Effects of Hand Massage and Stress Ball Interventions During Eyelid Surgery

While eye surgeries are effective in restoring visual function, they are predominantly performed under local or topical anesthesia. Because patients remain conscious during the procedure, they frequently experience increased anxiety and pain, which can negatively affect their physiological parameters, reduce compliance with the surgical process, and potentially increase the risk of complications. Pharmacological methods for managing anxiety and pain carry risks of drug interactions and side effects, particularly in the elderly population. Therefore, non-pharmacological nursing interventions such as hand massage (which promotes relaxation through tactile stimulation) and stress ball squeezing (which reduces pain and anxiety perception through cognitive distraction) are gaining importance as safe, low-cost, and non-invasive alternatives.

This study will be conducted at the ophthalmology clinic and operating room of Binali Yıldırım University Mengücek Gazi Training and Research Hospital. Participants will be assigned to one of three groups using computer-assisted block randomization to ensure homogeneity.

The study procedure follows three main phases:

1. Pre-operative Phase: Following informed consent, patients' baseline anxiety levels are measured. A brief training is provided to the intervention groups regarding the procedures they will perform during surgery.
2. Intra-operative Phase: Interventions are applied under the supervision of a researcher. For the hand massage group, a trained researcher applies a massage using hypoallergenic baby oil for 5 minutes on each hand (10 minutes total). For the stress ball group, patients squeeze a soft, latex-free ball for 5 seconds at rhythmic intervals over a 15-minute period. The control group receives standard intraoperative care without these specific interventions.
3. Post-operative Phase: Ten minutes after the patients are transferred back to their rooms, researchers collect data on anxiety, pain, and physiological parameters (systolic/diastolic blood pressure, heart rate, respiratory rate, and oxygen saturation).

Data collection is conducted face-to-face using a Personal Information Form, a Physiological Parameters Evaluation Form, a Numeric Rating Scale (NRS) for pain, and a Visual Analog Scale (VAS) for anxiety.

• Stress Ball (Behavioral): Squeezing a soft stress ball for 15 minutes during surgery.
• Hand Massage (Behavioral): A 10-minute hand massage applied by a researcher using baby oil.

Primary outcomes

• Anxiety Level [Pre-operatively (baseline) and 10 minutes post-operatively.]: Assessed using the Visual Analog Scale (VAS) for Anxiety. The scale is a 10 cm horizontal line ranging from 0 to 10. A score of 0 indicates "No anxiety" and a score of 10 indicates "Extreme anxiety". Higher scores indicate a worse outcome (higher anxiety levels).
• Pain Severity [10 minutes post-operatively.]: Assessed using the Numeric Rating Scale (NRS). The scale ranges from 0 to 10, where 0 represents "No pain" and 10 represents "Unbearable pain". Higher scores indicate a worse outcome (more severe pain).

Secondary outcomes

• Systolic Blood Pressure [10 minutes post-operatively]: Systolic blood pressure will be measured and recorded using a Physiological Parameters Evaluation Form.
• Diastolic Blood Pressure [10 minutes post-operatively]: Diastolic blood pressure will be measured and recorded using a Physiological Parameters Evaluation Form.
• Heart Rate [10 minutes post-operatively]: Heart rate will be measured and recorded using a Physiological Parameters Evaluation Form.
• Respiratory Rate [10 minutes post-operatively]: Respiratory rate will be measured and recorded using a Physiological Parameters Evaluation Form.
• Oxygen Saturation Levels [10 minutes post-operatively]: Oxygen saturation levels will be measured and recorded using a Physiological Parameters Evaluation Form.

Sex: All, ages: 18 Years to any

Inclusion Criteria:

* Being 18 years of age or older.
* Undergoing eye surgery under topical or local anesthesia.
* Being conscious, able to communicate, and having the cognitive capacity to answer questions.
* Having no communication barriers (e.g., hearing, speech, or language problems).
* Having no physical barriers or limitations that would prevent hand massage or stress ball application.
* Volunteering to participate in the study.
* Being able to read and understand Turkish.

Exclusion Criteria:

* Transitioning to general anesthesia during the eye surgery.
* Having a history of severe cardiovascular, neurological, or psychiatric diseases.
* Experiencing any discomfort during the hand massage or stress ball application.
* Cancellation of the surgery during the research process or the participant requesting to withdraw from the study.

• Results publication: Yenigun SC, Demir Korkmaz F. The Effects of Stress Ball Practice on Patient Anxiety, Pain and Vital Signs During Cataract Surgery: A Randomized Controlled Trial. Pain Manag Nurs. 2025 Oct;26(5):592-599. doi: 10.1016/j.pmn.2025.04.009. Epub 2025 May 20. PMID 40399154
• Results publication: Dastan N, Sezer Efe Y, Erkilic K. The Effect of Hand Massage Applied Before Cataract Surgery on Anxiety, Surgical Fear, Pain and Physiological Parameters. J Perianesth Nurs. 2024 Oct;39(5):831-838. doi: 10.1016/j.jopan.2023.12.018. Epub 2024 May 22. PMID 38775768
• Results publication: Cavdar AU, Yilmaz E, Baydur H. The Effect of Hand Massage Before Cataract Surgery on Patient Anxiety and Comfort: A Randomized Controlled Study. J Perianesth Nurs. 2020 Feb;35(1):54-59. doi: 10.1016/j.jopan.2019.06.012. Epub 2019 Sep 21. PMID 31551136