PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Mr. BALU S. L. I YEAR M.Sc. NURSING CHILD HEALTH NURSING YEAR 2011-2012 TULZA BHAVANI COLLEGE OF NURSING BIJAPUR, 586101
1 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. NAME OF THE MR. BALU S. L. CANDIDATE AND I YEAR M.Sc. (NURSING), ADDRESS TULZA BHAVANI COLLEGE OF NURSING, NEAR HAJARAT JUNEEDI DARGA GYANG BAWADI, BIJAPUR.586101 2. NAME OF THE TULZA BHAVANI COLLEGE OF INSTITUTE NURSING,
NO, 899/3, NEAR HAJRAT JUNEEDI DARGA, GYANG BAWADI, BIJAPUR- 586101 3. COURSE OF THE STUDY AND SUBJECT I YEAR M. SC (NURSING) PEDIATRIC NURSING
4. DATE OF ADMISSION TO 12TH MAY 2011 THE COURSE 5. TITLE OF THE STUDY A STUDY TO ASSESS THE PSYCHOSOCIAL PROBLEMS AND COPING STRATEGIES AMONG ORPHANAGE CHILDREN IN SELECTED ORPHANAGES AT BIJAPUR DISTRICT WITH VIEW TO DEVELOP INFORMATION BOOKLET
2 6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“Love heals people …Both the one who give it and ones who receive it”.
-Karl manager.
Children’s are major consumers of health care in India. About 35% of total populations are children below 15 years of age. They are not only large in number but vulnerable to various health problems and considered as special risk group. Children are the wealth of tomorrow.1
In the early 1900, orphans weren’t always defined as children without parents. Very often orphans were neglected kids of single parents, families in financial arrears or homeless children who where living on the streets, sometimes children sought out orphanages- some were called asylum back then because the living conditions were better there than with their families, unfortunately, orphanages were scarce and many children were left on their own.2
Orphan means child whose parents are dead be made an orphan and the orphanage is one the home which cares for orphans. Children represent the future, ensuring their healthy growth & development to be a prime concern of all societies. children are vulnerable to any condition of health, may of which can be effectively prevented or treated. An orphan is a child permanently bereaved of or abandoned by his or her parents. In common usage only a child (or the young of an animal) who has lost both parents is called an orphan.3
Globally the number of orphans is increasing due to HIV/AIDS, internal conflicts in families and others. Orphanage and vulnerability causes much of its burden on poor household and children. This study was initiated to assess household challenges of orphaning and coping strategies by families and guardians living with orphan and vulnerable children. It has also tried to look at the types and level of challenges facing orphan and vulnerable children’ Community based descriptive cross-sectional quantitative survey was conducted from October to November 2008 using a pre-tested Amharic questionnaire among guardians of orphan and vulnerable children in Hosanna town. Sixty nine percent (69%) of guardians were women.
3 Almost all of the orphans and vulnerable children had participated in one domestic activity and 26.9% of orphans and vulnerable children were involved in domestic work in other houses. A little more than twenty two percent (22.2%) have history of involvement in productive child labor : 79.7% were found working at the time of data collection above thirty five percent (35.6%) of respondents believe that the orphan and vulnerable children are discriminated. And 23.5% of the discriminators were step parents. As household coping mechanism 24.9% reported selling domestic animals, 15.6% selling household equipments and 12.9% sell plots of land which all occurs due to lack of resource in household. The study concluded that caregivers lack sufficient resources to provide basic needs to orphan and vulnerable children. Hence community based training on micro finance assistance, discrimination & psychological support should be given to the community in general.4
4 6.2 NEED FOR THE STUDY
Need for the study means scientific method which refers to a body of technique for investigation phenomena, acquiring new knowledge or collecting and integrating previous knowledge to be termed scientific method of enquiry must be based on gathering empirical and measurable evidence subject to specific principles of reasoning
Orphan children experience high rates of mind disturbance such as psychological problems and social problems with his own life or others he /she kept under isolated from the society.
