Rajiv Gandhi University of Health Science s3

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE,KARNATAKA .

SYNOPSIS PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

MS. ANNALAKSHMI .S I YEAR M.SC NURSING PSYCHIATRIC NURSING YEAR 2010-2011

DHANAWANTARI COLLEGE OF NURSING NO. 41/3 , VINAYAKNAGAR NEAR CHIKKABANAVARA RAILWAY STATION, HESARAGHATTA ROAD CHIKKABANAVARA BANGALORE – 560 090

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.

Curriculum Development cell

CONFIRMATION FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Registration No. :

Name of the Candidate : MS. ANNALAKSHMI .S

Address : NO. 41/3 , VINAYAKNAGAR NEAR CHIKKABANAVARA RAILWAY STATION, CHIKKABANAVARA BANGALORE – 560 090

Name of the Institution : Dhanawantari college of Nursing, Bangalore.

Course of Study & Subject : M.Sc. Nursing in Psychiatric Nursing .

Date of admission to the course : 31/10/2009

Title of the Topic : A study to assess the effectiveness of planned teaching programme (PTP)on stress management among the staff nurses working in selected hospitals at Bangalore .

Brief Resume of the intended work : Attached

Signature of the student :

Guide Name : MRS. LAKSHMI DEVI .R

Remarks of the guide :

Signature of the guide :

HOD Name : MRS. LAKSHMI DEVI .R

Signature of the HOD :

Principal Name : MRS. LAKSHMI DEVI .R

Principal Mobile no :

Principal Email Id :

Remarks of the Principal :

Principal Signature :

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

KARNATAKA,BANGALORE

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MS. ANNALAKSHMI .S, I YEAR M.SC NURSING, NAME OF THE DHANAWANTARI COLLEGE OF NURSING, 1. CANDIDATE NO. 41/3 , VINAYAKNAGAR, AND ADDRESS NEAR CHIKKABANAVARA RAILWAY STATION, HESARAGHATTA ROAD, CHIKKABANAVARA, BANGALORE – 560 090.

DHANAWANTARI COLLEGE OF NURSING, 2 NAME OF THE NO. 41/3 , VINAYAKNAGAR, INSTITUTION NEAR CHIKKABANAVARA RAILWAY STATION, HESARAGHATTA ROAD, CHIKKABANAVARA, BANGALORE – 560 090.

3 COURSE OF THE STUDY DEGREE IN MASTER OF NURSING, AND SUBJECT PSYCHIATRIC NURSING . 4 DATE OF ADMISSION TO THE COURSE 31/10/2009

A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP) ON 5 TITLE OF THE STUDY STRESS MANAGEMENT AMONG THE STAFF NURSES WORKING IN SELECTED HOSPITALS AT BANGALORE

6) BRIEF RESUME OF THE INTENDED WORK :

6.1) INTRODUCTION :

“ Tension is who you think you should be Relaxation is who You are . “ - Chinese Proverb

We generally use the word “ stress “ when we feel that every thing seems to have become too much - we are overloaded and wonder whether we really can cope with the pressures placed upon us,anything that poses a challenge or a threat to our well being is a stress .

Nevertheless, stress has been regarded as an occupational hazard since the mid 1950 s . Work stress in nursing was first assessed in 1960. Work stress and burnout remain significant concerns in Nursing, affecting both individuals and organizations .

For the individual nurse ,regardless of whether stress is perceived positively or negatively ,the neuroendocrine response yields physiologic reactions that may ultimately contributes to illness. In the health care organization work stress may contribute to absenteeism an turnover,both of which detract from the quality of care 1

The nurse’s role has long been regarded as stress filled based upon the physical labor , human suffering, work hours , staffing and interpersonal relationships that are central to the work nurses do . 2

MOJOYINOLA (1984) , OLALEYE (2002) Stress is an important Psychological concept that can affect health ,well- being and job performance in negative dimensions. 3

Stress is not inherently deleterious, however . Each individuals cognitive appraisal, their perception and interpretations, gives meaning to events and to determines whether events are viewed as threatening or positive . 4

A recent study indicated that stress management programs may reduce the risk of heart problems, including heart attack , by upto 75 percent in people with heart disease . 5

PESTONJEE (1987) , meditation , yoga , pranayam ,self hypnosis , biofeedback etc are techniques which can be practiced at individual level to deal with stress .

Since combination of strategies is almost always more effective than a single strategy , these techniques should be flexible and individuals must be encouraged to use coping strategies in new situations . 6

6.2 ) NEED FOR THE STUDY

“ The time to relax is when You don’t have time for it “

- Tim Goodwin & Sydney J. Harris

In INDIA, some of the issues related to nurse retention still remain to be tackled – job insecurity for the contractual staff,low pay in both the government and private sectors, lack of a conducive work environment and infrastructure facilities .

