PROFORMA FOR REGISTRATION OF TOPIC

FOR DISSERTATION M.Sc NURSING II YEAR

1. / NAME OF THE CANDIDATE AND ADDRESS / MRS. BINDHU N
M. Sc. Nursing First Year
SMT. LAKSHMI DEVI COLLEGE OF NURSING
HOSKOTE, BANGLORU.
2. / NAME OF THE INSTITUTION / SMT. LAKSHMI DEVI COLLEGE OF NURSING
HOSKOTE, BANGLORU.
3. / COURSE OF STUDY AND SUBJECT / M. Sc NURSING
PAEDIATRICS
4. / YEAR- SESSION / 2012- 2013
5. / SUBMITTED TO / RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
KARNATAKA
6. / TITLE OF THE STUDY:
.
A study to assess the level of stress among grandparents rearing grandchildren of employed mothers and to develop alternative family management programme in selected area of Banglore Karnataka .
1. / 1.1 STATEMENT OF THE PROBLEM
. A STUDY TO ASSESS THE LEVEL OF STRESS AMONG GRANDPARENTS REARING THEIR GRANDCHILDREN OF EMPLOYED MOTHERS AND DEVELOP ALTERNATIVE FAMILY MANAGEMENT PROGRAME IN SELECTED AEREAS AT BANGLORE KARNATAKA.
1.2 INTRODUCTION
“The things that grandmothers can see while sitting on the ground,
younger people cannot see even if they climb to the top of a tree.”
Old age is a natural feature of life and it’s also termed as second child hood because aged person needs the some amount of care and attention as child. Old age process that begans from the time of birth. This process may be slow in some persons, while some individuals may grow rapidly and prematurely (WHO 1998).1
Most of Grandmothers don’t expect to take on the role of caregiver for their grandchildren – and they usually fill this role longer than expected. About half of grandmothers who care for their grandchildren do it for two years or less, while about 40 percent of fill this role for five years or more this trend may sound overwhelming.2
When parents are not able to raise their children, it is often grandparents who step in to assume this responsibility. Many take on this role to “keep the family together,” rather than have their grandchildren grow-up in the foster care system. Grandparents who are caregivers to grandchildren are more prone to stress and depressive symptoms than non-caregivers according to the latest research by CaseWestern ReserveUniversity's Frances Payne Bolton School of Nursing. Carol Musil, associate professor of nursing at Case, is leading an ongoing National Institutes of Health-funded study which examines the effects of care giving on the health of 450 Ohio grandmothers, as well as how it impacts their families.
Grandmothers-headed households are those with a grandmothers having parental responsibility for grandchildren residing in the home. Parental responsibility is defined as time spent rearing, providing financial support, emotional support, and/or spiritual guidance to grandchildren. Although grandmothers do not need to have full legal custody to be considered head of the household in which the grandchildren reside, she may be the major financial provider and/or decision maker of the family. Grandmothers are by far the greatest providers of informal child care, yet little is known about how grandmothers view this role. Insights into grandmother’s experiences have the potential to inform child and family policies. Grandparents experienced a strong bonding with their grandchild, described by grandparents as a responsive, intensive form of nurturing.7
Each family has its own situation or system within which particular variables interplay and impact on decision-making processes. Within every grandmothers story or experience there were positive and negative aspects. However, underpinning all the stories was a desire on the part of grandmothers to support their adult children’s wellbeing. Associated with this was an intense desire to be part of their grandchild’s everyday life.7
1.3 NEED OF THE STUDY
Recent changes in family and society have meant that the roles grandparents take on have changed. Many grandparents are playing a bigger and more responsible part of grandchild care than they may have expected, which means additional pressures on their time, their health and their finances. The increasing importance of grandparents, particularly as carers for children, has positive effects for society as a whole and needs support to continue to be effective.
The involvement of grandmothers in their grandchildren’s care varies a great deal, depending on individual, ethnic, cultural, economic and parent’s age factors. It is also not a static situation: as parents evolve around different life challenges, grandmothers may change from “vacation buddies” to daily caretakers and eventually can be pushed into a full custody situation or, less likely, transition back to their previous roles.
