stress and fatigue [This finding is consistent with Rejeh et al., 2020 [