With westernized diet and changes in life environments, BPH (Benign Prostatic Hyperplasia) patients are increasing in Korea. According to a report [1] BPH showed 13.7% increase annually as it has increased 67.3% for 5 years from 2006 to 2010. By age, old age over 50s occupies 90.5% in BPH population. Considering the trend that BPH is prevalent in old age, it is expected that old BPH patients keep increasing with the ageing population.

BPH is a typical disease clinically causing lower urinary tract symptoms in males meaning increase in prostate volume. Major symptoms of BPH are lower urinary tract symptoms related to storage and discharge disorder of bladder including pollakisuria, nocturia, overactive bladder, delayed urination, and severed urination. It is reported that urination related lower urinary tract symptoms make important effects on BPH patients, their families and society [2]. For example, previous studies reported that quality of sleep was degraded and physical health related life quality was lowered [34]. Additionally urination issues may cause urination related anxiety or psychological problems such as depression, which may lead to lowered mental health related quality of life [45]. Diverse physical and mental issues caused by BPH have been reported. Therefore, it is necessary to assess the effects of BPH symptoms in order to manage BPH patients properly. However, few studies have researched the urination related stress of BPH patients.

The most effective treatment to remove BPH caused lower urinary tract symptoms is surgical extirpation. However, even though there is pathologically confirmed BPH and various BPH symptoms, it is not necessarily removed through operation. According to level of discomfort and pains that the patient feels, primary treatment will be designated. With increased BPH patients various medicines such as alpha-reductase inhibitors and α blockers have been developed and effectively applied to clinical treatment [6]. As recently BPH specific medicines have been developed, scope of pharmacotherapy has been continuously expanded [7]. However, some patients refuse to take medication because of side effects such as hyposexuality, gynecomastia and vertigo. Typical male pattern alopecia losing hair from forehead to crown is known to have direct and clear connection with BPH pharmacotherapy [8]. Although pharmacotherapy mitigates symptoms of BPH as such, it has some side effects. Therefore, public remedies are increasingly sought after. Most of previous studies dealt with prostate cancer patients [9], and there are few studies on nursing interventions to improvement symptoms of BPH patients.

According to a previous study [10], medical expenses of old aged patients with chronic disease requiring long-term treatment such as urologic diseases including prostate have enormously increased. To improve the situation caused by increased medical cost, it is addressed that countermeasures related to spontaneous cures such as oriental herb therapy, manipulated therapy, hydrotherapy, herb and biological therapy and mental and physical therapy should be made [10]. Hydrotherapy means all the methods using water for inner and outer health and cosmetic purposes. When water at a certain temperature contacts skin directly or indirectly, capillary vessels of skin are dilated, blood flow increases, blood vessel is expanded and bodily waste is removed.

Foot bath is a division of hydrotherapy putting two feet in warm water approximately 40℃. It is reported that foot bath makes your blood smooth, antagonism of autonomic nervous system normalized, brain tension lowered and body functions effectively improved as your whole body becomes warm starting from toes when you have a foot bath [11]. Recently, studies verifying effects of foot bath are increasing. The previous Korean studies have verified effects of foot bath on stress, fatigue, lower leg edema and sleeping of students, operation room nurses and other diverse populations [1213]. Overseas studies also verified effects of foot bath and there is a report that it has effects on respiratory pulse [14]. Although foot bath is expected to have diverse effects, it has not been sufficiently researched up to now. Therefore, studies that can help actual health issues should be continued. Lee et al. [13] proposed a study verifying effects of aroma foot bath therapy. Oh and Gang [12] reported that physical and psychological stress and fatigue have decreased more in fermented extract foot bath group and aroma oil foot bath group than in simple foot bath group.

