1
DISSERTATION PROTOCOL
1. / NAME OF THE CANDIDATE AND ADDRESS / NINGTHOUJAM MONALISA CHANUD/o. N. SARATCHANDRA
CHINGAMAKHA MAISNAM LEIKAI,
SINGJAMEI, IMPHAL WEST-795001
MANIPUR- STATE
2. / NAME OF THE INSTITUTION / S.B. COLLEGE OF NURSING YELAHANKA NEW TOWN,
BANGALORE-64
3. / COURSE OF STUDY AND SUBJECT / M. Sc. NURSING
(PSYCHIATRIC NURSING)
4. / DATE AND ADMISSION TO COURSE / 5th JUNE 2009
5. / TITLE OF THE TOPIC:
ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING STRESS AND COPING STRATEGIES AMONG CAREGIVERS OF HOSPITALIZED PATIENTS IN A SELECTED PSYCHIATRIC HOSPITAL IN BANGALORE.
6. BRIEF RESUME OF THE INTENDED WORK
6.1: NEED FOR THE STUDY
Coping with stress is one of the biggest health concerns and its effect can be different from one person to another. Stress is primarily a process of motivation since it requires some sort of adaptation (coping) to the demand or set of demands. The effect of stress is directly linked to coping5.
Stress is an organism’s total response to environmental demands or pressure. The cause of stress can include any event or occurrence that a person considers a threat to his or her coping strategies or resources and coping is a complex process. It is variously described as a situational and as a trait-like response to stress and as a disposition to respond to change11.
Caregivers are using a wide variety of coping strategies in both aspects. It was problem-focused coping strategies and emotion-focused strategies .While taking care of mentally ill-patient ,caregivers are facing overburden ,stress ,anxiety and depression .So ,they are trying to adopt the situation ,even though trying also ,they don’t have that much adequate coping abilities16.
A study was conducted regarding the burden of the primary family caregivers of schizophrenia patient and they collected the information from 126 caregivers of the schizophrenic patient 73% caregivers are facing moderate burden. Caregivers of patient with mood disorders were facing overburden and they have poor family functioning. In this, 74% of caregivers had depressive symptoms because of overburden and 22% of caregivers had poor family functioning.4, 13
A comparative study reported, among caregivers and non-caregivers that, 63% caregivers have higher rate of affective symptoms than non-caregivers (42%) and 17.5% caregivers have anxiety symptoms when compared to non –caregivers (10.9%).6
Indian mental health statistical reported regarding caregiver of mentally ill patient. It was suggested 40-75% of caregivers had significant psychological illness as a result of their care giving and 15-32% had clinically diagnosable major depression. There may also be physical health consequences; strained caregivers have impaired immunity and a higher mortality rate.10
According to WHO survey, it reported the problem of caregivers of psychiatric patients. It is stated that 51% of all caregivers are suffering from stress. 25% of caregivers have no job satisfaction and 43% caregivers are expecting to reduce their working hours.8
Thus, the major function of mental health nursing staff is to improve mental health through education and counseling. Hence, the investigator felt that there is a need to designed structured teaching programmed regarding stress and coping strategies among caregivers of psychiatric patients. It will help for the mental health programme to conduct stress and coping abilities for caregivers of psychiatric patients.
6.2: REVIEW OF LITERATURE
A descriptive study determined the patient and caregivers of the psychiatric patient’s characteristics associated with depression and it was found 32% of caregivers reported 6 or more symptoms of depression and were noted as depressed.9
A study suggested that caregiver consequences were found to be limited, although approximately 30% reported distress. Male caregivers used a more avoiding coping style than the female caregivers. A nurse should assess problems of caregiver’s distress and efforts should be undertaken to support the caregiver and teach them skill to cope effectively.12
A study found that those who are taking or providing care to psychiatric patients were worried about the patient’s general health. Treatment, safety and future there were relational strains and they felt burdened and they often felt distressed and had to visit a (mental) health practitioner. So, attention should be paid to support relatives and spouses of depressed patients and special attention should be paid to patient’s children.3
A preliminary study found that caregivers of psychiatric patients were seeking help from the others because of stress. They are expecting counseling from psychiatrics, psychologists, relatives and family members. Some of risk factors of stress and coping factors among caregivers are lack of information about care, lack of training, low quality care and dysfunctional coping and it leads to severs stress and loss of coping ability, nearly 50%.1
A comparative study was conducted among 50 caregivers both male and female and they reported female caregivers are facing more stress than male caregivers. It was 62% when compare to male caregiver 38% and majority of complains was found among caregivers such as depression, anxiety and mental disorders.2
A comparative study on relatives of long term psychiatric patients (schizophrenia and bipolar affective disorder) assessed the subjective and objective burdens of 54 caregivers of schizophrenia and bipolar affective disorder patients. Results showed that caregivers of schizophrenia patients should increased severity of burden as compared to bipolar affective disorder patients.14
