RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA. PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 Mrs. SRILATHA.K. 1. Name of the candidate and Dr.SYAMALA REDDY COLLEGE address OF NURSING, #111/1, SGR MAINROAD, MUNNEKOLALA, MARATHAHALLI BANGALORE-560037.
Dr. Symala Reddy College of 2. Name of the Institution Nursing.
3. Course of the study and M.Sc Nursing, I Year.
subject Psychiatric Nursing.
4. Date of Admission to Course 09.06.2008.
A study on assessment of level 5. Title of the Topic of self-esteem among physically
challenged adults in selected
rehabilitation centers at Bangalore.
2 6. BRIEF INTRODUCTION OF THE INTENDED WORK
INTRODUCTION
“So much is a man worth as he esteems himself”
Self-esteem is a universal need for every human being and a key component in restoring and maintaining mental and physical health. It is defined that self-esteem is a person’s personal judgment of his or her own worth based on how well behavior matches with self- ideal and also referred as the extent to which a person feels he lives up to his own expectations and to the expectations of people whose opinion he values.
Self-esteem is having two types like global and specific. Global self-esteem is how much one likes ones self as a whole. Specific self-esteem is how much one approves of a criteria part of one self.
Self-esteem is a motive that can be satisfied in a variety of ways by obtaining social approval, by finding self-respect, by attaining prestige or power or by achieving success in some line of endeavor. Self-esteem is the single most significant key to understand the behavior of a person. To understand a person psychologically one must understand the nature and degree of his self-esteem and the standards by which he/she judges him/herself.
The self-esteem is considered central aspect of psychological functioning and is thought to be related to a host of variables, including goal setting and attainment, sense of control and empowerment, ability to respond and adjust to challenges and general satisfaction with one’s life.
3 Self-esteem is important for a healthy individual. Self-esteem embraces the concepts of ego or ego strength, inner self or self image, personality, self concept, self worth, self respect and self satisfaction, self acceptance which is fundamental to high self- esteem. Self-esteem may be challenged when previous inspiration, roles and relationships have to be changed because of illness. Self-esteem is partly an inevitable trait and genetic as well as environmental influences are very important. Low self- esteem does sometimes cause problems compared to those with high self-esteem.
Self-esteem alteration is also associated with role alteration and the need to depend on public assistance. Often, the disabled are more than capable of doing a job but are perceived by others to be incapable. This devaluing of the person with a disability can have a devastating effect on self-esteem.
A person with low-esteem is likely to be sensitive to any evidence in the experience of daily life which testifies to his inadequacy, incompetence or worthless.
Behaviors associated with low-self esteem are criticism of self and others, decreased productivity, denied self pleasure, destructive towards self and others, disturbed interpersonal relationships, feelings of guilt, inadequacy and worry, negative out look about one’s body, abilities and life and withdrawal. The positive feelings about self during development is said to promote psychological well-being and stability.
4 6.1. NEED FOR THE STUDY
Around 10% of the world’s population, or 650 million people, live with a disability. They are the world’s largest minority. Twenty percentage of world’s poorest people are disabled and tend to be regarded in their own communities as the most disadvantages. Between 120 and 150 million disabled children and young people live in the world, with low self-esteem. The global literacy rate for adults with disabilities is as low as 3% and 1% of women with disabilities. Eighty percentage of persons with disabilities live in developing countries, and shows that there exists a moderate self-esteem.
According to the United States census bureau, about 5.2 million American youth, aged five through 20 had some long-term physical, mental or emotional disabling condition, and there was low self-esteem was found among those disabled.
According to experts (2008) about 7,800 Americans suffer spinal cord injuries each year, most (82%) occur among males and most frequently at age 19 had disturbed self-esteem.
The National survey organization surveys in 1991 registered 16.36 million disable persons out of which 9.51 million disabled persons were males and 6.63 million disabled persons were females. In 2002 recorded 18.49 million disabled persons out of which 10.89 million were males and 7.59 million were females.
The needs of the self-esteem level are met by achieving success in work and other activities. Recognition from others increases self-esteem and feelings of pride in
5 ones accomplishments. The young adults and middle age group population are prone to disabilities due to environment degradation, pollution and industrialization process accentured by haphazard develops without taking appropriate measures of preventing ecological imbalances and providing safety measures. Nearly 1/3 rd of the disabled persons have acquired disability since their birth depicting impact of hereditary, defective gene mutating congenital defects, inappropriate services at the tine of delivery and low level of nutrition and health care provided to the pregnant mothers during their pregnancy period. Thomas t. Thomas summarized the impact of stigma on self-esteem and confidence. In addition to the challenges of living and coping with a devasting illness, people with brain disease must deal with the stigma that society places on such illness and cope with the impacts to self-esteem and confidence.
