Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s28

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and JONITA NORONHA address I YEAR M.Sc. NURSING (in block letters) LAXMI MEMORIAL COLLEGE OF NURSING BALMATTA MANGALORE

2. Name of the Institution LAXMI MEMORIAL COLLEGE OF NURSING BALMATTA MANGALORE

3. Course of Study and Subject M. Sc. NURSING PSYCHIATRIC NURSING

4. Date of Admission to the 28.07.2012 course

5. Title of the Topic

EFFECTIVENESS OF SELF ENHANCEMENT PROGRAMME

[SEP] ON SELF ESTEEM OF ELDERLY INSTITUTIONALIZED IN

SELECTED OLD AGE HOMES AT MANGALORE

1 6 Brief resume of the intended work . 6.1 Need for the study

“The older the violin, the sweeter the music”

-Larry McMurray, Lonesome Dove

Ageing, which is a reality of the human existence on the planet earth, plays a major role in the global demographic transition.1 The theme of this year’s World Health Day, celebrated on 4th April 2012 was ‘Ageing and health-to which each and every one of us can relate’, using the slogan “Good health adds life to years”. Campaign activities and materials, focuses on how good health throughout life can help older men and women, to lead full productive life and to be a resource of their families and communities.2

Elderly is generally defined as a population above 60 years of age. The world’s population is rapidly ageing, between 2000 to 2050 the proportion of the world’s population over the 60 years, will double from about 11% to 22%. The absolute number of people aged 60 years and over is, expected to increase from 605 million to 2 billion over the same period.2

In India alone, the elderly population is over 82 million, it has gone up by 285 percentages in the last 50 years and the figure is expected to reach, the marks of 177 million by the year 2025.3 In Karnataka, percentage of old age population according to 2001 census, is estimated 7.3%. Projected population of old age, in Karnataka by 2021 is expected to be 12.5%.4 According to 2001 census, in Mangalore Taluk, there are approximately 75,217 elderly, where as females are 43,098 and males are 32,119.5

The joint family system in India is steadily breaking down; about 30% of elders live separately. Loneliness, dependency, poverty, lack of protection of their lives and property are some of the main problems faced by the elders. Hardly about 11% of elderly in India are covered by various pension and retirement

2 schemes and the large majority 89% remains uncovered without any social security protection.6

Hence old age homes are necessity in the present day scenario. India reported that, there were 900 old age homes in India in 2000. South India accounts for 375 old age homes, forming 52% of the total. The number of inmates of old age homes of South India accounts for 82, 214 in 2001.7

The idea of institutionalization of the aged has been largely borrowed from the western societies whose values and norms are quite different from that of India. Usually the old age homes evolve a picture of apathy, dependence and sadness. Old age homes generally, the last resort for the aged. In the absence of joint family system, nuclearization of families; the parents are left with no other alternation than joining the old age homes.6

Unfortunately old age has now become a prevalent social problem in our society. It is strange fact that, no one wants to grow old but everyone wants to live long. Today everyone knows that the old people are left alone without love and affection. Whether rich or poor, the younger generation is not in a position to take care of their aged people due to various reasons. Hence aged people are kept in old age homes, either on payment or free dependence according to the socioeconomic condition of the family.7

The problems faced by the elderly in old age homes are physical, social, psychological and economical problems. The physical involves poor eye sight, cataract, hearing impairment, joint pain and other health problems. Social includes, declined social interaction, lack of family support, psychological problems like depression, loneliness, ignorance, anxiety, boredoms, helplessness, worthlessness, fear about death, and feeling of insecurity and low self esteem.6

A cross sectional study on self esteem of the elderly and factors related among 270 elderly aged 60 years or above in rural areas of Nakhon Savan province. The data was collected by interview technique. The result shown that more than half of the elderly (65.6%) had a moderate level of self esteem ,