A study examined 70 caregivers, which were divided into subgroups according to high and low levels of depression and burden, with the three most common groups, reported 46% of caregivers are having low deep and low burden, 26% were having high deep and high burden and 23% were having low deep and high burden and 6% of caregivers reported high depression and low burden.7
A health survey conducted in Pondichery, evaluated the coping styles adopted by caregivers of schizophrenia patients. 44 patients (20 men and 24 women) and some number of caregivers were included in this study. 71% of caregivers used resignation strategies, 79% failed to maintain social contacts and 60% did not seek information about their illness. Only 1/3 of the caregivers were attempted active social involvement of the patients, coercion and avoidance strategies. 6
A research study was conducted to examine how caregivers cope with stressful care giving situations and the relations between coping strategies and caregiver’s psycho social wellbeing. Respondents were 58 family caregivers to patients discharged from a rehabilitation hospital. Caregivers identified a recent stressful event in care giving and indicated strategies used to cope with this even. After controlling for patients impairment level, analysis indicated that caregivers engaging in more escape-avoidance coping related greater depression and more conflict in their personal relationships.1
6.3: STATEMENT OF PROBLEM
Assess the effectiveness of structured teaching programme regarding stress and coping strategies among caregivers of hospitalized patients in a selected psychiatric hospital in Bangalore.
6.4: OBJECTIVES OF THE STUDY
1. To assess the level of knowledge regarding the stress and coping strategies among caregivers of hospitalized patients.
2. To evaluate the effectiveness of structured teaching programme regarding stress and coping strategies among caregivers of hospitalized patients.
3. To compare the knowledge of caregivers regarding the stress and coping strategies of hospitalized patients with their demographic variable.
6.5: HYPOTHESIS
H0: There will be no significant difference between the selected demographic variables with knowledge level of the stress and coping strategies of the caregivers of the psychiatric patient.
H1: There will be significant difference between the pre-test and post-test knowledge level score of the stress and coping strategies of the caregivers of the hospitalized psychiatric patient.
6.6 OPERATIONAL DEFINITION
ASSESS:
It is an organized systematic and continuous process of collecting data from a caregiver regarding stress and coping strategies of a hospitalized psychiatric patient.
EFFECTIVENESS:
It is the significant improvement in knowledge among the caregivers of the hospitalized patients after implementation of structured teaching programme as evidence by difference in pre-test and post-test.
STRUCTURED TEACHING PROGRAMME:
It is a systematically planned teaching programme designed to provide information regarding stress and coping strategies.
STRESS:
It is the non-specific response of the body to any demand made on it, regardless of whether the demand is pleasant or un-pleasant.
COPING:
Various strategies, conscious and unconscious to deal with stress and tensions arising from perceived threats to psychological integrity. It is the process of attempting to solve life problems in an effort to overcome the stress of the caregivers of the hospitalized patients.
STRATEGIES:
A well defined care plan to overcome the stress of the caregivers of the hospitalized psychiatric patients.
CAREGIVERS:
Male or female individuals who is taking care of the hospitalized psychiatric patient.
HOSPITALIZED PATIENT:
A person who is diagnosed with a psychiatric disease condition and who is admitted to a psychiatric hospital.
6.7: ASSUMPTION
1) Caregivers of the hospitalized patients will be having some knowledge regarding stress and coping strategies.
2) Structured teaching programme will enhance the knowledge of the caregivers of the hospitalized patients regarding the stress and coping strategies.
3) The knowledge of the caregivers of the hospitalized patients will vary from one individual to another individual.
7. MATERIALS AND METHODS
7.1: SOURCES OF DATA:
Caregivers of the psychiatric patients admitted in the selected psychiatric hospitals in Bangalore.
7.2: METHODS OF DATA COLLECTION:
Data will be collected by investigation herself by using rating scale for stress and coping. The data will be collected in the month of September- October 2010.
7.2.1: RESEARCH DESIGN AND APPROACH:
The research design adopted for this study is quasi experimental design in which one group of pre and post test approach without control group.
7.2.2: SETTING:
Study will be conducted in selected Psychiatric Hospital at Bangalore.
7.2.3: POPULATION:
The population of the present study will be the caregivers of the psychiatric patients.
7.2.4: SAMPLE SIZE:
The sample size is 50.
7.2.5: SAMPLING TECHNIQUE:
Purposive sampling technique will be used to select the samples for the study.
7.2.6: SAMPLING CRITERIA
INCLUSION CRITERIA:
Caregivers who are,
Ø in the selected psychiatric hospital.
Ø available during data collection.
Ø able to read and write in English and Kannada.
Ø willing to participate in this study.