Adults will have the high levels of self esteem when they are physically able, but times of physically disability their role functions alters and comparing with others feel that they are unable to perform their role and automatically develop a low self-esteem and their coping abilities will be reduced. In times of physical disability we should know how much they are able to cope up with the situation, and what type of coping skills they are using. There is a need to assess the level of self-esteem and educate them to use coping skills to improve their self- esteem levels. Feeling of securing, positive identification, belonging and sense of purpose influence self-esteem. Factors influencing self-esteem are age, gender, socio economic status and body image.
High self esteem trees you as a person. It gives you room to grow, there by allowing you mature and blossom. So that the whole world can see the greatness that lies within you. When your growth is no longer restrained by low self-esteem, only
6 then will you realize that you are truly worthy of happiness and success. But with low self-esteem and you belief that good things are not possible for you, ultimately you will aspire for less and in the end that is exactly what you will get.
Linda (2007), the self-esteem of 43 women with mobility impairments was examined on the basis of age of onset and nature of disability. Based on past literature, it was hypothesized that women with earlier-age of onset disabilities would report lower positive levels of self-esteem compared to women with later age of onset disabilities.
6.2. REVIEW OF LITERATURE
Self-esteem is the esteem one feels towards one’s self. It is a fundamental attitude that one has toward one’s self. It is a tough world, it is a tough life, and it is tough to know how to handle things sometimes. It is also a world of choices, feelings thoughts and free will. Every body gets to decide for him/herself how much esteem they are due.
Self-esteem refers to judgments about you. If you don’t like yourself very much and feel like most of your actions are stupid, you have low self-esteem; being teased and criticized a lot may contribute to poor self-esteem. If you think you are better than other people and are considered conceited, your self-esteem may be too high; you may feel hat any time something goes wrong it must be someone else fault.
If you basically like yourself and you considered yourself to have a fairly typical mix of strengths and limitations, you probably have pretty healthy self-esteem.
7 The related review of literature is organized and presented in the following headings:
1. Definition of self-esteem.
2. Branden’s primary properties of self-esteem.
3. Maslow’s approaches to self-esteem.
4. Physically challenged and self-esteem.
1. DEFINITION OF SELF-ESTEEM:
Self esteem as a ratio found by dividing one’s successes in areas of life of importance to a given individual by the failure in them or one’s success/pretensions.
2. BRANDEN’S PRIMARY PROPERTIES OF SELF-ESTEEM:
1. Self-esteem as a basic human need that is “it makes an essential contribution
to the life process…is indispensable to normal and healthy self-development,
and has a value for survival”.
2. Self-esteem as an automatic and inevitable consequence of the sum of
individual’s choices in using their consciousness.
3. Something experienced as a part of, or background to, all of the individual’s
thoughts, feelings and actions.
8 3. MASLOW’S APPROACHES TO SELF-ESTEEM:
American psychologist “Abraham Maslow” described two kinds of esteem needs. The needs for respect from others and the need for self-respect. Respect from others entails recognition, acceptance, status and appreciation. Without the fulfillment of these needs, Maslow suggests, an individual feels discouraged, weak and inferior.
Factors affecting self-esteem are predisposing from genetic as well as environment influences, parental rejection causes the child to be uncertain of himself and other human relationships. Over possessiveness, over permissiveness or over control can create a feeling of unimportance and lack of self-esteem. Frustration defeatism and destructive sense of inadequacy and inferiority, often creating sense of hopelessness and inferiority. Problems arise due to low self esteem include irritability, rigidity, defensiveness, self doubt, pessimism, over dependence on people or things, fears of or hostility to other people, rapid and sudden anger, inability to accept criticism, inability to accept new ideas.
A disability is defined as “A disadvantage or deficiency, especially a physically or mental impairment that interferes with or prevents normal achievement in a particular area, or something that hinder or incapacitates”.
Causes of physically challenged are errors in fetal brain defects, problems during pregnancy or delivery, toxins in child’s environment, child hood accidents, genetic, lead poisoning, metabolic disorders, malnutrition, Rh blood diseases, intrauterine and
9 other infectious diseases. Long-term disabilities are primarily caused by illnesses such as cancer, hypertention diabetes and arthritis.
Livson and Pes-Kin (1980) present data showing that in adulthood, late maturing, boys showed signs of less social ease, less self –control, more uncooperativeness, and greater impulsivity than did earlier maturing peers. Despite these data, other long-term follow-up observations of both boys and girls have shown improvements in self-esteem, self-confidence, social skills and cognitive competence.
4. PHYSICALLY CHALLENGED AND SELF-ESTEEM:
Sixty-two percent of national samples of women with physical disabilities reported having experienced emotional, physical or sexual abuse. In addition to the types of abuse experienced by all women, women with physical disabilities are sometimes abused by with holding needed orthotic equipment, medications, transportation or essential assistance with personal tasks, such as dressing or getting out of bed, due to that they are having low self-esteem.
