The purpose of this study was to examine the effect of slow stroke back massage(SSBM) on anxiety and immune response in patients undergoing open heart surgery and to compare the effect of 5-minutes with 10-minutes SSBM. Among the sixty-four patient subjects, twenty-one were one experimental group receiving massage for 10-minutes, twenty for the other experimental group receiving massage for 5-minutes and twenty-three for the control group. Subjects were admitted at Hospitals in Inchon and Puchon for open heart surgery. This study was carried out from October 10, 1997 to May 10, 1998. The levels of anxiety were measured by the Visual Analogue Scale(VAS), Trait anxiety scale, systolic and diastolic blood pressure, pulse rate, blood cortisol and the levels of immune response were measured by the blood T-lymphocyte and Natural killer cell. Study measurements were taken before and after SSBM on the 1st pst operative day. Data were analyzed using x2test, oneway ANOVA, paired t-test, t-test and Pearson product moment correlation. The results were summarized as follows: 1. After SSBM, VAS anxiety level, systolic and diastolic blood pressure and pulse rate of the experimental group were decreased significantly than those measurements before the SSBM. After SSBM, significant difference in the VAS anxiety level, systolic blood pressure and pulse rate between the experimental and control groups were found. 2. After SSBM, the blood cortisol of the experimental and control groups were increased significantly compared with before SSBM. But the significant difference in blood cortisol between the two groups was not found. 3. After SSBM, the blood T-lymphocyte percentages of the experimental and control groups were decease significantly and blood Natural killer cell percentages of the two groups were increased compared with before SSBM. But significant difference in blood T-lymphocyte and Natural killer cell percentages between the two groups was not found. 4. Significant difference in VAS anxiety level, systolic and diastolic blood pressure, pulse rate, blood cortisol, blood T-lymphocyte and Natural killer cell percentages between SSBM for 5 minutes and SSBM for 10 minutes were not found. Based upon the results, this study concludes that the slow stroke back massage for 5 minutes is a useful intervention that decreases anxiety and produces relaxation in patients undergoing open heart surgery.

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This study was done to evaluate the quality of clinical nursing care using the variables of structure, process, and outcome and to analyze the relationship between the variables. This study also explored which variables are validating indicators to evaluate the quality of nursing care. The results analyzed by multiple regression showed that, generally structural variables did not contribute to the variance in outcome scores, but process variables of nursing care contributed significantly to the outcome variable of patient satisfaction. A combination of structure and process variables more than structural variables alone. Also, patient satisfaction and hospital preference were significantly related to each other. Therefore, if nursing quality evaluation relies solely upon on structural variables such as number of available nurses and workload, it would be inaccurate because process variables of nursing care are strongly related to outcome variables and the two categories of structure and process variables helped to strengthen the relationships. Thus, it is important to focus on variables of structure, process, and outcome together in evaluating nursing care quality.

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