<p> “ AN EXPERMENTAL STUDY TO DETERMINE THE EFFECTIVENESS OF</p><p>GUIDED IMAGARY TECHNIQUE ON STRESS AMONG THE OLD AGE</p><p>PEOPLE AT SELECTED HOSPITAL IN BIDAR (dt), KARNATAKA.”</p><p>SUBMITTED BY</p><p>D. ROHINI</p><p>M.sc., NURSING 1st YEAR</p><p>GUIDE</p><p>Mrs. SUGANDHI.JEEVANADAM,</p><p>DEPT. OF MEDICAL SURGICAL NURSING ,</p><p>AKKA MAHADEVI COLLEGE OF NURSING,</p><p>BIDAR, KARNATAKA.</p><p>A PROJECT SUBMITTED AS A PART OF PRACTICAL EXPERIENCE IN AKKA MAHA DEVI COLLEGE OF NURSING, BIDAR, KARNATAKA,2010. 1 SL.NO INDEX PAGE NO.</p><p>1. NEED FOR THE STUDY</p><p>REVIEW OF THE LITERATURE 2.</p><p>STATEMENT OF THE PROBLEM 3.</p><p>OPERATIONAL DEFINITIONS 4.</p><p> o Effectiveness</p><p> o Guided Imagery Techique</p><p> o Strees</p><p> o Oldage</p><p>MATERIALS AND METHODS</p><p>5. o Source of data</p><p> o Inclusive and exclusive criteria</p><p>2 o Research design</p><p> o Setting of the study</p><p> o Sampling technique</p><p> o Variables</p><p> o Sample size</p><p>TOOLS 6. METHODS OF DATA COLLECTION 7. LIST OF REFERENCES</p><p>8.</p><p>3 ” AN EXPERIMENTAL STUDY TO DETERMINE THE EFFECTIVENESS OF</p><p>GUIDED IMAGERY TECHNIQUE ON STRESS AMONG THE OLD AGE</p><p>PEOPLE AT SELECTED HOSPITAL IN BIDAR , KARNATAKA”.</p><p>REASEARCH GUIDE PRINCIPAL</p><p>Mrs. SUGANDHI.JEEVANADAM, Mrs. AMEENA BEGAM</p><p>DEPT. OF MEDICAL SURGICAL NURSING, DEPT. OF CHILD HEALTH NURSING </p><p>AKKA MAHA DEVI COLLEGE OF NURSING, AKKA MAHA DEVI</p><p>BIDAR, KARNATAKA. COLLEGE OF NURSING,</p><p>BIDAR, KARNATAKA.</p><p>SIGNATURE SIGNATURE</p><p>A PROJECT SUBMITTED AS A PART OF PRACTICAL EXPERINCE IN AKKA </p><p>MAHA DEVI COLLEGE OF NURSING, BIDAR, KARNATAKA, 2010.</p><p>4 Brief resume of the intended work</p><p>Need for the study</p><p>“Men grow old, pearls grow yellow, there is no cure for it” (Chinese proverb). </p><p>Aging, the normal process of the related change, begins with birth and continues throughout life. Old age is the final phase of the life span.3</p><p>Ageing is an inevitable developmental phenomenon bringing along a number of changes in the physical, hormonal and the social condition. Ayurveda termed old age as</p><p>“Vardhakya” witch begins from the age sixty. In old age, the need for economic, health and emotional wellbeing assume special significance because of gradual reduction in abilities. 19</p><p>“We are aging- not just as individuals or communities but also as a world”. In the year</p><p>2004 it was accounted that old age population is 236/10000 in the world (WHO). In</p><p>2006, almost 500 million people worldwide were 65 and older. By 2030, that total is projected to increase one billion, (National Institute of Aging, U.S.A) accounting</p><p>13percent of the total population. Between 2006 and 2030, the number of older people in less developed countries is projected to increase by 140 percent as compared to an increase of 51 percent in more developed countries .2</p><p>5 The number of persons over age 65 in the united states is increasing dramatically.</p><p>The elderly population at million in 1990,is predected to be at 39million in2010 and at 66 million by 2050.Accounting for 4% of population in 1900,the percentage of elderly will increase 23% by the year 2030.The largest growth is occurring among those over the age of 85 years.3</p><p>In 2004 old age population in India contributes 1/20 in the total population. In the year 2002 there were more than 81 million elderly in India and this figure is expected to go up to over 324 million in the year 2050. In other words, elderly constituted 8 % of the total population in 2002 but would be a staggering 21 % of the total population in 2050(VHAI). According to our parliament discussion (5.12.2007),</p><p>India’s population of senior –citizens-above-60-would reaches 173 million by 2026.