Toronto Star (1987) the Ontario ministry of community and social services surveyed 62 women and are found that more of the women with disabilities had been battered as adults compared to the women without disabilities (33% versus 22%) but fewer had been sexually assaulted (23% versus 31%). This survey showed that women are having low self-esteem due to disabilities.
Ridington (1989), the disabled women network of Canada surveyed 245 women with disabilities and found that 40% had experienced abuse. Perpetrators of
10 the abuse were primarily spouses and ex-spouses (37%) and strangers (28%) followed by parents (15%), services providers (10%), and dates (7%) less than half these experiences were reported, due mostly to fear and dependency and low self-esteem.
King, et.al, (1993) conducted exploratory study to assess the level of defense mechanism in relation to the self-esteem of the disabled. Self-esteem rating scale was formulated and the reliability was found to be adoptive (r=o.82). The samples were
120 from the specialized institutions. The data were collected and analyzed. The findings revealed that people with disabilities engage in number of protective mechanisms used to bolster-self-esteem.
Shultz (1993) conducted a comparative study on self-esteem among physically disabled and normal adolescents. Females with physical disabilities were lower in self-esteem. In addition, social self -efficacy was found to be a significant predictor of both independence and persistence in adolescents with disabilities who are significantly less dependent and persistent than were normative samples.
Yvonne (1999) conducted a study on attitudes of employers regarding physically disabled employees. Seventy two disabled participants, 34 males and 38 females from
17 to 69 years old, completed a 20-minute survey on electronic mail. This survey involved six demographic items, ten questions taken from the Rosenberg self-esteem scale, and five items taken from the subjective probability questionnaire. Nineteen employers, twelve females and seven males from 30 to 63 years old, took a 15-minute survey through electronic mail. The survey contained three demographic questions and twenty-six items taken from the disability Rights attitude scale. Results did not
11 support the findings in the literature, which reflected a number of problems between employers and disabled employees. Results reported in raw scores that reflected no evidence employment, self-esteem and depression, scores within the disabled population. Results also showed no evidence among hiring preference and job accommodation scores within the population. Although the results failed to show problems regarding career attitude, the relevant literature stated that there is an assortment of obstacles preventing employees and disabled employees from working together.
Lewellyn’s (2001) conducted a descriptive study on individuals with physical and multiple disabilities. Objective was to examine the level of self-esteem among physical and multiple disabled persons. The Rosenberg’s self-esteem inventory was used as a tool. The data were collected from 110 boys and girls. The data were analyzed and checked for association and correlation. The findings were that orthopedically disabled people showed low self-esteem.
James (2004) did a study on body image among the lower limb amputee. A
110-item survey was sent to lower limb amputees to examine their self-perception and psychosocial well being. The subjects (N=90) were male unilateral, traumatic, lower limb amputees. The author used an amputee body image scale (ABIS) to measure each amputee’s perception of his body image. Data obtained from the ABIS were used to determine correlations with the other assessment scales. Findings indicated significant positive correlations between body image and self-esteem, anxiety and depression. A significant correlation also was found between body image and life satisfaction, indicating the more negative an amputee feels about his or her body
12 image, the less satisfied he or she is with his or her life. Results of this study support the hypothesis that a relationship exists in lower limb amputees between their perception of their body image and their psychosocial well being, in fact, the significant correlations tend to support other studies in which physical disability was found to increase a person’s tendency toward anxiety, depression, low self-esteem and less satisfaction with life.
Kip (2007) published an article regarding Arizoma Recreation Center for
Handicapped (ARCH). It is the organization, which offers a full range of indoor and outdoor programs for developmentally, physically and emotionally disabled adults.
Initial focus was to provide handicapped individuals with extensive opportunities to acquire socialization skills. ARCH serves approximately 350 handicapped individuals each week and over 3500 individuals annually. ARCH is committed to providing services, which enable handicapped individuals to obtain higher level of function, pride, dignity and self-esteem.
6.3. STATEMENT OF THE PROBLEM
A study on assessment of level of self-esteem among physically challenged adults in selected rehabilitation centers at Bangalore.
6.4. OBJECTIVES OF THE STUDY
1. To determine the level of self-esteem among physically challenged adults.
2. To describe the relationship between socio-demographic variables and level of self- esteem.
13 6.5. HYPOTHESIS
H1: There is a significant association between the socio-demographic variables and level of self-esteem.
6.6. OPERATIONAL DEFINITIONS
Self-esteem:
Self-esteem is the overall appraisal of ones own dignity or worth among physically challenged adults.