3 followed by low level (19.3%) and the high level (15.1%).The factors that are statistically significant related to self esteem of the elderly (p value <0.05) were monthly income, activities of daily living ,personality, participation in family activities and in social interaction and social support. Hence it is concluded that elderly should be encourage to participate in family and social activities.8

Self esteem is an important aspect of the adaptive process at all images of life, especially in elderly residing in old age homes. It is linked to quality of adaptation, well being, and life satisfaction. The studies have found that various techniques such as individual or group reminiscence therapy, life review program, physical exercise etc are effective in, improving self esteem and thereby enhancing the quality of life of institutionalized elderly.9

Lack of self esteem gives birth to a number of problems. The biggest and most damaging problem is lack of confidence. As a result he/she feels unworthy of anything. Such thinking cannot only destroy his/her own life, but also damages ones daily life and leads to isolation from family and society.10

Thus the investigator’s interactions with the elderly of old age homes created interest towards geriatric healthcare. So the research intends to provide, self care enhancement programme for the institutionalized elderly to improve their wellbeing to make their life more worthwhile.

6.2 Review of literature

A study was conducted regarding effectiveness of self enhancement programme on self esteem of elderly institutionalized. Samples selected were 60 institutionalized elderly between the age group of 60-80 years, from two different old age homes of Kottayam District, Kerala. Thirty samples from one setting were selected for experimental group and 30 were selected for control group from another setting. The sample was selected based on probability purposive sampling. The instrument used was Rosenberg’s self esteem scale. The study revealed that Self enhancement programme is an effective method to improve self esteem among institutionalized elderly (z=6.22, p=0.001). So study concluded that self enhancement programme is effective in increasing self esteem, so it can

4 be implemented in various nursing homes by nursing personnel.9

An experimental study on effect of group reminiscence therapy on depression, self esteem, and life satisfaction of elderly nursing homes residents in Taiwan. Quasi experimental study design was adopted. Purposive sampling was used to recruit participants who met the study criteria. Nine weekly one-hour sessions were designed to elicit reminiscence as group therapy for 12 elders in the experimental group. Another 12 elders were recruited for a control group matched to experimental subjects on relevant criteria. Depression is assessed by Geriatric depression scale, self-esteem is assessed by Rosenberg’s self esteem scale, and life satisfactions is assessed by Quality of life index and were measured one week before and after the therapy. Results indicated that group reminiscence therapy significantly improved self-esteem, although effects on depression and life satisfaction were not significant. Reminiscence groups could enhance elder’s social interaction with one another in nursing home settings and become support groups for participants. The model created here can serve as a reference for future application in institutional care.11

A descriptive study design was undertaken to study the self esteem of institutionalized elderly women in Coimbatore. The data were collected from the 30 elderly women, whose age was 60 years residing in 3 old age homes located at the Vadavalli Panchayath of Coimbatore district. Part I focused on socioeconomic demographic profile and part II was 2 points scale constructed by Nalini Rao (1989) to measure the self esteem. The result of the study was found that, major proportion of the elderly women’s level of self esteem is high by residing in old age homes due to ill treatment and seclusion in the home and a very small proportion of them have moderate self esteem, while none of old women’s have a low level of self esteem.12

A study was conducted on self esteem among elderly people receiving care insurance at home and at day care centres for the elderly. The study sought to analyze, the impact of the two social service approaches on the self esteem of the care seekers and included 300 elderly women (150 of whom received service at home and 150 at day care centres.) The finding showed that the self esteem of

5 elderly women receiving service in a day care centre was higher, than that of elderly women receiving the same services at home. The study concluded that the provision of services in a social context is important in giving elderly people proper attention which increases their self esteem, self- evaluation and a sense of mastery.13

A study on effect of regular exercise programme on the self esteem of the elderly, conducted on 22 elderly in the age homes of Rasht (north of Iran) in 2008. This study was a pre–post-test with the design of clinical trials. The qualified elderly after filling out the Rosenberg’s self esteem questionnaire, received one month of designed exercise programme and after one month their self esteem of the samples was determined. There was significant relationship between the numbers of children, marital status , job, and the number of previous jobs, education and last time to their visits. The mean score of self esteem was 22.81+ 4.84 before exercise programme this reached 26.84 + 4.35 after exercise programme and the change was statistically significant (p<0.001). So they conclude that doing exercise is effective in increasing self esteem and it is recommended as a harmless and inexpensive way in which has no complication14.