</p><p>(India world News) 4</p><p>Percentage of 60+ years of population will gradually increase, except in Assam where it will come down from 5.2% to 4.0% in 2016. Kerala and Tamilnadu will have more than 13 % of their population in the age group of 60+ years by 2016 (VHAI</p><p>Report).1</p><p>6 Now a days elderly people are having so many health problems those are heart disease, diabetes mellitus ,cataract, arthritis, osteoporosis, Alzheimer’s disease, asthma, endothelial dysfunction, psychological problems like stress, depression, delirium, dementia. Among all the health problems stress and depression are the major health problems among oldage.22 </p><p>WHO report of 2004 states that 236 elderly people per ten thousand population suffer from mental illness mainly due to stress, heart disease, stroke and cancer.6</p><p>Community study of depression in old age at Taiwan denoted that one-month prevalence of psychiatric disorders was 37.7 %, with 15.3 % depressive neurosis and</p><p>5.9 % major depression.10</p><p>Health status of elderly in developing countries projected that by 2020 three – quarters of all deaths could be ageing-related. Over 10% of India’s elderly suffer from depression (VHAI Report). Mental health concerns of the elderly include depression, delirium and dementia. Magnitudes of health problems among old age clients are high.4</p><p>7</p><p>The oldage problems are treated with pharmacological therapy, exercizes, yoga, meditation, music therapy, guided imagery technique. Among all these treatment modalities guided imagery is the one of the effective technique to manage the stress.14</p><p>Researchers at Ohio state university (2006) in Colombus, found that people with cancer who used imagery while receiving chemotherapy felt more relaxed and reduced stress, better prepared for their treatment and more positive about care than those who did not use the technique. Guided Imagery is proven relaxation techniques spoken by stress management expert.11</p><p>Joel Levey (2005). He state that technique helps in, relax people mind and body naturally and Learn effective ways to deal with stress.7</p><p>Dalai Lama (2004) of Tibet state that as more people achieve some degree of the mental calm, insight or the ability to transform negative emotions into positive ones, there will be a natural reinforcement of basic human values and consequently a greater chance for peace and happiness for all. That is through Guided Imagery.22</p><p>8 The investigator found that guided imagery technique is said to be one of the effective measure in relieving stress , depression , pain etc. Hence, the investigater aroused an select to conduct the study. The stress among the oldage people. </p><p>Review of literature</p><p>The investigator is doing the extensive review of literature to obtain comprehensive knowledge base and in depth information about Guided Imagery</p><p>Technique on stress among the old age people. The review of literature were presented under the following headings,</p><p> a. Review related to stress and old age people</p><p> b. Review related to Guided imagery technique</p><p>A.Review related to stress and old age</p><p>Elsa sanatombi Devi(2007) a study was conducted to determine the perceived depressive feeling experienced by elderly client above the age of 60 years. This study was adopted for the in order to identify the subjective depressive feeling from the 100 clients from udhyavara village. By using of non probability convenior sampling technique and by using of demographic, socio economic status scale. The individual</p><p>9 scoring mild stress( 0-10), moderate stress( 11-21), severe depression(22-32). The result of this study, majority of perceived depressive feeling experienced by 50% of elderly clients ( between the age group of 60-69 years). Out of 100 elderly clients 16 were hypertensive people.19</p><p>Rao (1996) conducted a study to determine the relationship between age distribution and depression. total 500 cases were examined in a series using the standered psychiatric examination and routine auxillary investigation. It was found that majority of instances of first in the age group between 41 and 60 years . total prevalence depression in individual over 65 years was 26%.18</p><p>Edwared and chapman(2004) conducted a study to determine the importance of promotion of wellness among older adults and depressive subjective feeling of elderly client. He has taken 100 samples