According to PRABHA S. CHANDRA , K R JAIRAM, ANILA JACOB (2004) Department Of Psychiatry , NIMHANS, indicates in their study that 92 % of palliative caregivers of HIV/AIDS had average to high levels of burnout .

According to LEO JEEVA S.P., CHANDRAMOHAN V .(2008) reveals that the majority of staff nurses (78 %) werefound to be suffering from mild to moderate level of stress .

According to KHETARPAL A & KOCHAR .G, The Internet Journal of World Health and Societal Politics (2006) was found that women (40 %) nurses were under moderately low levels of stress followed by 38% who reported moderately high level of stress and remaining women nurses experiencing very high or low stress are 12 % in each case .

According to VEMPATI R.P. and SHIRLEY TELLES (2007) Vivekananda – Kendra yoga research foundation, Bangalore indicates that people with high occupational stress appeared to be more likely to show reduced sympathetic activity after the two day yoga based stress management programme .

According to MOHIT P CHOPRA , KISHORE KUMAR K.V.,(2006) Indian Journal of psychiatry reported in their studythat 77 % used emotion focused coping strategy in overcoming their stress. 5% of them get relief through social support. Remaining 18 % use problem solving methods to deal effectively with their day- to- day life stresses .

According to PAILOOR SUBRAMANYA , (2009) Indian council of medical research center for advanced research in yoga and neurophysiology, SVYASA , Bangalore reported that a two-day cyclic meditation programme decreased occupational stress levels and baseline autonomic arousal suggesting significant reduction in sympathetic activity .

From these studies, nursing is acknowledged to be stressful work, and there is a growing need for reasonable and practicable guidance in relation to the management of work related stress and health .

6.3 ) REVIEW OF LITERATURE

Literature review related to stress and its management are obtained from various sources to have comprehensive and concrete - knowledge base .

For easy understanding the collected literature is divided into

6.3.1 : Studies related to causes of stress

6.3.2 : Studies related to Signs & Symptoms of stress

6.3.3 : Studies related to management of stress

6.3.1. STUDIES RELATED TO CAUSES OF STRESS

PAMELA GRAY TOFT and JAMES G.ANDERSON (2002) identified three major sources of stress . They are workload , feeling inadequately prepared to meet the emotional demands of patients and their families and death and dying . 7

ROGERS et al (2004) concluded in their study that the risks of making an error were significantly increased when work shifts were longer than 12 hours , when nurses worked overtime , or when they worked more than 10 hours per week . 8

OHIDA et al (2001) studied the influence of day , afternoon , night and rotating shifts found that job performances and satisfaction was less on a rotating roaster than on a fixed roaster . 9

BALL et al (2002), DEMEROUTI ET AL (2000) concluded that lack of reward is an increasing source of frustration and contributes to the disengagement, a component of burnout . 10

FOXALL et al ( 1990 found that nurses working in intensive care ranked coping with ‘death and dying’ more highly as a source of distress than did those in medical-surgical care who ranked workload and staffing issues higher . 11

6.3.2 . STUDIES RELATED TO SIGNS & SYMPTOMS OF STRESS

LIPKIN et al (1998) stated that shift workers are more likely to experience headaches , muscle pain respiratory infection and general malaise these in turn result in higher rates of absenteeism. Also stated that shift workers are more likely to suffer cardiovascular and digestive disorders . 12

ACHULU (1995) found that nurses that experienced high level stress were less satisfied with their career,had higher absenteeism rate and significantly less career commitment . 13 FRENCH et al (2000) identified nine sub-scales of work place stressors that might impact nurses such as conflict with physicians , inadequate preparation, problems with peers , problems with supervisor, discrimination ,workload , uncertainity concerning treatment dealing with death and dying patients, patients /their families . 14

COFFEY, SKIPPER & JUNG (1998) shown that shift workers accident rates are more than day workers . Also shown that the optimum mental performance level for workers occurs between 2-4 pm, maximum general awareness is between 1-7 pm. Performance levels are lowest between 3.30 – 5.30 am. 15

ALTERMAN et al (1994) in their study , found that the workers in high demand and low decision jobs had an elevated risk of heart disease mortality . 16

6.3.3 . STUDIES RELATED TO MANAGEMENT OF STRESS

FOLKMAN et al (1986) have been proposed two principal coping Strategies, they are emotion focused coping and problem – focused coping . 17

HEALY & MCKAY (2000) , PAYNE (2001) Indicates that problem- focused coping, such as problem,is the more effective at preventing burnout nurses . 18

RICK et al (2001) Ensuring provision of professional, emotional and social support in the workplace as part of stress management should be seen as being preventive .