Physically challenged:
Adults with physical disability experiencing certain disadvantages in life and unable to discharge his/her duty.
Adults:
Persons in the age group of 19-60 yrs including both male and female.
Rehabilitation center:
The centers where the physically challenged individuals are strengthened to a highest level of functional ability by training, retraining and medical treatment.
14 6.7. ASSUMPTIONS
A1: The level of self-esteem of physically challenged adults varies from
individual to individual.
A2: The level of self-esteem differs according to nature of disability.
A3: The cause and duration of disability influences the level of self-esteem
Among physically challenged adults.
A4: There is a significant association between socio-demographic variables and
Level of self-esteem of physically challenged adults.
7.0. MATERIALS AND METHODS
7.1. SOURCES OF DATA:
Adults between age group of 19-60 years in selected rehabilitation centers at
Bangalore.
7.2. METHOD OF DATA COLLECTION :
Research method: Descriptive study.
Research design: Cross Descriptive design.
Sampling Techniques: Convenient sampling Technique.
Sample size: 100samples.
Setting of the study: The study will be conducted at Rehabilitation
Centers at Bangalore.
15 7.2.1. SAMPLING CRITERIA
1. Adults with physically challenged between ages of 19-60 years.
2. Those are willing to participate in the study.
3. Those who know Kannada and English.
7.2.2. DATA COLLECTION
Structured interview questionnaire will be prepared to assess the level of self- esteem among physically challenged adults. The content validity of the tool will be obtained in consultation with guide and experts from various disciplines.
7.2.3. DATA ANALYSIS METHOD
Data analysis can be done by descriptive methods such as frequency distribution, percentage, mean and standard deviation and inferential statistics such as chi-square.
16 7.3. DOES THE STUDY REQUIRE ANY
INVESTIGATIONS OR INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR OTHER HUMAN OR
ANIMALS?
No. Only a structured interview questionnaire on the level of self-esteem among physically challenged adults will be used for data collection. No other invasive physical/laboratory procedures will be conducted on the subjects.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED?
Yes. A written permission will be obtained from the institution authority.
Verbal consent will be obtained from the subjects before conducting the study.
Confidentiality and anonymity of the subjects will be maintained throughout the study.
17 8. BIBLIOGRAPHY
Book reference:
1. Bimla Kapoor; Psychiatric Nursing; (2008); Volume-2; Kumar Publishing
House; 308 – 14 p.p.
2. Frisch and Frisch; Psychiatric Mental Health Nursing; Second Edition; Delmar
Publications; 87 – 162 p.p
3. . Fortinnash. Holoday- Worret; Psychiatric Mental Health Nursing; (1999);
Mosby Publications; 162 – 66, 688 p.p.
4. Gail W. Stuart, Michele T. Laraia; Principles and Practice of Psychiatric
Nursing; 8th Edition; Elsevier Publications; 305-09 p.p.
5. Haber, et al.; Comprehensive Psychiatric Nursing; 4th Edition; Mosby
Publications; 31 – 33, 35, 112, 290, p.p.
6. Keltner, Schwecke, Bastron; Psychiatric Nursing; 5th Edition; Mosby
Publications; 502 – 04 p.p.
7. Mary Ann Boyd; Psychiatric Nursing: Contemporary Practice; 2nd Edition;
Lippincott Publications; 323-27,989 p.p.
8. Rob Newell, Kevin Cournay; Mental Health Nursing: An Evidence- Based
Approach; Churchill Livingstone Publications; 174-75, 270-71, 328 p.p.
9. Stuart, Laria; Principles and Practice of Psychiatric Nursing; 7th Edition;
Mosby Publications; 232, 319-20, 22, 24.p.p.
10. Sheila L. Videbeck; Psychiatric Mental Health Nursing; 3rd Edition; Lippincott
Williams and Wilkins Publications; 213 p.p.
18 Website Address:
1. www.disabilitycanhappen.org
2. www.coping.org/groth/12k
3. www.scientific journals org/journals 2007/articles/1070.htm.
4. www.cye-net. Org/features/ft.confident parents.html.
5. www.womenabuse prevention.com/html/emotional-abuse-literature-rev.html.
6. www.4 to40.com/parenting/index.asp? Id=68.
7. www.cdb.utexas.edu/borich/pdfdocs/chapter3.pdf.
8. www.papillonsart palace.com/ex splodin.htm.
9. www.the awareness center.org/physically challenged.html.
10. www.advocatesforyouth.org/publications/frtp/challenged youth.htm.
11. www.archaz.org/kips.htm/10k.
12. www.psychology.wikia.com/wiki/self-worth-91k.
19 9 SIGNATURE OF CANDIDATE
10 REMARKS OF THE GUIDE
11 NAME AND DESIGNATION
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
11.6 SIGNATURE
12 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
20 21