and using prom well model. He shows that 23 had mild depression , 58 had moderate depression and 19 clients had severe depression.21</p><p>R. Sreevani (2007) a study was conducted about emotional problems among elderly people. She has selected 50 elderly people , by using of questionare and demographic data sheet, she shows that 60-70years elders are having 54% of emotional</p><p>10 problems, 71-80 years elders are having 32% of emotional problems, 80 years elders ae having 14% of emotional problems.15</p><p>Dr. Arvind kasthuri (2007) wrote about the travails of a greying nation. In this article mentioned that India is an example of a developing country, which lacks organized services for the elderly in the health, social or economic sectors. The health services available for the elderly in India are generally contained within the health services for the general population, without any special or specific initiatives for this group. It is estimated that 45% of the elderly have chronic diseases and disabilities. One among this disease is depression. So, specialized geriatric care is necessary.14</p><p>The journal named “Health Action” (2007) published a cover story on “Common geriatric problems”. In this article clearly stated that one problem as stress. Common sources of stress for the elderly included, change of life style and financial status after retirement, caring for grand children, caring for a sick spouse, death of relatives, beloved or close friends, deterioration of physical abilities and chronic illness, worries for not being able to live independently and worries for institutionalization. Management for this stress includes, share their difficulties and feelings, an active social life, healthy life style and relaxation exercises are all useful ways to handle stress, engaging in volunteer work is a means to help those who are less fortunate, positive thinking and can seek professional’s help.24</p><p>11 Mental health disorders are a major problems and threat to older adults and their families.</p><p>It is estimated that as many as 15%-20% of elderly have a mental or psychiatric disorders that is significant enough to require evaluation and treatement.8</p><p>This part of review emphasize how important to manage old age problems, especially stress. As per various experts suggestion some technique to be applied to resolve stress.</p><p>B. Review related to guided imagery technique</p><p>Paula Ford – Martin (2004) defined Guided Imagery is the use of relaxation and mental visualization to improve mood and / or physical wellbeing. He states that some therapist also uses Guided Imagery in-group settings. It is a two-part process. The first component involves reaching a state of deep relaxation through breathing and muscle relaxation techniques. The second component of the exercise is imagery or visualization.23</p><p>12 Cincinnati Children’s Hospital Medical Center (2004) Investigators at conducted a study concludes that imagery was affecting to reduce post-operative pain following tonsillectomy and /or adenoidectomy. Anxiety also was measured using the state trait anxiety inventory for children MANCOVA showed lower anxiety in the treatment group.16</p><p>University of South Florida (2003) in Tampa, researchers asked 19 men and women, ages 56 to 75, who had chronic bronchitis and emphysema to rate their levels of anxiety, depression, fatigue and discomfort before and after they began using imagery. The researchers concluded that imagery significantly improved the overall quality of these people’s lives.24</p><p>Haplin Lind et al., (2002) stated that in the clinical research it is demonstrated that</p><p>Guided Imagery is a simple form of relaxation could reduce pre- operative anxiety and postoperative pain among surgical patients (As cited by Sangeeta Bhujbal, 2005).17 </p><p>13 Cynthia (2000) stated that Imagery had been found to be very effective for the treatment of stress. Imagery is at the center of relaxation techniques designed to release brain chemicals that acts as your body’s natural brain tranquilizers, lowering blood pressure, heart rate and anxiety levels. By and large, researchers find that these techniques work.</p><p>Because imagery relaxes the body, doctor specializing in imagery often recommend it for stress – related conditions such as head ache, chronic pain in the neck and back, high blood pressure, spastic colon and cramping from premenstrual syndrome. 25</p><p>Chellammal. P. (2000) conducted a study among surgical patients regarding the effectiveness of muscle relaxation exercises in reduction of pain and anxiety. In this she had stated in her review one of the methods to relieve anxiety is imagery. Imagine can be begun with several minutes of relaxation exercises, then the patient been instructed to imagine himself in a calm tranquil place. Example, a spot where he / she feels comfortable and safe such as favourite room in his home or imagine that, he is on the beech seeing the sky, smelling the ocean, hearing the waves and crashing on the shore. 17</p><p>14 The journal of invasive cardiology (1999), article emphasized the many uses of Guided</p><p>Imagery in health care. It discusses how it can significantly reduce stress, pain, and side effects of treatments, blood pressure, headaches and strength immune functioning.30</p><p>Rollin Mc Craty (1999) from California conducted studies across diverse populations have associated the use of Guided Imagery techniques that increase psycho physiological coherence with a range of favorable outcomes, including reduced anxiety and depression, enhanced cognitive performance, reduced physical stress symptoms and reduced cortisol.</p><p>Additionally, practice of these interventions has been associated with reduced depression and improved functional capacity in patients with congestive heart failure. 24</p><p>Levey (1998) from California the cardiac team implemented a Guided Imagery programme to compare cardiac surgical outcome between two groups of patients. A questionnaire was developed to assess the benefits of Guided Imagery programme. These who are willing to take participate in the study were administered the questionnaire.</p><p>Overall Guided Imagery was considered a complementary means to reduce anxiety, pain and length of stay among cardio surgery patients.26</p><p>This part of the review states that the effectiveness of guided imagery technique. </p><p>15 Statement of the problem :</p><p>An experimental study to determine the effectiveness of guided imagery technique on stress among the old age people at selected hospital at Bidar , Karnataka.</p><p>Objectives of the study:</p><p> To assess the level of stress among the old age people</p><p> To determine the effectiveness of Guided Imagery Technique on stress among old</p><p> age people. </p><p> To associate the level of stress among the the old age people with their selected</p><p> demographic variables. (Age, Sex, Previously stayed place, Religion).</p><p>Hypothesis</p><p>H1: There will be significant reduction in the level of stress among the old age people after administration of Guided Imagery Technique.</p><p>H2: There will be significant association between the level of stress among the old age people and selected demographic variables</p><p>16 Operational definitions</p><p>1. Effectiveness</p><p>It refers to the significant reduction of stress level as determined by the differences between pre test and post test stress scores.</p><p>2. Guided imagery technique</p><p>In this study it refers to the use of relaxation and mental visualization technique to improve mood and/or physical well-being. Guided Imagery Technique is two-part process. The first component involves developing a state of deep relaxation through breathing exercise and muscle relaxation technique. The second component of the exercise is imagery or visualization itself. This specific technique is known as relaxation imagery used in this study.</p><p>]</p><p>3. Stress</p><p>Refers to the verbal responses of old age in the rating scale ranging “mild stress” to “severe stress” in relation to the factors such as physical, anticipatory, psychological,</p><p>17 socio-economic and environmental factors. Stress will be measured in terms of stress scores. </p><p>4. Old age</p><p>Refers to the clients who are admitted in the selected hospital between the age group of</p><p>60-70 years. </p><p>Delimitations </p><p>1. The study will be delimited to the selected hospital .</p><p>2. The sample size is limited to only 60 subjects (30 in experimental and 30 in control group).</p><p>3. The study period is limited to only 4 weeks </p><p>Assumption </p><p> Information provided by the selected hospital would represent their true stress.</p><p> Level of stress varies from individual to individual.</p><p>18  The subject who receives Guided Imagery Technique will experience reduction in</p><p> the stress.</p><p> Guided Imagery Technique helps to improve the relaxation of old age people.</p><p>Meterials and methods</p><p>Sources of data : People who are admitted in the selected hospital Bidar (dt), Karnataka.</p><p>Inclusive criteria:</p><p>The old age people who are</p><p> a) Admitted in the selected hospitals </p><p> b) Willing to participate.</p><p> c) Between the age group of 60-70 years. </p><p> d) Able to understand English, Kanada. </p><p> e) With normal cognitive function. (Those who scored more than 20 in MMSE)</p><p>Exclusive criteria:</p><p>People who are </p><p> a) seriously ill during the period of data collection </p><p>19 b) Are previously exposed to Guided Imagery Technique.</p><p> c) Not willing to participate</p><p>Research design</p><p>The research design that was chosen for this study was true experimental design.</p><p>Bidar {dt.}, Karnataka. The design can be represented as,</p><p>Group Pretest Intervention posttest</p><p>Experimental o1 x o2</p><p>Control o1 - o2</p><p>Setting of the study:</p><p>The study will be conducted in selected hospital of Bidar , Karnataka. The hospital will</p><p> be 500 beded hospital , rationale for selection of this setting is availability of adequate sample, familiarity, cooperation, feasibility of conducting the study. </p><p>Sampling technique</p><p>The technique that was adopted for this study was simple random sampling </p><p>Technique will be used.</p><p>20 Variables under study:</p><p>Independent variable : Guided Imagery Technique</p><p>Dependent Variable : Level of stress among the old age people .</p><p>Sample size</p><p>The sample size of this study will be 60, who are admitted in the selected hospital of </p><p>Bidar (dt), Karnataka. (Among them 30 subjects will be under the experimental group and the other 30 will be under the control group).</p><p>Tool for the study:</p><p>The tool for the study are as fallows</p><p>Section A - Tool to assess the demographic information of the samples.</p><p>Section B - Tool to assess the cognitive function ( Standardized Mini Mental Status</p><p>Examination)</p><p>This instrument included orientation, registration, attention and calculation, recall, language and construction ability of the client. This was used for sample selection. </p><p>Section C - Rating scale to assess the level of stress (Structured interview schedule)</p><p>21 This rating scale consists of 50 items in the areas of Physical, Anticipatory,</p><p>Psychological, Socio-Economic and Environmental factors. This scale was used for the pre test and post test. </p><p>The tools were translated in English for the convenience of data collection.</p><p>Method of data analysis and presentation:</p><p>The investigator will analyze the data obtained by using descriptive and inferential statistics. The plan of data analysis will be as follows.</p><p>Descriptive statistics :</p><p> Organize the data in a master sheet</p><p> Frequency and percentage distribution of demographic variables for the analysis </p><p> of background study.</p><p> Mean, median, standard deviation to assess stress in pre test and post test.</p><p> t’ values to determine the effectiveness of guided imagery technique.