Goodman and Silverstein focused only on grandmothers extensively involved on their grandchildren’s care. They divided their subjects between two groups: co-parenting and custodial. As they compared factors associated with these situations, they found that custodial grand parenting was usually assumed under disruptive circumstances, often the consequence of serious problems experienced by parents and it was typically an unanticipated, involuntary and indefinite situation. In contrast, co-parenting arrangements happened when grandmothers housed both grandchildren and their parent(s) and became partners in childrearing, a classic but not exclusive solution in case of very young mothers.
Stress is the physiological reaction of the body to life situations that can be either positive (eustress) or negative (distress) (Selye, 1956). A stressor is any environmental, social or internal demand that require a person to make an adjustment (Lzarus & Folkman, 1984). Stress without anxiety, but cannot have anxiety without stress. Coping strategies, therefore, rare important in preventing anxiety responses from occurring. Coping strategies are behavioral and cognitive attempts to adjust to situational demands that are perceived to exceed a person’s ability to adapt (Lzarus & Folkman, 1984). Pepole who effectively use buffers to deal with stress have been found to lead a healthier and better quality of life than people who do not.
Stress affects most people in some way. Acute (sudden, short-term) stress leads to rapid changes throughout the body. Almost all body systems (the heart and blood vessels, the immune system, the lungs, the digestive system, the sensory organs, and brain) gear up to meet perceived danger. These stresses could prove beneficial in a critical, life-or-death situation. Over time, however, repeated stressful situations put a strain on the body that may contribute to physical and psychological problems. Chronic (long-term) stress can have real health consequences and should be addressed like any other health concern. Fortunately, research is showing that lifestyle changes and stress-reduction techniques can help people learn to manage their stress.
In all four sites in Asia and Africa, the several biases against grandmothers were systematically disproved. First, rapid assessments in all sites revealed that grandmothers have considerable influence on all matters related to women and children’s well-being and on other household members’ attitudes and practices in this regard. Second, while some of their practices are harmful, overall, their experience, motivation and commitment to caring for women and children are very positive. Third, the majority of grandmothers, including illiterate ones, are capable of learning new things when the pedagogical approach used is based on respect and dialogue. Fourth, they are very open to combining “new” practices with “old” ones, even when this means abandoning certain traditions.
In a study by Peterman (2005) of grandmothers raising grandchildren, suggested factors associated with negative attachment among adolescent grandchildren included lack of exhibited warmth and closeness by grandmothers, little involvement with their grandchildren, and little or poor supervision. As a result, these grandchildren are at risk for poor social functioning. Certainly, not all grandchildren exhibit negative behaviours when living with their grandparents, but there is enough evidence that raises concerns and suggests specialized mental health intervention for grandchildren is a vital support service for these families.
For almost two decades, grandmothers have increasingly become primary caregivers for their grandchildren. Grandparent caregivers experience altered health outcomes secondary to the stress of stretched finances and other problems—when care giving roles are assumed, grandmothers are often pushed into poverty. In fact, approximately 19% of grandmothers caregiver families are below the poverty line.
In recent years, grandmothers have become an important source of childcare (Hayes, Weston, Qu & Gray, 2010). In fact, they are the major providers of informal childcare for infants and toddlers (0-2 years) when parents are working or studying; more than half (52%) of children in this age group who are in childcare are in the informal care of grandmothers (ABS, 2005 A). An overwhelming majority of parents report being very satisfied (92.4%) or satisfied (7.1%) with grandmothers care (NICHD, 1996). Grandmothers care is also more flexible than formal care and it usually costs nothing (ABS, 2005 A; Gray, Misson & Hayes, 2005).4
Hall EO conducted a study in Denmark (1990) by interviewing Grandmothers play an active part in family health and illness, but so far they are peripheral in both nursing and nursing research. This article addresses grandmothers' lived experiences when a small grandchild is critically ill. A convenience sample of 7 grandmothers was interviewed once. With the use of the methodology of Van Manen, (1990), the essence of the phenomenon was found to be a "double concern," a worry and loving care that encompassed both parents and grandchildren. Although the findings have limitations, they constitute a systematic and thematic description of Danish grandmothers' experiences and therefore add to a family-oriented body of knowledge in pediatric nursing.5
Based on the investigators experience and review of literature the investigator found that many grandmothers are suffering from stress and anxiety due to child rearing practices and they have inadequate knowledge regarding stress reducing and coping strategies, so the investigator would like to conduct this study.