It is estimated there are between 143 million and 210 million orphan worldwide [recent UNICEF report ] the current population of the United State is just a little over 300 million to give an idea of the enormity of numbers , every day 5760 more children become orphans, 2102400 more children become orphans every year in Africa alone. Russian study reported that of the 15000 orphans aging out of state – run institution every year 10% committed suicide, 5000 were unemployed, 6000 were homeless and 3000 were in prison within three year.5
Man is as social animal he is one of the asset for the society and also he is having rich in culture and suspect tradition and also have its own values in the society, but the person think who is having orphanage may not lead normal life in society the person who is isolated himself due to absence of parents and back to society will face problems since the society will not accept and hence the individual child is more prone for psychosocial problems such as.: Anxiety, Depression, Loneliness, Distress. Illiteracy, Unemployment, Social isolation, Financial instability.6
The coping is used to refer to the process by which a person attempts to mange stressful demands, It takes two major forms. A person can focus on the specific problem or situation that has arisen, trying to find some way of changing it or avoiding it in the future, this is called problem focused coping it helps to resolve change a persons behavior or situation . A person can also focus on alleviations the emotions associated with the stressful situation even if the situation it self cannot be change. This is called emotion-focused coping. Emotion focused coping strategies
5 help person relax and reduce feeling stress. These include progressive relaxation deep breathing guided imagery and distraction such as music or other activities.
Coping strategies are reality and task-oriented. For example, parents can be said to cope with the death of their child when they actively grieve and share their feelings with other supportive person, coping is the way an individual comes to terms with a situation and adapts to it.7
A study was to conducted with the aim to describe challenges and strategies for coping with their challenges among individuals living in an institutional setting. This study used a qualitative approach to analyze the interview of fourteen participants (11 males and 3 females) ages 10-24 residing in an Indonesia residential institution (orphanage). Insufficient access to educational recourses and basic necessities were major concerns the participants, as was the residential institution, unresponsiveness and the lack of connection experienced by residents. Individual coped with these challenges by turning to others for social support and by trying to change the focus of their thoughts, such as to more pleasant thought are simply to mentally disengage. Some youths and young adults residing in institution such as residential institution demonstrate resilience at the individual level by utilizing coping strategies to address problems in obtaining adequate educational, material and psychological support. However because inadequacies in these kind of support ultimately impede psychological development.8
Today orphanage children are facing psychosocial problem, This causes behavioural changes in children as anxiety, Depression, Loneliness, Unemployment, social isolation. Hence the investigator felt to create awareness regarding psychosocial problem among orphanage children.
6 6.3 REVIEW OF LITERATURE
The review of literature in a research report is a summary of current knowledge about a particular problem and includes what is known and not known about the problem. The literature is reviewed to summarize knowledge for use in practice or to provide a basis for conducting a study.
