RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA,
BANGALORE
ANNEXURE-11
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / Nam Name of the candidate andAddr Address
(in b / LID LIDIYA ELIZABETH JOSEPH
M.Sc M.Sc. NURSING 2010 BATCH
ST.J St.JOHN’S COLLEGE OF NURSING
2 / Nam Name of the Institution / COL St.JOHN’S COLLEGE OF NURSING
St.
3 / Cou Course of study
Subj Subject / M.Sc MASTER OF SCIENCE ( NURSING )
MED MEDICAL SURGICAL NURSING
4 / Date Dateof admission to course / 3 -5-2 03-05-2010
5 / Title Title of the topic
EFFECTIVENESS OF YOGA NIDRA ON THE PHYSIOLOGICAL
P PARAMETERS AMONG THE HYPERTENSIVE PATIENTS.
6 Brief Resume Of Intended Work
6.1 Need For Study
In the modern scenario, human life is becoming hectic and demanding that leads to stress. Stress has been attributed as the modifiable risk factor of many of the chronic illness. Hypertension is one of the important chronic illness, a leading causes of death as well as morbidity in most developing countries and also in India. According to WHO 2007 report, the prevalence of hypertension in developing countries seem to be similar to that in European or other technically developed societies. In Framingham Heart study, hypertension contributed a large portion of heart failure cases, particularly in women. Coronary diseases and hypertension are responsible for the largest proportion of new heart failure cases in population.1
Hypertension is one of the most prevalent vascular diseases in the world and poses majorpublichealthproblem.ThejointNationalCommitteeforprevention,detection, evaluation,treatment of hypertension (JNC-V) estimates that hypertension is responsible for more than 50 million coronary attacks every year. Hypertension is a major public health problem in India .The prevalence of hypertension was 59.9 and 69.9 per 1000 in males and females respectively in the urban population and rural population and 35.5 and 35.9 per 1000 in males and females respectively in the rural population.2
High blood pressure is one of the chronic illness which is a major risk factor for stroke, CHD, heart or kidney failure. Hypertension is a disease which has a lot of complications on the major organs. These complications can be prevented by control of blood pressure. Epidemiological studies carried out in India, reveals that there would be approximately 50 million cases of hypertension in India with a prevalence of 2.3 percent.3
Though hypertension is a major cause of heart failure, stroke and kidney failure, yet it is called the ‘silent killer’ because the person who has it is often symptom free. Many individuals with hypertension do not know that they have it. Prevention and control of high blood pressure represents a major challenge to our acute care oriented health care system.3 keeping in view the most important function of a nurse is health promotion, nurses must adopt strategies to promote and maintain health of the people and also help in preventing illness. Prevention is always better than cure.
The report of the WHO expert committee for hypertension and Joint National committee on prevention ,detection, evaluation and treatment of high blood pressure recommends that non pharmacological treatments as the first measure in the control of hypertension.5
Life style modifications like daily exercises, walking, practicing regular exercise programs, relaxation techniques like progressive muscle relaxation, yoga and its various asanas had been proved to have a positive effect on hypertension and all patients must continue to follow non pharmacological therapy even if they are on medications..5
In today’s health care delivery system, under National Health Policy, AYUSH has gained lot of importance.Yoga is one of the system of medicine under AYUSH. Among the non pharmacological measures there are lot of studies which proved that Yoga Nidra has positive effects on hypertension .Yoga nidra is a relaxation technique which provides relaxation to body and mind. Yoga nidra is a meditation as well as relaxation practice which was first discovered by Swami Satyananda Saraswathy. Through the practice of yoga nidra one can achieve true relaxation .Yoga nidra induces deep physical, emotional and mental relaxation by training the mind to remain calm. In the present scenario, where the stress related chronic illness, especially stress related hypertension are on the rise, the technique of yoga nidra may serve as a real boon for mankind. Stress being one of the modifiable risk factor for hypertension, measures to reduce stress would be appropriate to reduce the incidence of hypertension. Therefore the researcher is interested to study the effect of Yoga nidra on physiological parameters of hypertensive clients.