1.4 REVIEW OF LITERATURE
“Literature review is defined as a broad, comprehensive, in depth, systematic & critical review of scholarly publication, unpublished printed or audio visual materials and personal communications.”
-S.K Sharma
The review of literature for the present study has been organised under the following headings:
. Studies related to prevalence of stress in the grandparents involved in child rearing practices.
2.Studies related management of stress in the grandparents involved in grandchildren rearing practices.
1.5 OBJECTIVES OF THE STUDY
  1. To assess the level of stress among grandparents rearing grandchildren of employed mothers.
  2. To find out correlation between stress among grandparents rearing grandchildren of employed mothers .
  3. To develop family management programme on stress among grandparents rearing grandchildren of employed mothers.
  4. To find out association between stress among grandparents of grandchildren with employed mothers with their child rearing practice.
1.6 OPERATIONAL DEFINITIONS
STRESS:
It refers to type of pressure or tension that brings unhappiness and eventually a compulsion to grandmother involved in grandchildren rearing activities.
2. GRANDPARENTS: Grandparents who is ones parent’s mothers or father have stress in child rearing practices.
3. REARING: It refers to build or bring up the grandchildren by grandparents.
4. FAMILY MANAGEMENT PROGRAMME: It refers to an organized teaching programme to grandparents involved in grandchildren rearing practices.
This includes general information on stress, causes, prevalence, risk factors, signs and symptoms, effects of stress, complications and follows up. It will be prepared in English and Kannada.
1.7ASSUMPTIONS
The study assume that
  • grandparents will have stress regarding rearing their grandchildren of employed mothers
  • The structured teaching programme regarding effects of stress level will helpful for grandparents in child rearing practice.
1.8DELIMITATION:
  1. The study is limited to stress among grandparents rearing grandchildren of employed mothers.
  2. The study is limited to selected areas at Karnataka.

2. / MATERIALS AND METHODS OF THE STUDY:
2.1 SOURCE OF DATA:
Grandparents with stress in grandchildren rearing practices in selected areas at BANGLORU.
2.2 METHODS OF DATA COLLECTION:
Structured interview schedule will be used to assess the knowledge regarding effects of stress among grandparents with grandchildren rearing practices.
2.2.1 Type of study/research approach
2.2.2 Research design:
Evaluative research approach
2.2.3 Variables:
  • DEPENDENT VARIABLE: Knowledge regarding effects of stress among grandparents in grandchildren rearing practices.
  • INDEPENDENT VARIABLE: Structured teaching programme on effects of high levels of stress in grandchildren rearing practices.
  • EXTRANEOUS VARIABLE: Socio demographic variables of grandparents like age, educational status, occupation, Family income, Type of family, Area of residence, Religion, Number of grandchildren, Family history of stress and sources of information on management of stress.
  • Sampling technique:
convenient sampling technique will be used to select the sample
2.2.5 Sample size:
Sample size of the study is 60(n=60)
2.2.6 Criteria for selection of sample:
Inclusion criteria:
  • Grandparents with grandchildren rearing practices.
  • Grandparents with grandchildren who are willing to participate in the study.
Exclusion criteria
  • Grandparents with no grandchildren.
  • Grandparents with grandchildren who are not available during time of data collection period.
  • Grandparents with any serious problems.
2.2.7 Follow up: Post test will be conducted after one week of pre test
2.2.8 Tools/ Instrument:
A structured questionnaire will be prepared in such a way it will consist two parts.
SECTION- A: The socio demographic data sheet consists of details of the respondents in terms of grandmothers like age, educational status, occupation, Family income, Type of family, Area of residence, Religion, Number of grandchildren, Family history of stress.
SECTION- B: Knowledge questionnaire on Effects of stress in grandchildren rearing practices.