A study was carried out to determination of emotional and developmental disorders among orphanages children in sharkia governorate. The sample was included 294 children recruited from 4 orphanages in sharkia governorate. All children aged between 6-12 years old, from both sex and have no social limitation. All participants were subjected to psychiatric assessment for depression by child depression inventory , anxiety by revised children’s manifest anxiety scale , self- esteem by rosenberg’s self-esteem scale and pediatric assessment for developmental disorder by pediatric symptom checklist . The prevalence rate of depression was 21%, anxiety was 45% , low self-eastem was 23% and developmental disorder was 61%. Hence the study was recommended sthat there is high rate of emotional and developmental disorders among orphanages children and strongly inter-related with socio demographic characteristics.9
A study compared the behavioral problems of children living in an SOS Village, which attempts to provide a family setup for its children, with those living in conventional orphanages. They were conducted a cross-sectional survey of 330 children, aged 4-16 years, living either in an SOS or other conventional orphanages of Karachi, and assessed their behavioral problems using strengths and difficulty questionnaire (SDQ). Behavioral problems on composite SDQ and subscales, rated by foster mothers, were compared between children in the two groups using χ(2) test of independence. The overall prevalence of behavioral problems was 33%. On univariate comparison, They were found that groups did not differ in their overall behavioral problems. They were found a high burden of behavioral problems among children living in orphanages of Karachi, Pakistan. Foster mothers' depression and child's nutritional status, which are associated with behavioral problems, can be target of interventions to reduce behavioral problems of children living in orphanages.10
7 A study carried out to the last parent has a profound effect on survivors. Health care workers are often the first source of anticipatory guidance for newly orphaned adults as they cope with grief, loss and awareness that their lives are forever changed. It is estimated that more than 80 million Americans were born between 1946 and 1964. As this Baby Boomer generation, often defined as seeing themselves as culturally special, becomes “orphaned” they may be less aware, less prepared, and less supported than any previous group of Americans regarding this life event. For a number of adults, the loss creates many unexpected results that can destabilize life in profound ways. This study was described the unique new realities of helping adult orphans as they relate to health care providers and discusses the problems associated with prolonged and complicated grief. Implications for geriatric caregivers. Mental health providers, health educators, and others are proposed.11
A study was conducted on the basis of information collected about the situation of double orphans who are heading household in Rakai District, Uganda. The information will be used as justification and guidance for planning actions to improve the situation of these and similar children. This research is thus the first step in an Action Research approach leading to specific interventions. The aim of this study is to describe the situation of these orphaned children, with an emphasis on the psychological challenges they face. The study involved interviews, focus group discussions, observations and narratives. Forty-three heads of sibling-headed households participated. Information derived from informal discussions with local leaders is also included. The responses were analyzed using a modified version of Giorgi’s psychological phenomenological method as described by Malterud. Factors such a lack of material resources, including food and clothes, limited possibilities to attend school on a regular basis, vast responsibilities and reduced possibilities for social interaction all contribute to causing worries and challenges for the child heads of households. Most of the children claimed that they were stigmatized and, top a great extent, ignored and excluded from their community. The children’s experienced their situation as a huge and complex problem for themselves as for people in their villages. Hence the study was recommended that the situation might improve if actions focused on practical and psychological issues as well as on sensitization about the children’s situation could be initiated.12
8 The study was conducted the obstacles to a successful resolution of grief normally faced by children whose parents have died, children orphaned by AIDS may face additional psychological and social challenges. However, limited attention has been paid to psychological and developmental needs of children orphaned by HIV/AIDS, particularly in resource-poor countries or regions. In this article the authors review the global literature on child bereavement and AIDS orphan care experiences in developing countries and present a developmental psychopathology model of the psychological issues facing AIDS orphans. The authors identify gaps in the literature and provide suggestions for future research on AIDS orphans in resource poor countries and regions. They emphasize that future studies need to assess the status of behaviors and mental health of children orphaned by AIDS within a developmental framework, identify those individual and social factors associated with grief, and examine the long-term impact of quality of care, developmental maturation, and attachment with caregivers on the psychological well-being of AIDS orphans.13
A study was conducted to the examined the prevalence of emotional and behavioral problems and associated factors in children and adolescents aged 6-18 years that were reared in orphanages. They were aimed to compare these children and adolescents with a nationally representative age-matched sample that were raised by their own families and to identify mental health service needs in orphanages. This cross sectional study included 674 children and adolescents aged 6-18 years that were selected from orphanages using stratified and probability cluster sampling. A socio- demographic information form, and the child behavior checklist (CBCL) Teacher’s report from (TRF) and youth self-Report form (YSR) were used for data collection. According to the information provided by caregivers, teachers, and youths, the prevalence of problem behaviors ranged between 18.3% and 47% among those in institutional care versus between 9% and 11% among the national sample. Hence the study was recommended that there is an urgent need to develop alternative care models and routine screening for mental health. The training of professionals and development of mental health services for children in institutional care should be a priority.14
A study was carried out to mental health problems among orphanage children in the Gaza strip, the aim to establish the level of emotional problems among 115 children aged 9-16 years (average 13.4), who were living in two orphanages in the
9 Gaza Strip. The children's age of admission to the orphanage (average 8.8 years) was higher than in traditional orphanages in other countries. This was related to the reasons for admission, following their father's death, and the inability of their remaining family to care for them. However, children retained substantial contact with their family of origin by visiting during school holidays (88.6%) or being visited at the unit (97.4%). Using previous standardized mental health measures completed by the children and their main carers, children demonstrated high rates of anxiety, depressive and post-traumatic stress reactions. These mental health problems were strongly inter-related but were not found to be associated with social/care variables. These should take into consideration the socio-cultural characteristics of each country and limited local resources; involve non-governmental organizations and local communities.15
The study was carried out in Tuzla, Bosnia and Herzegovina, in March 2002. They were assessed 186 (96 girls and 93 boys) elementary school children aged 12.7+ 1.8 years for war trauma, presence of posttraumatic stress disorder (PTSD), and depression. There were 38 (14 girls) children from the government orphanage. 48 (24 girls) children from the non-governmental organization (NGO) SOS children’s Village 50 (24 girls) children who lost a parent in the war but lived with the surviving parent. And 50 (31 girls) children who lived with both parents. For data collection, thy were children’s Posttraumatic Stress Reaction Index and Children’s Depression Inventory. Basic socio demographic data were also collected. All children experienced war trauma and many had psychological consequences. The highest prevalence of PTSD, often comorbid with depression, was found among children who lost one or both parents. The children with the lowest rate of psychological disturbances were those living with both parents.16
A study was conducted to compare orphans development in two care systems. Based on age, sex psychological orphans in the traditional poster (n=94) and orphanages (n=48) in a middle large in Iraqi Kurdistan. At an index interview, child behavior checklist (CBCL) Harvard Uppsala trauma questionnaire for children & post traumatic stress symptoms for children were administered to the caregivers. Although both samples revealed significant decrease in the means of total competence and
10 problem scores over time the improvement in activity scale, externalizing problem scores and post traumatic stress disorder related symptoms proved to be more significant in the poster care than in the orphanages. Even if the two orphan care systems showed more similarities than difference the poster care revealed better outcomes over time. The result are discussed in relation to gender, age, socio economic situation, cultural values and the characteristic of each care system.17
A comparative study was conducted to know the mental health & cognitive development of 9-12 years old Eritrean war orphans living in two orphanages that differed qualitatively in patterns of staff interaction and styles of child care management. The directors and several child care workers at each institution were asked to complete staff organization and child management questionnaires. The psychological state of 40 orphans at each institution was evaluated by compare in their behavioral symptoms and performance on cognitive measures.Orphans who lived in a setting where the entire staff participated in decisions affecting the children, and where the children were encouraged to become self-reliant through personal interactions with staff members. The resulting when orphanages are the only means of survival for war orphans a group setting where the staff shares in the responsibilities of child management, is sensitive to the individuality of the children’s and establish personalities with the children serves the emotional needs & psychological development of the orphans more effectively than a group setting.18
A study was conducted to examine the psychological effect of orphanhood in a case study of 193 children in Rakai district of Uganda. Studies on orphaned children have not examine the psychological impact. Adopting parents and schools have not provided the emotional support these children often need. Most adopting parents lack information on the problem and are therefore unable to offer emotional support. And school teachers do not know how to identify psychological and social problem and consequently fail to offer individual and group attention. the concept of the locus of control is used to show the relationship between the environment & individual assessment of their ability to deal with & to adjust behavior.Most orphans risk powerful cumulative and often negative. Effect as a result of parent’s death thus becoming vulnerable and predisposed to physical and psychological risks. 193
11 children aged 6-20 years in Rakai district were interviewed in a study exploring the psychosocial effects of orphaned. All of the children were orphaned due to their parents death from AIDS. Teachers and some orphans also participated in focus group discussions, while teachers, and where possible, guardians were interviewed. Hence the study was recommended that the children were able to distinguish between their quality of life when their parents where alive and well.19
12 6.4 STATEMENT OF PROBLEM
“A study to assess the psychosocial problems and coping strategies among orphanage children in selected orphanages at Bijapur district with view to develop information booklet.”
6.5 OBJECTIVES OF THE STUDY
1. To assess the psychological and social problems among orphanage children. 2. To assess the coping strategies among orphanage children. 3. To find out the association between psychosocial problem and coping strategies with selected socio demographic variables.
4. To prepare and administer information booklet on orphanage children.
6.6 OPERATIONAL DEFINITIONS
1. ASSESS: It refers to organized systematic and continuous process of collecting information about the psychosocial problems among orphanage children.
2. PSYCHOSOCIAL PROBLEMS: In this study It refers to both psychological and social problems, such as Anxiety, Depression, Loneliness, Distress. Illiteracy, Unemployment, Social isolation, Financial instability.
3. COPING STRATEGIES: In this study coping strategies refers to the various individualized method in which a person use to cope up with psychosocial problem.
4. ORPHANAGE CHILDREN: In this study orphan refers to a child who has lost both parents and enrolled in an institution. age group between 6-18year.
13 6.7 ASSUMPTIONS
1. The orphanage children may face some degree of psychosocial problems in
orphanages
2. The orphanage children may need psychosocial support
3. The orphanage children may adopt some degree of coping strategies.
6.8 HYPOTHISES
H1: There is significant relation between psychosocial problem and coping strategies among orphanage children. H2: There is significant association between psychosocial problem and coping strategies with their elated variables
14 7. MATERIAL AND METHODS
7.1 SOURCE OF DATA
: Selected orphanages at Bijapur district
7.2 METHODS OF DATA COLLECTION
7.2.1. Research Design
: Descriptive study research design and a study to assess the psychosocial problem experienced by the orphanage children in a selected orphanage at Bijapur district
7.2.2. Research approach : Descriptive survey approach
7.2.3 Research Variables
Dependent variable : Psychosocial problem and coping strategies among Orphanage children
Independent variable : Information booklet
Demographic variables : Socio demographic variable such as age, gender, religion, education status, and source of information.
7.2.4 Setting : Selected orphanages at Bijapur district.
7.2.5 Sample size : The orphanage children in selected orphanages at Bijapur districts, who fulfill the inclusion criteria and the sample size is 60
7.2.6 Population : The orphanage children in selected orphanages at Bijapur who are willing to take part in the study.
15 7.2.7 Criteria for the sample selection
Inclusive criteria:
Orphanage children who are willing to participate in the study
Orphanage children who are between 6-18year
Orphanage children who are able to read and write the kannada and English
Exclusive criteria:
Orphanage children who are not willing to participate in the study
Orphanage children who are above 18year
Orphanage children who are not able to read and write the Kannada and English
7.2.8 Sampling technique: Non-probability, convenient sampling technique.
7.2.9 Tool for data collection : The tool consist of the following sect
Section : Includes the socio- demographic variables
Section B : Structured interview schedule to assess psychosocial problems.
Section C : Increase rating scale to assess coping strategies
16 7.2.10 Method of Data collection :
1. Permission will be obtained from the consent authority
2. Consent will be taken from the subject
3. Data will be collected by using self structured interview schedule
4. Duration of the study 4-6weeks
7.2.11 Plan for data analysis : The collected data will be analyzed using descriptive and inferential statistics.
Descriptive statistics : Frequency, percentage, mean and standard deviation will bused.
Inferential statistics : Karl person and chi-square test will be used.
7.3 DOES THE STUDY REQUIRES ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMALS?
Yes, there is an intervention as information booklet and there is no active manipulation on the subjects.
7.4Has ethical clearance been obtained from your institution?