6.2 Review Of Literature
Review of literature is a key step in the research process .It refers to an extensive and a systematic examination of literature relevant to research study to generate data what is known and not known about a particular situation and to provide in depth of knowledge base needed to study the selected problem. An attempt made by the researcher to review research literature to the present study and literature review is organized and presented under the following headings.
Section -1»The incidence and the prevalence of hypertension and its
complications
Section-2»Effectivenessofdifferentrelaxationtechniqueson hypertension
Section-1: The incidence and the prevalence of hypertension and its complications.
The Prevalence of hypertension in developing countries seems to be similar to that in European countries or other technically developed societies ranging from 10 percent to as much as 20 percent among adults. Hypertension can be termed as one of the “ice berg”diseases. The submerged portion of the ice berg represents the hidden mass of the diseases while floating tip denotes the clinical signs and symptoms. The prevalence of hypertension in India was 59.9 and 69.9 per 1000 in males and females respectively in the urban population, and 35.5 and 35.9 per 1000 in males and females respectively in rural population. High blood pressure is a major risk factor for stroke, CHD, heart or kidney failure. The higher the pressure the greater the risk and lower the expectancy of life.Mortality rates from hypertension are also misleading, as hypertension is a grossly under reported factor in cardio vascular mortality.1
A study was conducted in Shimla about the awareness of hypertension among North Indian population. A mass screening of 7630 people living at high altitude town was done by simple random sampling for blood pressure measurement. Hypertension was detected in 2535 cases .Of these,559 (22.05%) were aware of their hypertensive status and 1976 were unaware. The level of awareness in hypertensive was 12.32% in less than 35 years of age group;22.42%in 35-49 years age group and rose to 27.09% in >50 years individuals.24
A meta analysis study was conducted in Jaipur about the prevalence of hypertension in India. The comparative study among urban areas (n=10) shows significant increase in the prevalence of hypertension (p=0.014).Studies in rural areas (n=14) also show an increase in prevalence of hypertension although the rise is not steep as in urban population (p=0.097). In India hypertension is emerging as a major health problem and is more in urban than in rural population.22
A study was conducted in Hyderabad to assess the knowledge and learning needs of clients with hypertension regarding their disease condition .It was done in two institutions of Hyderabad. Mean score percentage was obtained by the hypertensive clients using a knowledge assessment questionnaire. Sixty two percent of the clients were suffering from hypertension for 1 to 6 years and 86% had a systolic pressure up to 160mmof Hg and diastolic pressure up to 140 mm of Hg .The result showed that there was an inadequate knowledge among the study population.7
A study was conducted in Italy to assess the effect of aging on blood pressure changes. It was a prospective cohort study, 144 nuns belonging to a secluded monastic order and 138 control laywomen were followed for 20 years to investigate whether living for a long time in a stress free environment influences the effect of aging on blood pressure. Family history of hypertension was not similar between the two groups. Parity affected the increase of systolic, but not of diastolic, blood pressure with age among the laywomen, but nuns and no-childbirth controls maintained a significantly different blood pressure. The study suggested that the increase in blood pressure in women over 20 years may be avoided by living in stress free environment.23
Community based prospective cohort study was conducted in USA showed the residual life time risks of developing hypertension and stage -1 high blood pressure were 90% in both 55 and 65 yrs old study participants . The risk of hypertension is remaining unchanged for women, but it was approximately 60% higher for men. In contrast, the residual life time risk for stage -2 high BP was considerably lower in both sexes in recent period 23
Section -2 Effects of different relaxation techniques on hypertension
The person’s life style has substantial influence on both on the disease occurrence and the course and the outcome of a disease. Rapid changes taking place in peoples lives in addition to behavioral modifications favor the onset of chronic diseases.5
An experimental study conducted in Hyderabad regarding the effect of Yoga nidra on stress among the nursing students .The sample consisted of 40 subjects in the experimental group and 40 subjects in the control group. Sampling technique used was simple random technique. Yoga nidra was given to experimental group and after one week post-test was administered to both the groups. Those who practice yoga nidra showed significantly less stress than those nursing students who did not practice yoga nidra p(0.05).13
