RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MR. RAHUL NIGAM
I YEAR M.Sc. NURSING
PSYCHIATRIC NURSING
YEAR 2010 – 2012.
SRI VENKATESHWARA COLLEGE OF NURSING, NO. 98, MARUTHI INDUSTRIAL ESTATE, PEENYA 2ND STAGE, BENGALURU – 560058. RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BENGALURU, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MR. RAHUL NIGAM 1ST YEAR M.Sc. NURSING
1 NAME OF THE CANDIDATE SRI VENKATESHWARA COLLEGE OF AND ADDRESS NURSING, NO. 98, MARUTHI INDUSTRIAL ESTATE, PEENYA 2ND STAGE, BENGALURU - 560058.
Sri Venkateshwara College of Nursing 2 NAME OF THE INSTITUTION No. 98, Maruthi Industrial Estate, Peenya 2nd stage, Bengaluru - 560058.
3 COURSE OF THE STUDY I Year M.Sc. Nursing AND SUBJECT Psychiatric Nursing DATE OF ADMISSION TO 4 7TH June 2010 THE COURSE
“ A study to assess the effectiveness of 5 TITLE OF THE STUDY progressive muscle relaxation technique on anxiety among senior citizen in selected old age home at Bengaluru”. 6 BRIEF RESUME OF INTENDED WORK
6.0 INTRODUCTION
God grant us the serenity to accept, Things that we cannot change courage To things that I can and, Wisdom to know the difference. - Keats
The term anxiety has become a part of our everyday life. The concepts of anxiety may differ according to the individual’s state of contexts and interpretations. Is recognized that certain amount of anxiety is desirable, productive and can facilitates the individuals to grow but when the anxiety exceeds disturb the normal functions.1
Aging is a natural process and an inevitable one. Elderly is a crucial phase where the physiological, psychological and socio-cultural changes in elderly contribute to develop anxiety. National Population survey shows that the population of India is 1.029 billion. Nearly 77 million constitute the elderly population, among them 75% of elderly persons live in rural areas and 25% live in urban areas. The records show that 38 millions are males and 39 millions are female population.1
1 Anxiety is a normal emotion. All human beings develop it as a means of protection from danger and threat when we perceive danger. Human body undergoes a number of autonomic physiological changes such as perspiration, restlessness, discomfort, palpitation and tightness in the chest.2
National Health Interview Survey shows that 39% of people over 65 years of age suffer from some limitation of activity due to chronic conditions and 11% are unable to carryout major activities because of their anxiety towards illness and also they suffer from some kind of anxiety disorders. Many researchers have stated that anxiety is uncontrollable and ambiguity is more stressful for a geriatric, which can be predicted, modified or terminated. Nurses being the central figure in a geriatric care can help to identify the level of anxiety and provide opportunity for these people to cope with the stressful situation.3
One of the skills that are highly important to learn and implement into your daily life is relaxation. Relaxation can be highly beneficial if practiced routinely in one’s everyday life. Techniques involving relaxation are widely used by people to reduce anxiety and cope with stress-related problems. Relaxation therapy is initiated and taught to peoples but is practiced primarily in the client’s own environment. There are countless methods used to achieve relaxation, but the procedures that are most commonly practiced in the clinical setting are Jacobson’s (1938) Progressive Muscular Relaxation,
2 Schultz and Luthe’s (1969) Autogenic Training, and Benson’s (1975) Relaxation Response (Weiten & Lloyd, 1998). In the last a few decades, a substantial amount of data has been collected on many factors related to relaxation.4
A study was conducted on the progressive muscle relaxation technique with audio assistance is the elderly individual using the same relaxation script for the post test. The measurement by State Trait Anxiety Inventory scale showed that each treatment condition to be equally effective in producing significant changes in anxiety level of the client. The author emphasizes that a certain level of anxiety can cause many disease. It is good that one learns how to control anxiety or at least reduce it by a progressive muscle relaxation technique5.
6.2 NEED FOR THE STUDY
Anxiety can affect each person in different ways: there are several symptoms that are quite common. Some of these are emotional, which include feeling of fear, disappointment, anger, depression or helplessness. Other symptoms are more behavioral, ranging from fidgeting or pacing to substance abuse or other self-destructive behaviors. There are also physiological symptoms, which include fast heart, feeling of nausea, headache, lightheadedness, sweating and other disruption in bodily functions. Finally many people have experience cognitive symptoms such as negative thinking
3 about oneself, racing thought, loss of memory and “blanking” out.6
It is estimated that about 25% of the population will experience an anxiety disorder at some stage of their life. Women are twice more likely to suffer from an anxiety disorders than men. Unfortunately, only 50% of people receive treatment for their disorder. Anxiety problem often leads to mental disorders. People with anxiety disorders are also at higher risk of being affected by substance abuse. So it needs to be addressed before an anxiety disorder can be effectively treated.7
A study was conducted on alternative and complementary therapy for stress and anxiety. Data was collected from 315 students. Creativity is necessary in meeting the need of elderly persons every day by the care givers both in acute and critical care environment. For the elderly persons many alternative and complementary therapies including meditation, progressive muscle relaxation, aromatherapy, hydrotherapy, humor therapy, imagery, massages, music and relaxation can be used successfully as adjunct therapies to help in reducing stress and anxiety.8
In population census of India shows that the population of the aged was only 19 million in 1950 and it has tremendously increased to 77 million by the year of 2001 is 2 and expected to reach 100 million in 2013. The needs and
4 demand of the elderly population have been increasing as they have not been given much attention by family members and relations, and also due to modernization, and increasing nuclear family system and inadequate time to take care of them.1
Elderly is a crucial period where they can be more vulnerable to develop physical and psychological trauma. They are said to be suffering from chronic diseases due to physical, psychological and emotional problems and how the nervous system inter communicate anxiety has been shown to alter susceptibility to various mental disorders. Therapeutic use of relaxation responds positively in anxiety related disorders and is found to be an important tool of therapeutic strategy which severe as primary and secondary prevention in disease.9
The study is to reduce the anxiety of the elderly persons by the number of the health team members. The mental health nurse should understand the nature of the anxiety among the elderly person and can play an important role in reducing the anxiety of the elderly persons by practicing progressive muscle relaxation technique.
Progressive muscle relaxation technique is one of the simplest forms of relaxation technique. The investigator realized that progressive relaxation technique will help the elderly persons to maintain their emotional balanced.
5 So the investigator, by helping the elderly to practice daily for 30 minutes would help them to reduce the level of anxiety in order to keep their emotion balance and happy throughout the day. As a mental health nurse adopting the progressive muscle relaxation technique as a relaxation therapy, the investigator test that it will be beneficial of people in the old age home and can be implemented as a community programmed as it can continuously assist them in maintaining their life successfully.
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of progressive muscle relaxation technique on anxiety among senior citizen in selected old age home at Bengaluru”.
6.4 OBJECTIVE OF THE STUDY
1. To assess the level of anxiety among the senior citizen in selected old age home at Bengaluru. 2. To assess the level of anxiety after given Jacobson progressive muscle relaxation technique among the senior citizen in selected old age home at Bengaluru. 3. To find out association between the level of anxiety and selected demographic variable. 6
6.5 OPERATIONAL DEFINITIONS
1. Assess: In this study assess refers to examining or analyzing the difference in knowledge level regarding effectiveness of progressive muscle relaxation technique on anxiety.
2. Knowledge: Knowledge refers to awareness or familiarity and skills acquired by a person through experience, situation or education; the theoretical or practical understanding of effectiveness of progressive muscle relaxation technique on anxiety.
3. Senior citizen: Individuals whose age is 60 years and above of both sex staying in old age home.
4. Progressive muscle relaxation technique: It is a procedure of progressive muscle relaxation technique followed by eleven steps for elderly persons those who are scoring in mild and moderate level of anxiety.
5. Anxiety: Anxiety is a basic human emotion consisting of fear and uncertainty that typically appears in individual. 7 6.6 ASSUMPTION:
Practicing of progressive muscle relaxation technique enhances sense of well being among elderly persons.
6.7 HYPOTHESIS:
H1: There will be a significant difference between the level of anxiety before and after giving Jacobson progressive muscle relaxation technique.
H2. There will be a significant association between the levels of anxiety after Jacobson progressive muscle relaxation with demographic variation.
6.8 REVIEW OF LITERATURE:
A study was conducted on anxiety disorder in older age with a prevalence rate of 10% an important psychiatric problems and pathologic anxiety was evaluated are a normal reaction by elderly proper the co morbidity of anxiety disorders with other psychiatric disorder are depression and somatic disease was high.5
A study carried out on association of hormones on the affect in elderly 180 elderly was selected for the study. 8 Blood was taken from the participants and was sent for analysis. The study shows that 90% as the elderly had decreased serum cholesterol level, dopamine level which led to the development of anxiety and depression.10
A study which examined the effect of Progressive muscle relaxation technique on anxiety state and blood pressure in patient with essential hypertension forty subjects from a hypertension outpatient clinic received progressive muscle relaxation technique training once in a week and practiced at home daily for 4 weeks. The study concludes that Progressive muscle relaxation technique significantly enhanced their perception of health and in beneficial for patients with essential hypertension.11
A study conducted on Progressive muscle relaxation technique based on muscle stretching exercise on 100 elderly patients. The study explored the clinical efficacy of the techniques. The potential role of stretch-based relaxation technique was effective in the management of anxiety. In this study the result revealed that these procedures are useful in the treatment of neck tension / pain and anxiety.12
A study was conducted on the effectiveness of guided imagery with Progressive muscle relaxation technique to reduce chronic pain and mobility difficulties of osteoarthritis in elderly. 28 elderly women with osteoarthritis were given treatment of listening twice a day 10 to 15 minute audio taped script was used to guide the women in guided imaginary with Progressive 9 muscle relaxation technique. The result showed that there was a self management which was effective to reduce pain and mobility difficulties associated with osteoarthritis.13
A study was done to compare frontal EMG feedback training and progressive muscle relaxation training in the treatment of chronic anxiety. Two groups (N=26) of patients with chronic anxiety were compared in their response to different forms of relaxation therapy. One group received 16 sessions of frontal EMG and the other 16 sessions of progressive relaxation although EMG feedback was much superior in reducing frontal EMG activity this treatment was no more effective than progressive relaxation in reducing symptoms of anxiety. The study concluded that progressive muscle relaxation training in patients with each group showed more than marginal improvement.14
The study was done to investigate the effects of relaxation exercises on anxiety levels in an inpatient gero-psychiatric unit, thirty nine subjects were measured with STAI scale progressive Muscle Relaxation Technique, meditative breathing, guided imagery and soft music employed to promote relaxation. A significant reduction in the level of anxiety was obtained through progressive Muscle Relaxation Technique.15
A study was conducted for evaluation of Progressive muscle relaxation technique on anxiety related symptoms in elderly population 10 participants rated with highly anxious women Progressive muscle relaxation 10 technique was thought effective in reducing psychosocial symptoms for 2 weeks of training. The study confirmed that in both state and trait anxiety a significant improvement continued during the 2 weeks of practice at home following the end at training.16
A study was done to identify the effects of relaxation and mnemonics on memory, attention and anxiety in the elderly. They measured attention capacity on twenty five normal elderly subjects, who were trained in techniques to improve face name recall. Techniques consist of relaxation training and a mnemonic device. Anxiety was measured simultaneously with attention measures. They hypothesized that their techniques would increase available memory processing capacity by improving attention and reducing anxious rumination. The result suggests that the elderly anxiety has a cognitive component that interferes with performance on attention and memory tasks, but which can be reduced through relaxation training.17
A study was conducted on effectiveness of Progressive muscle relaxation technique and self induced relaxation training. Their relative effects on subjective anxiety and autonomic arousal. Two group 48 elderly patients with anxiety was compared. They concluded that the progressive muscle relaxation technique was effective on subjective anxiety and autonomic arousal. 15
11 7 MATERIALS AND METHOD 7.1 Source of data Data will be collected from the senior citizen residing in selected old age home.
7.2 Method of collection of data
I) Research design: Quasi experimental approach will be used.
II) Research variables: Independent variable: Knowledge regarding effectiveness of Jacobson progressive muscle relaxation technique on anxiety among senior citizen residing in selected old age home. Dependent variable: Anxiety among senior citizen.
III) Research setting: The study will be conducted at selected old age home in Bengaluru.
12
IV) Population: Population will be the senior citizen residing at selected old age home in Bengaluru.
V) Sample: Senior citizen residing at selected old age home in Bengaluru and who fulfill the inclusion criteria is consider as sample and sample size is 60.
VI) Criteria for sample collection:
Inclusion criteria: The study includes 1) Senior citizen who are willing to participate in this study. 2) People who are of age above 60 years. 3) Senior citizen those who able to read and write Kannada.
Exclusion criteria: The study excludes 1) Senior citizen those are not available at the time of data collection. 2) Senior citizen those who are unable to do progressive muscle relaxation technique.
VII) Sampling techniques: Non probability purposive sampling method.
VII) Tool for data collection: It consists of two sections: 13 Section A – Demographic variables such as age, sex and education etc. Section B –state – trait anxiety inventory scale will be used to measure the anxiety level.
VII) Method of data collection:
After obtaining permission from the respective authorities of old age home the investigator obtain informed consent from the senior citizen personally who will be identified as per inclusion criteria by purposive sampling technique. The investigator will assess the level of anxiety by using state- trait anxiety inventory scale. After that progressive muscle relaxation technique will be demonstrated to them. On the 8th day post test will be conducted by using the same state trait anxiety inventory.
Duration of study: 4 – 6 weeks.
IX) Plan for data analysis:
The data collected will be analyzed by means of descriptive statistics and inferential statistics. Descriptive statistics frequency, percentage distribution of demographic variables and Mean, Standard Deviation will be used to assess the level of knowledge. Inferential statistic chi Square test will be used to associate the level of knowledge and selected demographic variables. 14 X) Project outcome:
After this study the investigator will know the level of knowledge regarding effectiveness of progressive muscle relaxation technique on anxiety among senior citizens at selected old age home in Bengaluru.
7.3 Does the study require any investigation or interview o be conducted on patient or human or animal? Yes, progressive muscle relaxation technique will be administered.
7.4 Has ethical clearance been obtained from institution? Yes, the permission will be obtained from the ethical committee of the Sri Venkateshwara College of Nursing.
15 8 LIST OF REFERENCE:
1. Population Census 2001. Elderly census. Retrieved. July 10 2005; http:www.statistics.com 2. Ahuja N. A Short Text book of Psychiatry. 2nd ed.New Delhi: Jaypee brother’s pub; 2002. 3. National health census 2001. Elderly census. Retrieved Aug 5th 2005; http: www.health org .com 4. panicdisorder.about.com/od/livingwithpd/a/PMR.htm 5. Robb SL. Music assisted progressive muscle relaxation. Journal of music therapy. 37 (1); 2000. 21 – 2 6. Tamara. D. Hanoski. Anxiety: What it is and how to cope with it. Student counseling services. University of Alberta. April 2000. 7. Boemer RJ. Anxiety in elderly people. Fort Scholar Neurological psychiatry. 72 (10); 2004. 564 - 73 8. Kelgan. Alternative and complementary therapy for stress and anxiety. Journal of psychosocial nursing. 22 (7); 2003. 12 - 4 9. Margon TC. Introduction to psychology. 3rd ed. New Delhi: Mc Graw Hill; 1994. 10. Hassed . Association of Hormones on the affect in elderly. Psychological Quarterly. 25(3); 164 – 70. 11. Sheu S. Lin HS. Effect of progressive muscle relaxation on blood pressure and psychosocial status. Holistic Nursing Practice. 17 (1). 2003. 41 – 7. 12. Curran SL. Clinical efficacy of progressive muscle relaxation technique. Nursing practice. 2 (5) ; 2000. 154 – 7.
16 13. Baird CL. Sand L. Effectiveness of guided imaginary with progressive muscle relaxation on elderly pain management. Pavi management nursing. 5 (3); 1999. 94 – 104. 14. Leboduf A. Lodge J. A comparison of frontal Emg feedback and progressive relaxation. American Journal of psychotherapy. 27 (2); 1999. 170 – 4. 15. Weber A. The effect of relaxation exercises on anxiety. Journal of Holistic Nursing. 14 (3) ; 1996. 196 – 205. 16. De Berry S. An evaluation of progressive muscle relaxation on anxiety. International journal of aging human development. 14 (4); 1982. 255 – 69. 17. Yesavage JA. Jacob R. Effects of relaxation on elderly. Experience of aging research. 10 (4) ; 1984. 211 – 4.
17 9. Signature of the candidate :
10. Remarks of the guide :
11. Name and designation of
11.1 Guide :
1.2 Signature :
11.3 Co-guide (if any) :
11.4 Signature :
11.5 Head of the department :
11.6 Signature :
12.1 Remarks of the principal :
12.2 Signature :