RAJIV GANDHI UNIVESITY OF HEALTH SCIENCES BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION.
1. / NAME OF THE CANDIDATE AND ADDRESS. / Mr. JUSTIN MATHEWI YEAR M.Sc.NURSING
RAJEEV COLLEGE OFNURSING,
K.R .PURAM.HASSAN
2. / NAME OF THE INSTITUTION. / RAJEEV COLLEGE OFNURSING,
K.R .PURAM.HASSAN
3. / COURSE OF STUDY AND SUBJECT. / I YEAR M.Sc. NURSING,
MENTAL HEALTH NURSING
4. / DATE OF ADMISSION TO COURSE. / 24. 06. 2012
5. / TITLE OF THE TOPIC. / “KNOWLEDGE OF ADOLESCENTS ADJUSTMENT PROBLEMS AND ITS MANAGEMENT AMONG HIGH SCHOOL TEACHERS ”
6 / STATEMENT OF THE PROBLEM. / “A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE OF ADOLESCENTS ADJUSTMENT PROBLEMS AND ITS MANAGEMENT AMONG HIGH SCHOOL TEACHERS IN SELECTED HIGHSCHOOLS AT HASSAN.”
6.0 BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
The word ‘adolescence’ comes from the Latin word ‘adolescere’ which means ‘to grow’. So the essence of the word adolescence is growth and it is in this sense that adolescence represents a period of intensive growth and change in nearly all aspects of a child’s physical, mental, social and emotional life. Adolescence has been described by Stanley Hall as ‘the period of storm and stress of human life’. It is a very crucial period of one’s life which covers roughly from 12-18 years. The most important fact about adolescence is that it is a period of transition from childhood to adulthood. Transition from one period to another always is associated with some problems. Adolescence is not an exception and it is also associated with some problems. By 2025, the world's population is expected to include more than 830 million people at an age of 12-18 years1.
Adjustment is a continuous process, not fixed or static state, in fact adjustment is defined as the continuous process of satisfying one’s desires, and it involves many aspect of behavior. Adjustment covers four specific areas which are the academic adjustment, social adjustment, personal-emotional adjustment, as well as attachment and commitment towards educational along with institutional goals.
Human behavior normally represents of various problems, needs and requirements and to solve these we have to make an effort on the part of the organism to avoid tension, trouble and other consequences. This process by which a living organism requires a particular way of acting or behaving or changes an existing form of behavior or action is called adjustment2.
The maladjustment refers to a tendency to live in a fancy world, volatile feeling such as fear, anger and excitement, depressive feelings coming from isolation and from feeling of inferiority. The feelings that one is the victim of fate and misfortune, feeling of self consciousness and feeling of being hurt easily, feeling of guilt, worry, anxiety and nervousness.
Life is the continuous adjustment of internal relations to external relations. Every new adjustment is a crisis in self-esteem. All biological phenomena act to adjust, there are no biologic actions other than adjustment. Adjustment is another name for equilibrium. Equilibrium is the universal, or that which has nothing external to derange it. Adjustment problem occurs when there is an inability to make own decision to some need or stress which occur in the environment both internally and externally3.
Teachers plays very important role in early diagnosis of mental health problems, giving reference to medical personal and also promotion of mental health among adolescents in their schools.Adolescents will spend their more time with their respective teachers. Teachers need more knowledge on adjustment problems and mental health of adolescents.
6.1 NEED FOR THE STUDY
Adolescence is defined by WHO as, “the age group of 12-18 years”. In India, adolescents constitute 21.4 percent of the population, comprising one fifth of the total population. Adolescence is the transitional stage of development between childhood and adulthood, representing the period of time during which a person experiences a variety of biological changes and encounters a number of emotional issues4.
Adolescents has been identified as a period in which young people develop abstract thinking abilities, become more aware of their sexuality, develop a clear sense of psychological identity and increase their independence from parents.Adjustment problems can be found in many families and frequently create a stress full and challenging situation for parents. Teachers should teach constructive ways for them to express their feelings. Anticipatory guidance is recommended to help teachers adequately prepare their students for the development of good character during this transition period5.
Adolescents are rich in memory, perceiving things, concept formation, association, generalization, imagination and decision making. Questioning on most of the things is prevalent but they become satisfied in approval and recognition of their own views.
Adolescence is a period when rapid physiological changes and demands for new social roles take place. The adolescents, due to these changes often face a number of crises and dilemmas. Emotional development is at peak and there is no emotional stability in general. It is the period when the child moves from dependency to autonomy. It is a period demanding significant adjustment to the physical and social changes which distinguish childhood behaviour from adult behaviour. It is a period of rapid physical and psychological transition which makes adolescents particularly vulnerable to emotional conflicts and behavioral disorders6.
Adolescents are facing multitude of problems throughout the world. Adolescents suffer from different maladjustment problems at one time or the other during their development. The major problems that usually involved with these age groups are substance abuse, internalizing disorders (depression, anxiety) and externalizing disorders (delinquency, aggression, educational difficulties, truancy). Many of these problems are of transient nature and are often not noticed. Further children may exhibit these problems in one setting and not in other (e.g. home, school). Several key transitional periods (moving from early elementary to middle school, moving from middle school to high school or moving from high school to college) can present new challenges for these adolescents and symptoms of dysfunction may occur7.
Nowadays, because of rapid industrialization and urbanization majority of parents are employed and live in unitary setup, so unavoidably they get less time to look after their children. Under these circumstances, these maladjustment problems and psychiatric problems are on the rise. Most of the epidemiological survey on school going children and adolescents has reported a wide variation (20-33%) in the prevalence of psychosocial problems8.
In a study on current opinion in psychiatry in India, the author found that the incidence rate or epidemiology of adolescent mental health disorder is about 10% in India. A study was conducted to find out the recent statistics of India about adjustment problems. Among the all age groups adolescents have more adjustment problems. The researcher reported that nearly 10.9% of adolescents are having adjustment problems. Among them 11% of boys and 7.7% of girls are having this adjustment problem. Approximately 17.7% of adolescents are having adjustment problem9
Adolescence is a crucial period which faces manifold problems of recognition with their parents, peer groups, teachers and all other members of the society. Therefore it is the responsibility of the teacher to understand the adolescents, their adjustment problems. Hence the investigator justifies the importance of exploring the adjustment problems of the adolescents.
So, after notice this statistics the researcher has decided to do the research work on the adjustment problem and coping strategies of adolescents. Because adolescence is a crucial period and adolescents faces many problems in society and they are the future treasurer of the society.
6.2REVIEW OF LITERATURE
This chapter deals with the information collected with relevant to the present study through published and unpublished materials. These publications were the foundation to carry out the research work. Highly extensive review of literature pertaining to research topic was done to collect maximum information for laying foundation of the study.
Reviews of literature were organized as follows:
6.2.1Studies related to prevalence ofadolescents adjustment problems.
6.2.2Studies related to types of adolescents adjustment problems and its management among high school teachers.
6.2.3Studies related to effectiveness planned teaching programme.
6.2.1Studies Related To Prevalence of Adolescents Adjustment Problems:-
A cross-sectional survey was conducted by National health and Nutrition examination survey at United States between 2001-2004, to assess the prevalence and treatment of mental disorders among US Children with 3,042 adolescents. This study reveals disorders in this sample were 8.6% for attention-deficit hyperactivity disorder, 3.7% for mood disorders, 2.1% for conduct disorder, 0.7% for panic disorder or generalized anxiety disorder and 0.1% for eating disorders. Boys had 2.1 times greater prevalence of attention-deficit hyperactivity disorder than girls, girls had twofold higher rates of mood disorders than boys, and there were no gender differences in the rates of anxiety disorders or conduct disorder. These data constitute a first step in building a national database on mental health in children and adolescents10
A Cross-sectional study was conducted in the year 2007 to estimate the prevalence of mental health problems in children and adolescents from the outskirts of Sao Paulo City at Brazil with 479 children and adolescents. This study conducted by Social Psychiatry Division, Department of Psychiatry, Brazil. This study reveals the prevalence of mental health problems in children and adolescents: 24.6% (20.7-28.5) without considering global impairment; 7.3% (5.0-9.6) with global impairment (cases in need of treatment). Current annual service capacity can only provide care for 14.0% of impaired cases; approximately seven years would be necessary for all to be treated11.
A cross sectional study was conducted during 2006-2007 to find out the prevalence of psychosocialproblems among 840 adolescents, selected by multistage random sampling technique atDoiwala block, Dehradun. Data was collected on a structured and pre-tested questionnaire by interviewing the adolescents. The study reveals the overall prevalence of psychosocialproblems among the adolescents was found to be 31.2%,thepsychosocialproblems were more in males (34.77%) as compared to females (27.6 %)12.
A Cross-sectional study was conducted to study the prevalence of psychiatric morbidity in school going girls at selected schools, New Delhi. Sample sizeis 1,097 school girls. This study conducted by department of community medicine, Lady Hardinge medical college, New Delhi. This study reveals 13.76% girls showed psychiatric morbidity. The most common problem was anxiety/depression. The social factors most significantly associated with psychiatric morbidity were girl’s relationship with father, perception of mother's love for them, self-perception of their looks, and relationship with their mother and the girl being hit13.
6.2.2Studies Related To Types of Adolescents Adjustment Problems and Its Management among School Teachers:-
A study was conducted in the year 2001 to examine the relationship between child maltreatment, clinically relevant adjustment problems, and dating violence in a community sample of adolescents. Sample size includes 1,419 high school students. Using questionnaires the study completed by Department of Psychology, University of Western Ontario at Canada. This study reveals one third of the school sample reported levels of maltreatment above the cutoff score on the Childhood Trauma Questionnaire. Girls with a history of maltreatment had a higher risk of emotional distress compared with girls without such histories. They were also at greater risk of violent and nonviolent delinquency and carrying concealed weapons. Boys with histories of maltreatment were 2.5 to 3.5 times as likely to report clinical levels of depression, posttraumatic stress, and overt dissociation as were boys without a maltreatment history14.
A study was conducted in the year 2006 to investigate age and gender effects on perceived interpersonal stress, coping with interpersonal stressors, and psychological adjustment among early and middle adolescents. The sample size included 286 Austrian adolescents .This study conducted byCenter of Clinical Psychology and Rehabilitation, University of Bremen, at Germany. Self-report data collected on perceived stress, coping, as well as emotional and behavioural problems were assessed. This study concluded that fifth graders scored lower on maladaptive coping strategies and externalizing problems and reported more adaptive coping strategies than sixth and seventh graders. Compared with boys, girls evaluated a higher amount of perceived interpersonal stress and used more social support15.
A comparative study was conducted in the year 1993 focuses on adjustment problems of adolescent girls of immigrant Pakistani families settled in Bradford at United Kingdom.200 samples selected by random sampling technique method. The IPAT (Institute for personality and ability testing) Anxiety scale was used to measure free-floating anxiety. The Chi-Square test, Student's t-test, Fisher Exact Probability test, and Regression Analysis were the statistical measures used for analysis of data. Level of significance was taken at 5%. The study reveals that the family and parent-adolescent communication play a very vital role in adolescent adjustment16.
A study was conducted in the year 1997 regarding Family environment and adolescent psychological well-being, school adjustment, and problem behaviour by Department of Social Work, Chinese University of Hong Kong. Sample size is 365 adolescents. The findings of the study suggest that family factors play an important role in influencing the psychosocial adjustment, particularly the positive mental health, of Chinese adolescents17.
6.2.3 Studies Related To Effectiveness Planned Teaching Programme:
A research study was conducted to evaluate the effectiveness of a planned hypertension treatment and teaching programme in general practice.200 patients with 30 to 60 years old, mean of the last two blood pressure measurements at or above 160 and/or 95 mmHg were selected. Half were controlled group, and half were intervention group. Of the 100 control patients 26 and of the 100 intervention patients 14 were lost to observation;46 patients had agreed to participate in the programme. In the control group 9% and in the intervention group 33% of patients had documented reduction of body weight. The study concluded that the introduction of a planned hypertension treatment and teaching programme in general practice may lead to significant improvement of hypertension care18
A study was conducted to develop a planned hypertension treatment and teaching programme, aiming at intensification of antihypertensive therapy by active involvement of the patient in his own treatment by means of information about non-pharmacological and pharmacological therapies and instruction to regular blood pressure self measurements. The feasibility of planned hypertension treatment and teaching programme was evaluated in several studies. The result showed that the programme motivated self-help measurements among the patients19.
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE OF ADOLESCENTS ADJUSTMENT PROBLEMS AND ITS MANAGEMENT AMONG HIGH SCHOOL TEACHERS IN SELECTED HIGHSCHOOLS AT HASSAN.”
6.3 OBJECTIVES OF THE STUDY
- To assess the knowledge level of high school teachers regarding adolescents adjustment problems and its management before intervention.
- To assess the effectiveness of planned teaching programme regarding adolescents adjustment problems and its management.
- To determine the association between the high school teachers knowledge regarding adolescent adjustment problems and its management with their selected socio-demographic variable.
6.3.1 HYPOTHESIS
H1: There will be significant difference in level of knowledge before and after planned teaching program among high school teachers regarding knowledge on adolescents adjustment problems and its management in selected high schools.
H2: There will be a significant association between the levels of knowledge regarding adolescent adjustment problems among high school teachers with their selected socio demographic variables.
6.3.2 ASSUMPTIONS
The study assumes that;
- The adolescents are the vulnerable group exposed to adjustment problems.
- The high school teachers have some knowledge regarding adjustment problems and its management.
- Planned teaching programme will help to enhance the knowledge of high school teachers regarding adjustment problems of adolescents and its management.
6.3.3 OPERATIONAL DEFINITIONS:
ASSESS: It refers to an activity to estimate the outcome PTP on level of knowledge regarding adolescents adjustment problems and its management.
EFFECTIVENESS: It refers to statistically significant difference between knowledge scores of high school teachers regarding adolescents adjustment problems and its management.
PLANNED TEACHING PROGRAMME: Planned teaching programme refers to systematically developed teaching programme to improve the knowledge of high school teachers regarding selected adjustment problems (Anxiety,depression,aggression and educational difficulties) of adolescents and its management.
KNOWLEDGE: It refers to the awareness of high schoolteachers regarding physical and psychosocial adjustment problems of adolescents and its management.
ADOLESCENT ADJUSTMENT PROBLEMS: It refers to maladaptive reactions that occurs due to physical, social or psychological stress at the age between 12-18 years and evidenced by symptoms like anxiety, depression, aggression and educational difficulties20.
MANAGEMENT: It refers to the process of early detection and teaching of coping strategies, immediate referral to medical aid, in order to help the child to overcome his/her adjustment problems.
HIGH SCHOOL TEACHERS: The persons who are having B.Ed certificates and working as a full time faculty in selected government or private high schools at Hassan
6.3.4 DELIMITATION
1. The study is delimited to teachers who are working in selected government or private high schools.
2. This study is delimited to high school teachers who are available at the time of data collection
7.0 MATERIAL AND METHOD OF STUDY
7.1 SOURCE OF DATA
The data will be collected from high school teachers who are working in selected government or private high schools, Hassan
7.2 METHODS OF COLLECTION OF DATA
7.2.1RESEARCH APPROACH
Evaluative approach
7.2.2RESEARCH DESIGN
Quasi experimental Design [one group pretext –post text design] which includes manipulation without randomization21
Group / Pretest / Intervention / PosttestHigh school teachers / 01 / X / 02
KEY
01=Pre- test assessment of knowledge of high school teachers regarding adolescents adjustment problems and its management
X=Administration on PTP
02=Post –test assessment of knowledge of high school teachers regarding adolescents adjustment problems and its management