6.3 Statement of the problem

Effectiveness of self enhancement programme on self esteem of elderly institutionalized in a selected old age homes at Mangalore.

6.4 Objectives of the study

Objectives of the study are:

1. To assess the level of self esteem of the elderly institutionalized.

2. To find the effectiveness of the self enhancement programme on self esteem of elderly in terms of gain in self esteem scores.

3. To determine the association of level of self esteem of the elderly and selected demographic variables.

6.5 Operational variables

Effectiveness: The degree to which objectives are achieved and the extent to which the targeted problem are solved.15

6 In this study it refers to the extent to which the self enhancement programme improves the level of self esteem as measured by gain in Rosenberg’s Self esteem scale.

Self enhancement programme: It is a type of motivational programme that works to make people feel good about themselves and to maintain self esteem.16

In this study it refers to the activities that include introducing oneself, group activity (review of past experience), instrumental reminiscence activity (listening to instrumental songs for 10 min), pen paper exercise (writing or drawing the experience which had pleasant experience) and closing section which are taught to enhance self esteem. The sample is divided into 3 groups of 10 members each and for each group the above activities are conducted, for one hour per day for 7 days in selected old age home at Mangalore.

Self esteem: The degree of regard or respect that individuals have for themselves. It is a measure of worth of that they place on their abilities and judgements.17

In this study it refers to the level of self worth and self confidence among elderly.

Elderly Institutionalized: Elderly has been defined as the chronological age of 65 years old or older.18

In this study it refers to both male and female who are in the age group of 60 years or above and residing in old age homes.

6.6 Assumptions

 Elderly are predisposed to psychosocial problems like self esteem problems, due to deficit in functional capacity and new challenges.

 Self enhancement programme may help the elderly to improve the level of self esteem of the elderly.

6.7 Delimitations

The study is delimited to:

 Elderly in the age group of 60-80 years.

7  Elderly who reside in old age homes for a period of minimum 6 months.

6.8 Hypotheses

The hypothesis will be tested at 0.05 level

H1: There will be significant difference between the mean post-test and pre- test level of self esteem scores of elderly.

H2: There will be significant association between the level of self esteem of the elderly and selected demographic variables.

7. Material and Methods

7.1 Source of data

Data will be collected from the elderly residing at the selected old age homes.

7.1.1 Research design

Pre-experimental one group pre-test post-test design will be used for study.

7.1.2 Setting

Study will be conducted in selected old age homes at Mangalore.

7.1.3 Population

The population in this study includes elderly of age groups above 60 years.

7.2 Method of data collection

7.2.1 Sampling procedure

Sample for the study will be selected by purposive sampling.

7.2.2 Sample size

8 In this study sample consists of 30 elderly of old age homes.

7.2.3 Inclusion criteria for sampling

It includes elderly:

 who are willing to participate in the study.

 who are staying in old age home for minimum of six months.

 Who are in the age group 60-80 years.

 who are able to read and write.

 who can understand instructions.

7.2.4 Exclusion criteria for sampling.

 Elderly who are acutely ill.

 Elderly with hearing and vision problems.

7.2.5 Instruments intended to be used

 Rosenberg’s self esteem scale.

7.2.6 Data collection method

 Data from participants will be collected after obtaining prior consent from authorities and elderly of selected old age homes of Mangalore.

 The investigator will introduce herself to the participants.

 The objectives of the study will be explained.

 Rosenberg’s self esteem scale will be administered on day 1.

 Self enhancement programme will be administered for 7 days for each group of 10 members.