AUERBACH et al (2007) & ENCARTA (2008) states that Aerobic exercise such as running ,walking, biking and skiing can help keep stress levels down.

MARTIN KWASI ABIEMD (2009) indicates that trancendental meditation (TM) practices are associated with reduced heart rate, lowered oxygen consumption and decreased blood pressure . 6.4 ) STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME(PTP) ON STRESS MANAGEMENT AMONG THE STAFF NURSES WORKING IN SELECTED HOSPITALS AT BANGALORE .

6.5) OBJECTIVES

1) To assess the pre level Knowledge on stress and its Management among the staff nurses working in selected hospitals at bangalore . 2) To Assess the effectiveness of planned teaching programme on stress management by post level knowledge score . 3) To Compare the pre and post test level of Knowledge on stress management among the staff nurses working in selected hospitals at bangalore . 4) To find out the association between stress management and selected demographic variables among the staff nurses .

6.6 ) RESEARCH HYPOTHESIS

H1 :- There will be a significant difference between the Pre test level knowledge and post test level of knowledge on stress management among the staff nurses . H2 :- There will be significant association between stress management and selected demographic variables among staff nurses .

6.7 ) OPERATIONAL DEFINITION

6.7.1 EFFECTIVENESS It refers to the outcome or result of the given health education in terms of Knowledge obtained by the staff nurses .

6.7.2 PLANNED TEACHING PROGRAMME It refers to a prepared teaching program with systematically developed instruction for a group of staff nurses regarding knowledge towards stress management.

6.7.3 STRESS MANAGEMENT A set of techniques used to help an individual cope more effectively with difficult situations in order to feel better emotionally, improve behavioral skills, and often to enhance feelings of control .

6.7.4) STAFF NURSES Staff Nurses in the age group of 21-40 years,working in selected hospitals at Bangalore . 6.8 ASSUMPTIONS

1) The staff nurses working at selected hospitals may not posess adequate knowledge on stress management . 2) The Planned teaching programme will enrich the knowledge of staff nurses on stress management .

6.9) DELIMITATION

1) The sample size is limited to 30 staff nurses 2) The period of study is limited to 6 weeks 3) The study is limited to staff nurses in the age group of 21-40 years who are working in selected hospitals at Bangalore. 4) The Staff nurses those who are working in operation theatre(OT) and intensive care unit (ICU) of selected hospitals at Bangalore . 5) The Staff nurses who are willing to participate in the study 6) The Staff nurses those who are available during data collection period .

7) MATERIALS AND METHODS

7.1) RESEARCH APPROACH

An evaluative approach is considered to be appropriate for this study .

7.1.1) SOURCE OF DATA

The Source of data for this study is staff nurses working in selected hospitals at Bangalore.

7.1.2) RESEARCH DESIGN

The research design selected for the present study is Quasi- experimental design.(one group Pre test and Post test design) .

7.1.3) SETTING OF THE STUDY

The Study will be conducted in selected hospitals at Bangalore .

7.1.4) POPULATION

Staff nurses in the age group of 21-40 years working in selected hospitals at Bangalore is selected as population for this study.

7.1.5 ) SAMPLE Staff nurses at the age group of 21-40 working in OT and ICU are the sample for this study .

7.1.6 ) SAMPLE SIZE

Sample size consists of 30 staff nurses working in OT and ICU . 7.1.7 ) SAMPLING TECHNIQUE

Stratified random sampling will be used to select the staff nurses .

7.2 ) METHODS OF DATA COLLECTION

The method of data collection for this study is structured interview schedule .

7.3) SAMPLING CRITERIA

7.3.1 ) INCLUSION CRITERIA a. Staff nurses in the age group of 21-40 years b. Staff nurses who are working in OT and ICU of selected hospitals at Bangalore c. Staff nurses who can communicate freely in Kannada and English . d. Staff nurses who are willing to participate in the study.

7.3.2 ) EXCLUSION CRITERIA

a. Staff nurses who are working in general wards b. Staff nurses who are suffering with any physical illness line hypertension & diabetes . c. Staff nurses already using the stress relaxation techniques .

7.4) TOOLS FOR DATA COLLECTION

Semi structured questionnaire will be used for data collection .

7.5) DATA COLLECTION PROCEDURE

Prior to the data collection , the investigator will obtain permission from the higher authorities as well as consent from the staff nurses of selected hospitals at Bangalore .

The investigator will then collect the data before and after the planned teaching programme by using semi structured questionnaire answered by each sample taking 30 minutes time .