1. Yes, the informed consent will be obtained from institution. Tulza Bhavani college of Nursing, Bijapur.
2. Permission will be obtained from selected orphanages at
3. Consent will be obtained from the sample.
17 8. LIST OF R EFERENCES:-
1. Parul datt,Text book of “Pediatric nursing” Jaypee brothers medical publishers, second edition-2009, 1p.
2. Super User published on 05 september 2011, Hits.67 www.pubmed.com
3. Orphan, from Wikipedia, www. Pubmed.coms
4. Balew G, worku N, Tilaye T, Huruy K, Fetene T, “Assessment of household burden of orphaning and coping strategies by guardians and families with orphans and vulnerable children”, Ethiop med J. 2010 Jul; 48(3): 219-28p.
5. Life Adaption Discovery, www. Pubmed.com.
6. K Park’s text book of “preventive and social medicine” seventh edition 242p.
7. R, Sreevani : “A guid to mental health psychiatric nursing” , third edition 262p
8. Wanat s et al, coping with the challenges of living in an Indonesian residential Institution. Health policy 2010 June: 96(1): 45-50- Epub 2010 Jan 25.
9. Nagy Fawzy and Amira Fouad, Psychosocial and Developmental Status of Orphanage Children: Epidemiological Study-2010
10. Lassi ZS, Mahmud S, Syed EU, Janjua NZ. Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanage, Soc psychiatry epidemiol. 2011 Aug;46(8): 787-96p. 2010 Jun 24.
11. Mc Daniel JG, clark PG,. The new dault orphan: issues and considerations for health care professional. J Gerontol Nursing . 2009 Dec: 35(32): 44-9p.
18 12. Nina Dalen, Ann Jacqueline Nakitende & seggane musisi “They don’t care what happens to us” The situation of double orphans heading households. BMC public Health, 2009 : 9:32’ published online 2009 September 4.
13. Lix et al, A developmental psychopathology frame work of the psychosocial needs of children orphaned by HIV, J Assoc Nurses AIDS care 2008 Mar- Apr: 19(2): 147-57p.
14. Sismek Z, Erol N, Oztop D, Ozer Ozcan O, Epidemiology of emotional and behavioral problems in children and adolescents reared inn orphanages: a national comparative study, Turk psikiyatri Derg 2008 Fall : 19(3): 235-46p.
15. Thabet, Mental health problems among orphanage children in the Gaza strip, Adoption & Fostering Journal, volume 31, Number 2,Summer 2007, 54-62p.
16. Mevludin Hasanovie, Osman sinnovie, Zihnet selimbasic, IZet Pahevic and Esmina Avdibegovie, Psychological Disturbance of war-traumatized children from dDifferent Foster and Family setting in Bosnia and Herzegovina croat med J, 2006 February:47(1): 85-94. Coppyright 1 2006 by the Croatian medical Journal.
17. Ahmad A, et al. A 2- year follow-up of orphans’ Competence, Social motional problemsand spost- traumatic stres symptoms in traditional foster care and orphanages inn Iraqi Kurdistan-2004.
18. Wolff Ph, Fesseha G. The orphans of Eritrea: are orphanages part of the problem or part of the solution? Am J psychiatry 1998 oct: 155(10):1319-24p.
19. Segendo, J. Nambi J. The psychological effect of orphanhood: a study of orphans. Health Trasnit Rev.1997:7: 105-24p.
19 9. Signature of the candidate :
10. Remarks of the guide :
11. Name and designation of 11.1 Guide : MR. NAGARAJA G. J. ASSOCIATED PROFESSOR AND HOD OF CHILD HEALTH NURSING, TULAZA BHAVANI COLLEGE OF NURSING BIJAPUR
11.2 Signature :
11.3 Co-Guide (If Any) :
11.4 Signature :
11.5 Head of the department : MR. NAGARAJA G. J. ASSOCIATED PROFESSOR AND HOD OF CHILD HEALTH NURSING, TULAZA BHAVANI COLLEGE OF NURSING BIJAPUR
11.6 Signature :
12. 12.1 Remarks of the principal :
12.2 Signature :
20