Ø both male and female.
EXCLUSIVE CRITERIA:
Caregivers who are not,
Ø willing to participate in this study.
Ø able to read and write English and Kannada
Ø available during the time of data collection
7.2.7: DATA COLLECTION TOOL:
Rating scale for stress and coping.
7.2.8: DATA ANALYSIS METHODS:
1. Data will be analyzed according to the objectives of the study using descriptive and inferential statistics and will be presented in the form of tables, graphs and diagrams.
2. The effectiveness of pre and post test knowledge scores will be analyzed by paired ‘T’ test.
3. The significance of relationships between the selected demographic variable and knowledge score will be analysed by using chi-square test.
7.3: DOES THE STUDY REQUIRED ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
- NO –
7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? IN CASE OF 7.3
Ethical clearance will be taken from the concerned authority before proceeding to final study.
8. LIST OF REFERENCES:
1. Anna Kristensson, Ekwall (2007), ‘Older Caregivers’ coping strategies and sense of coherence in relation to quality of life’. Journal of Advanced Nursing 57 (6): 584-596.
2. Annir Steele, Nancy Maruyama (2009). ‘Psychiatric symptoms in caregivers of patients with bipolar disorder: A review’. Journal of Affective Disorder. Article in Press.
3. Bob Van Wijngaorden, Aart H. Schene(2008) ‚Family care giving in depression: impact on caregiver’s daily life, distress and help seeking’. Journal of Affective Disorders, 81 (3): 211-222.
4. Christine E. Ryan, Alison H. Heru (2005), ‘Depressive symptoms and Family Functioning in the caregivers of recently hospitalized patients with chronic / recurrent mood disorders’. International journal of Psychosocial Rehabilitation, (7): 53-60.
5. Stress and coping, by Fumi O. Naughton (spring 1997), California State University, Northridge.
6. Ganguly KK, Chadda, RK (2009), ‘A study of socio cultural perspectives of care givers in Burden coping behavior in Bipolar disorder and schizophrenia cases’. International Journal of Psychosocial Rehabilitation, 13 (2): 93-103.
7. Jae L. Pearson, Linda Teri (1993). ‘The relationship of problem behaviors in dementia patients to the depression and burden of care giving spouses’. American Journal of Alzheimer’s Disease and other Dementia, 8 (1): 15-22.
8. Jonathan Stone ,Media Evercare ,2009
9. Kenneth E. Couinsky, Robert Newcomer (2003), ‘Patient and caregiver characteristics associated with depression in caregivers of patients with dementia’. Journal of General Internal Medicine, 18 (12): 1006-1014.
10. Koutenya Sinha ,TNN ,2009
11. Larry E. Beutler, Rudolf H. Moos (2003), ‘Coping and coping styles in personality and treatment planning: Introduction to the special series’. Journal of Clinical Psychology, 59 (10): 1045-1047.
12. P.J.J. Goossens (2008), ‘Family care giving in Bipolar Disorder: Caregiver consequences, caregiver coping styles and caregiver distress. International journal for Social Psychiatry, 54 (4): 303-316.
13. Shu-Ying Hou, Yi-ching Li (2007), ‘Exploring the burden of the primary family caregivers of schizophrenia patients in Taiwan’.
14. Singh TB., Ganguly KK (2009). ‘A study of Socio Cultural Perspectives of care gives in Burden coping behavior in Bipolar disorder and schizophrenia cases’. International Journal of Psychosocial Rehabilitation, 13 (2): 93-103.
15. Stephens, Mary AnnParris, Norris, Virginia K (1988), ‘Stressful situations in care giving: Relations between caregiver coping and well-bung’. Psychology and Aging, 3 92): 208-209.
16. Subho Chakrabati, Sapna Gill (2002), ‘Coping and its correlates among caregivers of patients with bipolar disorder: a preliminary study’. Bipolar Disorder 4 (1): 50-60.
9. / SIGNATURE OF THE STUDENT:10. / REMARKS OF THE GUIDE: / The study is feasible to conduct and researchable. The need for the study and methodology is appropriate to the statement of problem. Hence, can be approved.
11. / NAME AND DESIGNATION OF THE GUIDE: / Mr. Rajarathinam
Asst. Professor and Head of the Department,
S.B.College of Nursing, Bangalore.
11.1 / GUIDE SIGNATURE:
11.2 / HEAD OF THE DEPARTMENT: / Mr. Rajarathinam
Asst.Professor and Head of the Department,
S.B.College of Nursing, Bangalore.
11.3 / SIGNATURE:
12. / REMARKS OF THE CHAIRMAN AND PRINCIPAL: / The study is based on the need of the care giver in psychiatric hospitals and approved by the research committee. Hence, study can be conducted.
12.1 / SIGNATURE: