RAJIV GANDHI UNIVERSITY OF THE HEALTH SCIENCES, KARNATAKA, BANGALORE

ANNEXURE-II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1 / NAME OF THE CANDIDATE AND
ADDRESS / MR. CHANAMALLAPPA.I.HADAGINAL
1ST YEAR MSc NURSING
P.D. BHARATESH COLLEGE OF NURSING, HALAGA, BELGAUM.
2 / NAME OF THE INSTITUTION / P.D.BHARATESH COLLEGE OF NURSING HALAGA, BELGAUM
3 / COURSE OF THE STUDY AND SUBJECT / MSc NURSING 1st YEAR
PSYCHIATRIC NURSING
4 / DATE OF ADMISSION TO COURSE / 25/03/2010
5 / STATEMENT OF THE PROBLEM / A STUDY TO ASSESS THE EFFECTIVENESS OF PSYCHOEDUCATION INREDUCTION OFANXIETY AMONG THE HIV POSITIVE PATIENTS ADMITTED IN SELECTED HOSPITALS, BELGAUM, KARNATAKA.

6. BRIEF RESUME OF INTENDED WORK:

6.1. INDRODUCTION:

‘’It is clear before God and man that the entire war on

HIV and AIDShas not been waged with any degree of piety, responsibility and care.”

Psycho education refers to the education offered to people who live with a psychological disturbance. Frequently psycho educational training involves patients with schizophrenia, clinical depression, anxiety disorders, psychotic illnesses, eating disorders, and personality disorders, as well as patient training courses in the context of the treatment of physical illnesses in which the Family members are also included.

A goal is to understandand be better able to deal with the present illness of the patient's, in which the patients own strengths, resources and coping skills are reinforced, in order to avoid relapse and contribute to their own health and wellness on a long-term basis.Improved knowledge about a problem allows clients to better utilise methods of reacting to it and live with their condition1.

Since it is often difficult for the patient and their family members to accept the patient's diagnosis, psycho education also has the function of contributing to the stigmatization of psychological disturbances and to diminish barriers to treatment. Through an improved view of the causes and the effects of the illness, psycho education frequently broadens the patient's view of their illness and this increased understanding can positively affect the patient. So relapse risk is lowered.Also family members of the patients, who are more well-informed about the disease condition feel less helpless.

Psycho education also changes clients lives by increasing their skills like communication, problem solving, coping, medication adherence, modification of routines, environment adjustment/management, and social connections1.

HIV disease is not only a medical issue, but a psychosocial one as well. Infection and the subsequent progression of this disease present the client with a broad range of personal experiences to negotiate2.Resolving psycho social problems in similar ways psycho education is helpful for chronic and debilitating diseases. Among the diseases,HIV/AIDS is worsen by existing psycho social problem associated.

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. The Centers for Disease Control establish the definition of AIDS, which occurs in HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections. In 1992, the CDC redefined AIDS to include 26 CDC-defined AIDS indicator illnesses and clinical conditions that affect persons with advanced HIV2.

So,HIV/AIDS brings forth lot of psychological chaos among the infected patients. The investigator also have witnessed about psychological problems among HIV/AIDS patients and the anxiety they exihibit towards the disease state.

6.2 NEED FOR THE STUDY

"We need to band together as a unit every day, especially to conquer the

strength of the AIDS virus."

The Human Immunodeficiency Virus (HIV) is the virus that leads to AIDS. HIV belongs to a subset of retroviruses called lentivirus, which means that there is an interval -- sometimes years -- between the initial infection and the onset of symptoms. Upon entering the bloodstream -- through mucous membranes or blood-to-blood contact HIV infects the CD4+T cells and begins to replicate rapidly.

Acquired Immunodeficiency Syndrome (AIDS) is defined as the most severe form of continuum of illness associated with HIV virus a final stage of HIV infection. Which occurs in HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections. Once the person is infected the virus will be present for life time.

Globally there were estimated 33million people infected with HIV in 2007 with 2.7 million new infections and 2 million HIV related deaths. Nearly an estimated 5 million people infected with HIV lived in Asia in 2007 and

about380 000 people were newly infected [2008 UNAIDS Global Epidemic Update]5.

In India, the estimated number of HIV infections as of 2008 is 2.47 million. The distribution of HIV infection and mode of transmission varies by state. Most HIV infections in India (86% of reported AIDS cases) are due to unprotected heterosexual transmission (UNAIDS, 2008 Report on Global AIDS Epidemic). HIV prevalence tends to be higher in the industrialized, peninsular states. The six states with the highest HIV prevalence are: Maharashtra, Andhra Pradesh,Tamil Nadu, Karnataka, Manipur, and Nagaland. In India, more than 1,88,000 people living with HIV/AIDS are accessing ART from public sector hospitals/clinics as of November 20085.

Karnataka, a diverse state in the southwest of India, has a population of around 53 million. HIV prevalence among antenatal clinic attendees exceeded 1% from 2003 to 2006, and dropped to 0.5% in 2007. Districts with the highest prevalence tend to be located in and around Bangalore in the southern part of the state, or in northern Karnataka's "devadasi belt". The average HIV prevalence among female sex workers in Karnataka was just over 5% in 2007, and 17.6% of men who have sex with men were found to be infected6.

The study findings indicated that 16% of individuals withHIV in this national study had symptoms of generalized anxietydisorder and 10.5% percent screened positive for a history ofpanic attacks . The study of HIV-infected individualsliving in the Deep South of the US found that over one quarter(29.5%) had significant levels of anxiety as reported onthe Brief Symptom Inventory . In the study, symptomsof anxiety were only slightly higher in women and no differencesin gender were identified in the study . However,in the study, African-Americans were less likely to havesymptoms of an anxiety disorder . Several studies have foundthat anxiety symptoms have been associated with less optimalHIV medication adherence7.

A high prevalence of PTSD, which greatly exceeds that of thegeneral population, has been found among HIV-infected individuals,ranging between 16% and 54% . This is consistentwith the high rates of abuse and trauma reported previously.A study conducted on PTSD amongwomen with HIV indicated that PTSD was associatedwith less social support and a greater number of traumatic experiences. Consistent with the associations of depression and anxietywith health behaviour, a number of studies have identified anassociation of PTSD with poorer medication adherence and greater HIV risk behaviour7.

There are no published meta-analyses of the effectiveness of passive psycho education in reducing symptoms of depression, anxiety or psychological distress.Although it is commonly believed that psycho education interventions are ineffective, this meta-analysis revealed that brief passive psycho educational interventions for depression and psychological distress can reduce symptoms. Brief passive psycho education interventions are easy to implement, can be applied immediately and are not expensive. They may offer a first-step intervention for those experiencing psychological distress or depression and might serve as an initial intervention in primary care or community models. The findings suggest that the quality of psycho education may be important8.

A retrospective cohort study conducted in French Guiana to determine the predictive factors and the incidence of anxiety and depression. A total of 2315 patients were followed for a total of 9116 years of follow-up. The study found that depression was 1.89 per 100 person years. The incidence rate of first observed generalized anxiety was 1.27 per 100 person years and a single failure Cox proportional hazards also showed that recently diagnosed patients and females were at increased risk of anxiety.. Knowledge of this pattern may help medical personnel to be more vigilant to psychological distress at certain phases of life with HIV9.

The researcher assumes that most of the patients infected with HIV/AIDS positive show the psychological disturbances such as anxiety, depression, PTSD and GAD. So the patients are in need of psycho-education to improve own strengths, resources and coping skills are reinforced, in order to avoid relapse and contribute to their own health and wellness on a long-term basis.Improved knowledge about a problem allows clients to better utilise methods of reacting to it and live with their condition1.

6.3: REVIEW OF LITERATURE:

Literature review is a standard requisition of scientific research. It means reading and writing the pertinent information of the attempt in research topic to understand better about the proposed topic. It also supports and explains why the proposed topics taken for research and avoid unnecessary duplication explore the feasibility and illuminate way to new research.

Review of Literature has been carried out in the following headings 

PART 1- Studies related to effect of Psycho education in reduction of anxiety among HIV positive patient.

PART-2 Studies related to level of anxiety among HIV positive patient

.

PART 1- Studies related to effect of Psycho education in reduction of anxiety among HIV positive patient.

A quasi-experimental research study found that a 10-session psycho educational group intervention was effective in increasing knowledge of AIDS and decreasing depression, anxiety, and trauma symptoms among male inmates in a large southeastern jail facility. The group intervention consisted of both AIDS education topics and psychological support. Results indicated significant differences between the experimental and comparison group participants. Implications for future research and practice are discussed11.

A study on Psycho educational program for individuals who are seropositive for the human immunodeficiency virus (HIV) is provided at the Naval Hospital (NH) Bethesda. Education is critical to help patients understand their medical condition, prevent transmission of the virus, and alter lifestyles that may compromise health. The educational program consists of eight classes in which patients receive information on the medical nature of HIV infection and acquired immunodeficiency syndrome (AIDS), the psychological impact of HIV infection, Navy career implications, how stress affects the immune system, how to reduce stress, how to prevent transmission of HIV through safer sex, religious issues connected with being at high risk for a fatal disease, and alcohol and drug issues. The HIV program at NH Bethesda is described including contents of the eight classes, and a case is presented to facilitate understanding of emotional issues faced by the HIV-seropositive person12.

The effectiveness of a psycho educational group intervention for HIV/AIDS-infected and affected women was examined at a large south-eastern county jail facility. A quasi experimental pre-test post-test design was used to examine depression, anxiety, and trauma symptoms of women inmates. A multivariate analysis of covariance yielded significant differences between the experimental and comparison groups. Subsequent analysis of covariance for each dependent variable indicated significant differences between groups as well. Effect sizes ranged from moderate to strong. Concluded that the psycho educational group intervention appeared to be effective in alleviating depression, anxiety, and trauma symptoms among women inmates infected and affected by HIV/AIDS13.

PART-2 Studies related to level of anxiety among HIV positive patient

Fifty-seven ambulatory, human immunodeficiency virus (HIV)-infected patients at various stages of disease progression and 17 HIV seronegative controls were examined in a cross-sectional study with self-administered measures of emotional distress, coping, and adjustment to illness. All infected and control subjects were homosexual or bisexual and free of acute medical illness. The findings indicated that both uninfected and infected subjects had enhanced emotional distress in a variety of domains. However, while somatic and cognitive-ruminative complaints were greater in symptomatic subjects relative to controls, depression and anxiety were not. Professed coping strategies were heterogeneous and not particularly related to HIV diagnostic status, with the exception of planful problem solving which was decreased for acquired immune deficiency syndrome subjects. Disruption in several aspects of daily life adjustment was markedly increased in symptomatic subjects. The findings suggest that both HIV seropositive status and perceived risk for infection produce a sustained level of generalized psychological distress. Even in the absence of current medical illness, patients with advanced disease progression are concerned primarily with anticipated medical implications and cognitive effectiveness

Study to measure the level of HIV/AIDS related anxiety among health care workers and identify its determinants. Data were obtained by means of a mailed, anonymous, self-administered questionnaire distributed to 2561 Danish medical doctors, nurses and nursing aides drawn randomly from the lists of members of the respective national associations. The data were analyzed on the basis of a pre-study model including 12 variables hypothesizing a hierarchy of causal dependencies with anxiety at the top. 44% of the participants expressed HIV/AIDS related anxiety--hospital workers more than primary care workers, the older less than the younger. Anxiety was significantly associated with negative/restrictive attitudes towards HIV positives and gay men and with low levels of knowledge about HIV transmission and less education about HIV/AIDS. Negative/restrictive attitudes towards HIV positives were associated both with less knowledge regarding HIV transmission and fewer contacts with HIV positives. Similar associations were found regarding gay men. It is suggested that new kinds of training programmes be established which focus much more on attitudes and norms concerning HIV/AIDS--especially among health care workers with only occasional contact with HIV patients

The researchers assume that most of the patient infected with HIV positive shows the signs and symptoms like anxiety, Depression etc. so the patients are in need of psycho education.So the researchers felt study to assess the effectiveness of Psycho education in reduction of anxiety among the HIV positive patients admitted in selected hospitals, Belgaum. Karnataka.

6.4. STATEMENT OF THE PROBLEM:

A STUDY TO ASSESS THE EFFECTIVENESS OF PSYCHOEDUCATION IN REDUCTION OF ANXIETY AMONG THE HIV POSITIVE PATIENTS ADMITTED IN SELECTED HOSPITALS, BELGAUM. KARNATAKA.

6.5. OBJECTIVES OF THE STUDY:

  • To determine the level of anxiety among the HIV positive patient before attending the Psycho education.
  • To assess the effectiveness of psycho education in terms of reduction of

anxiety among the HIV positive patient.

  • To compare the level of anxiety before and after psycho education among the HIV positive patient.
  • To explore the association of level of anxiety with selected demographic

variables of HIV positive patients.

6.6 NULL HYPOTHESIS

H1- The mean post test score of subjects exposed to psychoeducation on reduction of anxiety wil be significant

to their mean pre-test scores as measured byreduction in anxiety at higher level of significance

H2- There will be a significant difference between the pre test and post test anxiety level among the HIV

positive patient

H3- There will be significant association of level of anxiety with selected demographic variables of HIV

positive patients.

6.7 OPERATIONAL DEFINITIONS:

 ASSESS:-

In this study it refers to, estimate or judge the quality or quantity of level of anxiety of HIV positive patients.

 EFFECTIVENESS :-

Effectiveness is a measure of whether and to what extent the set goals have been

achieved.

PSYCHO EDUCATION:-

In this study, Psycho education refers to the education offered to the HIV positive

patient who live with a psychological disturbances with a goal to understand and to deal

with the presented illness.

 ANXIETY:-

In this study it refers to, a state of apprehension and fear resulting from the

anticipation of a threatening event or situation10.

HIV:-

In this study, HIV stands for human immune deficiency virus that causes AIDS.

HIV POSITIVE PATIENT:-

In this study , HIV positive patient are those clients who are affected with the Human

Immune Deficiency virus (HIV).

6.8. ASSUMPTIONS:

The researcher assume that,

Anxiety is more common among the HIV positive patient.

There is a need for Psycho education in reduction of anxiety among HIV positive patients.

After attending the psycho education programme there will be reduction in anxiety level among HIV positive patients.

There will be a significant changes in the level of anxiety before and after attending the psycho education.

6.9.DELIMITATION.

1. The study will be limited to 50 samples of HIV positive patients.

2. Prescribed data collection is only 4-6 weeks.

3. Study design is limited to Pre-Experimental design.

7. MATERIALS AND METHODS OF STUDY:

RESEARCH APPROACH:-

Quantitative approach (Evaluative approach).

RESEARCH DESIGN:-

Pre -Experimental Design (One Group Pre –test & Post test design).

Group / Pre Test / Intervention / Post Test
(30 Th Day)
Experimental group / O1 / X / O2

O1:Level of anxiety before attending psycho education

X: Psycho education

O2:Level of anxiety after attending psycho education

SETTING OF THE STUDY:-

The study will be conducted in selected hospitals .Belgaum,Karnataka.

POPULATION:-

The population under study consist of HIV positive patient aged between 25 -60 years

SAMPLE SIZE:-

50 HIV positive patients.

SAMPLING TECHNIQUE:-

Non- Probability- purposive sampling technique.

SIGNIFICANCE OF THE STUDY:-

Psycho education will have a strong influence on the reduction of level of anxiety among the HIV positive patients.

VARIABLES UNDER THE STUDY:-

DEPENDENT VARIABLE

Effectiveness, Level of anxiety, Psycho education.

INDEPENDENT VARIABLES