9  Post test will be conducted on 8th day.

7.2.7 Plan for data analysis

The data will be analyzed by using descriptive and inferential statistics.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes, the investigator needs to assess the effectiveness of self enhancement programme among elderly.

7.4 Has ethical clearance been obtained from your institution in case of above statement?

Yes, Ethical clearance has been obtained.

8. Bibliography

1. International Year of Older Persons launched 1 October 1998. Press release WHO/65. [online]. Available from:www.int/inf-pr-1998/en/pr98- 65.html

2. WHO. World Health Day 2012-Good health adds life to years. [online]. Available from: URL:www.who.int/ageing/en/

10 3. Rajan S, Irudaya. Population ageing and health in India. Mumbai: Centre for enquiry into health and allied themes (CEHAT): July 2006; p-4. [online]. Available from: URL:www.cehat.org/humanrights/rajan.pdf

4. Population projection for India and state 2001-2026. [online]. Available from: URL:www.nrhm-mis.inc.in/UI/public

5. MUDA Mangalore. Population composition Mangalore Taluk-2001. [online]. Available from: URL:www.mangalore.com/wp- content/uploads/2011/02/MASTER-PLAN-part-1.pdf.

6. Pai M. The elderly. [online] 2002 Oct 15 [cited 2002 Nov 15]. Available from: URL:www.karmayoga.org/seniorcitizens23619.htm

7. Saroja CA, Sarathy K. Geriatric problems and their management. The nursing perspective. Nur Jind 2002 Apr;89(4):78-80.

8. Nanthamongkolchai S, Makapata A. Self esteem of the elderly in rural areas of Nakhon Sawan province. J Med Assoc Thai 2007 Jan;90(1):155- 9.

9. Aswathy MR. Effectiveness of self enhancement programme on self esteem of elderly institutionalized elderly. Indian Journal of Gerontology 2011;25(2):200-7.

10. Perera K. Self esteem-the art of loving yourself. 2009 [cited 2010 Oct 15] Available from: URL:www.more-selfesteem.com/affiliatearticles.htm

11. Chao SO. The effects of group reminiscence therapy on Depression Self esteem and life satisfaction of elderly nursing home residents. Journal of Nursing Research 2006;14(1):36-42

12. Kavitha RS. Self-esteem of institutionalized elderly women in Coimbatore-a case history. Language in India 2010 Apr 4;10:440-8.

13. Pnina R. Self-esteem among elderly people receiving care insurance at home and at day centre for the elderly. International Psychogeriatrics 2007

11 Dec;19(6).

14. Shahbazzadeghan B. The study of the effect of the regular exercise programme on the self esteem of the elderly in the old people home Rasth. European Journal of Social Sciences 2010 Nov;13:271-7.

15. Business dictionary. Definition and meaning. [online]. Available from: URL:www.buisnessdictionary.com/definition/effectiveness.html

16. Ask.com. [online]. Available from:www.ask.com./questions- about/Definition-of-self-enhancement

17. Townsend MC. Psychiatric mental health nursing. 6th ed. New Delhi: Jaypee Brothers’ Medical Publishers. P. 861.

18. Health spastics’ and health information system. WHO. [online]. Available from: URL:www.int/healthinfo/survey/ageingdefnolder/index.html

9. Signature of the candidate

10. Remarks of the guide

11. Name and designation of (in block letters)

11.1Guide MRS. THEREZA MATHIAS, M. Sc. (N)

12 PROFESSOR AND H.O.D DEPT. OF PSYCHIATRIC NURSING LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE

11.2Signature

11.3Co-guide (if any) MR. SHIVAKUMARA J., MSC(N) ASSOCIATE PROFESSOR DEPT. OF PSYCHIATRIC NURSING LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE

11.4Signature

12 12.1Head of the department MRS. THEREZA MATHIAS, M. Sc. (N) PROFESSOR AND H.O.D DEPT. OF PSYCHIATRIC NURSING LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE

12.2 Signature

13. 13.1 Remarks of the Chairman and Principal

13.2 Signature