</p><p> Chi sqare to determine association between the level of stress and selected </p><p> demographic variables</p><p>THE DOES STUDY REQUIRES ANY INVESTIGATION (OINTERVENTION </p><p>TO BE CONDUCTED ON THE PATIENTS (OR) OTHER HUMAN BENIGS </p><p>(OR) ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY,</p><p>22 Yes, the study will be conducted on patient’s who are admitted in the hospital in Bidar</p><p>(dt), Karnataka. Guided imagery technique will be administered to reduce the level of stress among the oldage.</p><p>HAS ETHICAL CLARENCE BEN OBTAINED FROM YOUR INSTITUTION IN</p><p>CASE IF THE STUDY REQUIRES INVESTIGATION TO BE CONDUCTED ON</p><p>PATIENT’S (OR) OTHER HUMAN BEINGS.</p><p>Yes, informed cosent will be obtained from the selected hospital authorities and subjects.</p><p>Privacy, confidenciality and anonymity will be guarded scientific objectivity of the study will be maintained with honesty and impartiality.</p><p>23 List of references</p><p>.</p><p>1. Better care of Elderly. VHAI, New Delhi: The Independent Commission on</p><p>Development and Health in India, 2002.</p><p>2. Birren & Renner, Community Mental Health Nursing. Bangalore: NIMHANS,</p><p>2002. </p><p>3. Brunner and siddarth’s “Text book of Medical and Surgical Nursing”, 10th</p><p> edition, Lippincott Williams and Wikkins, 2004.</p><p>4. Care of the Elderly. VHAI, New Delhi: The Independent Commission on</p><p>Development and Health in India, 2002.</p><p>5. Charlotte Elipoulos, Gerontological Nursing (2nd ed.). Philadelphia: Lippincott,</p><p>1987.</p><p>6. Chowdhry Paul, D., Aging and the aged. New Delhi: Neelkamal, 1992.</p><p>7. Dhillon, P.K., Psycho-social aspects of Ageing in India. New Delhi: Concept,</p><p>1992.</p><p>8. Joyce M. Black “Text book of Medical Surgical Nursing”, 7th edition , Vol: 1,</p><p>Elsevier publication, 2007</p><p>9. Lalitha, K., Mental Health and Psychiatric Nursing (1st ed.). Bangalore: Gajana</p><p>Book, 2000.</p><p>10 Stanhope, Community Health Nursing (4th edition) Philadelphia,Mosby.1990. </p><p>11. Alison Timerney, J. Can nurses help identify patients with Depression. Journal</p><p>Of Advanced Nursing .2007. </p><p>24 12. Antall, G. F. The use of guided imagery to manage pain an elderly.</p><p>Orthopaedic Nursing, 2004.</p><p>13. Arvind Kasthuri, Travails of a Graying Nation. Health Action, June 2007.</p><p>14 Basarakar, Geriatric Health Care. Health Action, June 2007.</p><p>15. Ball, T. M. use of guided imagery for the treatement of children. Clinical</p><p>Paedrics, 2003.</p><p>16. Carol Bairds, L. Effectiveness of guided imagery with progressive muscle</p><p> relaxation to reduce the pain. Pain Management Nursing , 2004.</p><p>17. Rao , Journal of Nursing India, 2007.</p><p>18 Elsa Sanatombi Devi, Nursing Journal of India, 2007</p><p>Secondary sources</p><p>19 www.indiatigether. Org/2 008/mar/soc-oldage.hmtl.</p><p>20 www.ageing .oxfordjournal.org/cgi/content/abstract.</p><p>21 www.aurvedictalk.com/ayurveda-approch</p><p>22 www.guidedimagery inc.com/g research.html.</p><p>23 www.holisticonline.com/guided -imagery.html.</p><p>24 www. medscape.com</p><p>25 www.nejm.org/abstact</p><p>26 www.mindtool.com/smpage.</p><p>SIGNATURE OF THE CANDIDATE :</p><p>REMARKS OF THE GUIDE :</p><p>25 NAME AND DESIGNATION OF GUIDE :</p><p>Mrs. SUGANDHI .JEEVANANDAM SIGNATURE</p><p>M.sc., (N) MEDICAL & SURGICAL NURSING .</p><p>CO- GUIDE SIGNATURE</p><p>HEAD OF THE DEPARTMENT : SIGNATURE</p><p>REMARK OF THE CHAIRMAN : SIGNATURE</p><p>The topic selected is relevant as there is a </p><p>Need to evaluate the effectiveness of guided</p><p>Imagery technique among the old age people to decrease the level of stress.</p><p>REMARKS OF THE PRINCIPAL : SIGNATURE</p><p>AN EXPERMENTAL STUDY TO DETERMINE TH EFFECTIVENESOF </p><p>GUIDED IMAGERY TECHNIQUE ON STRESS AMONG THE OLD </p><p>26 AGE PEOPLE AT SELECTED HOSPITAL IN BIDAR(dt) , </p><p>KARNATAKA .</p><p>SYNOPSIS SUBMITTED BY</p><p>D . ROHINI</p><p>1st YEAR M . Sc., NURSING</p><p>.</p><p>SUBMITTED TO</p><p>RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES , BANGALOOR ,</p><p>KARNATAKA.</p><p>IN THE PARTIAL FULFILLMENT OF THE REQUIREMENT FOR THE </p><p>DEGREE OF Msc.NURSING MEDICAL SURGICAL NURSING</p><p>UNDER THE GUIDENCE OF</p><p>Mrs. SUGANDHI . JEEVANANDAM, Dept OF MEDICAL SURGICAL NURSING</p><p>AKKA MAHA DEVI COLLEGE OF NURSING , BIDAR , KARNATAKA .</p><p>27</p>