An experimental study was conducted in Mumbai regarding the effect of relaxation exercises on hypertensive patients .Sample consisted of 50 subjects assessed by interview schedule to obtain data regarding demographic profile and their view on relaxation exercise. The subjects reported that stress was a contributory factor to the origin of hypertension. Physiological parameters observation record showed that a significant decrease in systolic and diastolic blood pressure immediately after the exercise as well as after fifteen days of regular relaxation exercise. In the study group the decrease is significant at <0.01level where as in control group there was no significant decrease in systolic and diastolic blood pressures even after fifteen days. The findings in this study suggest that a relaxation exercises have a positive effect in reducing blood pressures among hypertensive patients.15
A study was conducted in Mumbai, to assess the effect of yoga on the physiological, psychological, psychomotor and modifying cardiovascular risk factors in mild to moderate hypertensive patients. Twenty patients in the age group of 35-55 yrs with mild to moderate essential hypertension underwent yogic practices daily for one hour for three months. The results of the study showed significant decrease in blood pressure among the experimental group..18
A study was conducted in Pondicherry about the modulation of stress induced by isometric hand grip test in hypertensive patients following yogic relaxation training. 13 essential hypertensive patients aged 41-60 patients were given yoga training for 60 min daily, Monday to Saturday for a total duration of 4 weeks. The results showed a significant reduction (p<0.001) in resting heart rate.
After two weeks of yoga training, systolic pressure, diastolic pressure (P<0.001) and mean pressure (P<0.05) showed a significant reduction at 3 weeks of training period.17
A study was conducted in Mumbai,to assess the effect of yogic practices on subject healthy wellbeing .Forty eight healthy volunteers who participated in the practice of yoga over a period of four months were assessed on subjective wellbeing inventory before and after the course in order to evaluate the effect of practice of yoga on subjective feelings of wellbeing and quality of life .A significant improvement in 9 0f 11 factors of subjects was observed at the end of 4 months in these participants. A significant improvement on ‘General Well being’ was observed suggesting that the participants felt that they were happy and their life was interesting.19
6.3Problem Statement
An experimental study to assess the effectiveness of yoga nidra on the physiological parameters among the hypertensive patients admitted in medical wards of a selected hospital, Bangalore.
6.4 Objectives Of The Study
1. To assess the physiological parameters among the hypertensive patients before and after Yoga nidra in the experimental group.
2. To assess the physiological parameters among the hypertensive patients in the control group.
3. To compare the physiological parameters between the experimental and the control group.
4. To determine the association of physiological parameters with the selected baseline variables in both the experimental and the control group.
6.5 Operational Definitions
Effectiveness
Effectiveness is the ability to produce a specific result or to exert a specific measurable influence.9
In this study it refers to the power of yoga nidra as a relaxation therapy to bring about significant change in physiological parameters like blood pressure, pulse and respiration among the hypertensive patients.
Yoga nidra
It is a systematic method of inducing physical, mental, and emotional relaxation.13
In this study it refers to an audio tape guided systematic method of inducing physical, mental and emotional relaxation to hypertensive patients which will be administered by the investigator by placing an earphone to the patient’s ear for a period of 15 minutes.This intervention will be administered to every patients for 3 consecutive days.
Hypertensive Patients.
In adults, hypertension is defined as when systolic blood pressure is equal to or greater than 140 mm Hg or diastolic blood pressure is equal to or greater than 90 mm Hg for extended periods of time. 5
In this study it refers to the patients admitted in medical wards with systolicblood pressure ≥140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or patients diagnosed as hypertensive and on anti hypertensive treatment.
Physiological Parameters
In this study it refers to the blood pressure, pulse, respiration of patients which will be assessed by the investigator before and after the administration of Yoga nidra.
Selected Baseline Variables
In this study it refers to age, gender, occupation, family history, duration of illness, medication, co morbidity, practice of a regular exercise program,hypertensive drugs,habits like smoking, alcoholism, and substance abuse.