7.6) DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER ANIMALS ? IF SO PLEASE DESCRIBE BRIEFLY ?

7.7) HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE ABOVE ?

No. 8 ) LIST OF REFERENCES

 NIRAJ AHUJA, MD , A Short text book of Psychiatry, 5th ed, New Delhi: Jaypee Brothers Medical Publishers ; 2002 .

 DR(MRS.) . K LALITHA, Mental Health and Psychiatric Nursing an Indian perspective,1st ed, Bangalore:V.M.G Book - House ;2007 .

 BIMLA KAPOOR, text Book of psychiatric nursing , 1st ed, Delhi: Kumar Publishing House ; 1994.

 STUART W,SUNDEEN T, Principles and practice of psychiatric nursing, 4th ed, St. Louis; Mosby –year book;1991.

 BARTLETT D, STRESS,perspectives and processes, 1st ed, Buckingham: Best paper publishers : 1988.

 LEHRER P. M, WOLFFOLK R.L,principles and practice of stress Management , 1st ed, London : Guildford Press ; 1993.

 HUNGLER AND POLIT , Nursing Research principles and Methods , 6th ed , philadelphia : Lippin cott ; 1999 .

 TREECE E.W. et al , Essentials Of Research in nursing, 4th ed, St. Louis : the C.V. Mosby co; 1992 .

 WEISS CAROL H, Evaluation Research , 1st ed,New Jersey: Prentice Hall inc ; 1972 .

 BAUM A, GATCHEL R.J,KRANTZ D.S, An Introduction to Health Psychology , 1st ed, New york: Mc.Graw-Hill Companies inc; 1997 .

Journals

1) L.C. Yu,P.K. MANSFIELD, et al, Occupational stress among nurses in hospital setting,in AAOHN Journal,1989;vol.37,121-29.

2) HARTEL C,The consequences and distinctiveness of shift work, Journal of occupational and organizational psychology,2000;42,168-77 .

3) MOJOYINOLA J.K. Occupational stress among the nurses,Online Journal of issues in nursing,1984;5(2);1-22

4) MORANO J, The relationship of workplace social support to perceived work-related stress among staff nurses , Journal of Post Anaesthesia Nursing,1993;8,395-402 .

5) LEES S.et al ,The design of a stress management programme for nursing personnel ,Journal of advanced nursing,1990;15,946-961 . 6) HEALY C, MCKAY M.F, Nursing stress ;The effect of coping strategies and job satisfaction in a sample of Australian nurses, Journal of advanced nursing , 2000;31,681-88 .

7) GRAY TOFT ,ANDERSON T.G.,Stress among hospital nursing staff; Its causes and effects,Journal of social science and medicine,1981;15, 539-47.

8) ROGERS E et al, The working hours of hospital staff nurses and patient safety,Journal of health affairs,2004;23(4);202-12 .

9) OHIDA T. et al,Night shift work related problems in young female nurses, Journal of occupational health,2001;43,150-56.

10) BALL et al, A model of burnout and life satisfaction amongst nurses,Journal of advanced nursing, 2002;32,454-64.

11) FOXALL M.J. et al, A comparision of frequency and sources of nursing job stress perceived by intensive care , hospice and medical-surgical nurses, Journal of advanced nursing,1990;15,577-84 .

12) LIPKIN J et al, Chronic fatigue syndrome , The American journal of medicine, 1998; 105(3),91-93.

13) ACHULU E ,Occupational stress;Your job can be dangerous to your health, Nigeria school health journal, 1995;8(1),46-49 .

14) FRENCH S.E. et al, An empirical evaluation of an expanded nursing stress scale , Journal of nursing measurement, 2000; 8,161-78.

15) ALTERMAN T.R et al, Decision latitude , psychologic demand, job strain and coronary disease in the western electic study, American journal of epidemology,1994;139,620-27 .

16) COFFEY L et al, Nurses and shift work effect on job performance and job related stress, Journal of advanced nursing , 1998; 13(2),245-54 .

17) FOLKMAN S et al, Appraisal , coping, health status and psychological symptoms , Journal of personality and social psychology, 1986;50,571-79.

18) HEALY C. et al, Identifying sources of stress and job satisfaction in a sample of Australian nurses, Journal of advanced nursing , 2000;31,681-88.

9. Signature of the Candidate

10. Remarks of the Guide

11.1 Name and designation of the Guide

11.2 Signature of the Guide

11.3 Co- Guide (if any)

11.4 Signature of the co- guide

11.5 Head of the department

11.6 Signature

12.1 Remarks of the principal

12.2 Siganture