Aroma therapy is one of alternative therapies that various effective ingredients in essential oils improve incongruity of body and mind, balance them, encourage bodily strength and enables body to promote natural healing. Aroma oil directly goes into bloodstream through skin or makes effects through chemical transformation by reacting to neurotransmitter, hormone and enzyme. Essential oil absorbed in our body through many different paths circulates the whole body and continues healing process through chemical reactions to hormones and enzymes while staying in specific organs with affinity for longer time such as days [15]. It is not accumulated in the body unlike general chemicals but is metabolized in liver. It has mostly been discharged through urination and some of it is discharged through breath, stool and sweat [15]. There are many different kinds of essential oils. It seems like more than 300 kinds. Out of them 40 kinds of essential oils are usually used ones and it is more effective to mix 2 or 3 kinds together which have similar effects rather than using a single oil [16]. Juniper berry and fennel are known to have effects in blood circulation and detoxification, and lavender is reported to have effects in stress mitigation [11]. Juniper berry has been known to have effects in backache, arthritis, bladder infection and urinary tract infection which are caused by coldness in the body, as it has warm characteristics. Fennel can be used for urogenital disease because of diuretic and detoxification ingredients [11]. Lavender is reported to help stress and blood pressure management in many previous studies [17]. Therefore, it is meaningful to verify if foot bath which warms patient's body and helps bodily waste and fatigue materials discharged by activating blood circulation to mitigate BPH patients' symptoms and aroma therapy in which patients can smell aroma with nose and absorb good ingredients through skin have effects of natural healing in that it provides basic materials for evidence centered nursing application. However, previous studies related to BPH related intervention have focused on medication, thermal treatment device or acupuncture [1819] and few studies on interventions that can be applied to patients easily from the perspective of nursing have been made. Accordingly, this study was tried to secure grounds to utilize aroma foot bath therapy as nursing intervention to identify urination status and mitigate urination related stress of BPH patients.

To achieve the purpose of this study, the following hypotheses were set.

Hypothesis 1. There is difference in urination status between experimental group with aroma foot bath and control group without aroma foot bath.

Hypothesis 2. There is difference in urination related stress between experimental group with aroma foot bath and control group without aroma foot bath.

This study is a nonequivalent control group pretest-posttest design quasiexperimental study to identify effects of aroma foot bath on urination status and urination related stress of BPH patients.

The subjects of this study were 52 patients at home in G city who are neither inpatients nor outpatients of the hospital after being diagnosed as BPH. Screening criteria are like the followings.

For the purpose of the study, minimal sample size for t-test was calculated. When setting number of groups=2, significant level .05, effect size .80, and power (1-β)=.80, it was found that 26 are needed per group. Considering missing data, 30 people per group were recruited. Excluding 8 subjects who stopped foot bath in the middle of the experiment or answered the survey insincerely, 52 subjects were selected. After getting written consent from candidates who agreed on participation, they were placed in experimental group and control group randomly through coin tossup.

This study was performed from July to November in 2013 in the order of preparation, preliminary test, pretest, experimental treatment and posttest. In this study, subjects were recruited through intention sampling method for example the researcher went to churches or companies where many males gathered and posted recruitment bulletin asking participation or explained the purpose of study and subject selection standards to relatives and asked them to introduce right candidates. When candidates volunteered and wanted to participate in the study, the researcher visited those candidates and explained study purpose and processes. Survey was performed asking subjects read and answer the survey questions for themselves.

The content and method of this study was approved by IRB (Institution Review Committee) of Chosun University (IRB-13-019). Before experiment, the researcher explained purpose, methods and procedures of the study to all subjects and received written consent from the subjects. The researcher also explained that they could withdraw from the study participation at any time without any disadvantages. After data collection was completed, control group had the same education on aroma foot bath as experimental group for ethical equality.

Collected data were statistically analyzed using SPSS 21.0 program. Analysis methods are as follows.

Two groups were homogeneous as there was no significant difference in general characteristics of experimental group and control group (Table 1).

Two groups were homogeneous as there was no significant difference between experimental group and control group in the homogeneity test on major variables before experiment (Table 2).

The level of urinary symptoms of experimental group reduced by 6.50 from 20.77 to 14.27 while that of control group reduced by 1.35 from 18.50 to 17.15. Thus there was difference between two groups (t=-5.56, p<.001).

Discomfort from urinary symptoms of experimental group reduced by 1.23 from 3.73 before experiment to 2.50 after experiment while that of control group reduced by 0.30 from 3.62 to 3.31, which confirms difference between two groups (t=-4.60, p<.001) (Table 3).

Urination related stress of the experimental group decreased by 1.88 from 6.62 to 4.73, while control group by 0.54 from 6.19 to 5.42, which confirms difference between two groups (t=-5.79, p<.001) (Table 3).