2.2.9. Data collection procedure
  • Formal permission will be obtained from the authorities of selected hospitals
  • The investigator introduces self and purpose of the study
  • Consent will be obtained from selected immobilized orthopaedic patients
  • Pre test will be conducted for the patients
  • Planned teaching programme will be administered to the patients
  • Conduction of post test after one week.
2.2.10. Plan for statistical analysis
The data obtained will be analyzed in terms of the objective of the study using descriptive and inferential statistics
Descriptive statistics
  • Frequency and percentage analysis will be used to describe the demographic characteristics of immobilized orthopaedic patients
  • Descriptive analysis such as mean, range standard deviation and mean score percent will be used to assess the knowledge on prevention of deep vein thrombosis among immobilized orthopaedic patients
Inferential statistics
  • Paired t - Test will be carried out to assess the statistical significance and compare the pre and post test knowledge score on prevention of deep vein thrombosis among immobilized orthopaedic patients
  • The Chi -Square analysis will be used to determine the association between knowledge and selected demographic variables.
EXPECTED OUTCOMES
•The findings of this study will reveal the stress level regarding grandparents rearing grandchildren. This will also help in reducing the stress among the grandparents by which using copping strategies among grandparents for develop positive effects for society and for family and to encourage the grandparents to lead a positive life.
3. / BIBLIOGRAPHY
  1. WHO. Population aging: A looming public health challenge, Health for the millions; Sept-Oct 1998; Pg No. 20.
  2. Usha V.K and Lalitha K.Social problems of senior citizens. Journal of Nightingale Nursing Times;Vol:7, No:7; Oct-2011; Pg:12,13,64.
  3. Manpreet Kaur; “Time for introducing geriatric care”; Journal of Nightingale Nursing Times; Vol:6, No:11; Feb-2011;Pg No. 21-23.
  4. Suzanne .C. Smeltzer. Benda Bare. “Brunner and Suddharth’s Text book of medical and surgical nursing”; 10th edition; 2004; Lippincott company; Philadelphia : Pg. No.189,197.
  5. Burton L. M. (1992). Black grandparents rearing children of drug-addicted parents: Stressors, outcomes, and social service needs;
  6. By June Groden, Ph.D., Pat Levasseur, M.Ed., Matthew S. Goodwin, M.A;’’ Stress and Autism—Coping and Self-Control Techiques for those on the Autism Spectrum’’;
  7. Minal Sharma and Shubhada Kanani; “Grandmothers influence on Child care”; Indain journal of pediatrics; vol:73,Apr-2006; Pg No.295-298.
  8. Gayathri Ponvannan, “The virtual grandmother”; The Hindu News paper; July 25 2009; Pg No.13.
  9. The changing role of grandparents; Nov.18.2010;
  10. Bonita F.Bowers and Barbara J.Myers.Grandmothers providing care for grandchildren : Conseqences of various levels of caregiving (1999).
  11. Beatriz Carlini-Marlatt. Grandparents in custodial care of their grandchildren : A literature review; Dec 2005; Mentor publications; UK; Pg No. 01-20.
  12. Denies.F, Pilot, Chergl Tatano Blank, “Nursing Research”; 8th edition. 2008; Lippincott. New delhi; Pg No.411.
  13. Basavanthappa B.T. Nursing research. 1st edition. 1998; Jaypee brothers medical publications, New Delhi; Pg No.49,411.
  14. Goodman and Silverstein;
  15. Conway F, Jones S, Speakes-Lewis A (2011);
  16. Smith GC Hencock GR (2010);

4. / SIGNATURE OF THE CANDIDATE
5. / NAME AND DESIGNATION OF (IN BLOCK LETTERS)
5.1 SUPERVISOR
5.2 SIGNATURE OF THE SUPERVISOR
5.3 Co- SUPERVISOR
5.4 SIGNATURE OF THE Co-SUPERVISOR
5.5 HEAD OF THE INSTITUTION
5.6 SIGNATURE OF THE HEAD OF THE INSTITUTION

INDEX

S.No / CONTENT / PAGE NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10
11 / STATEMENT OF THE PROBLEM
INTRODUCTION
NEED OF THE STUDY
REVIEW OF LITERATURE
OBJECTIVE OF THE STUDY
OPERATIONAL DEFINITIONS
ASSUMPTION
DELIMITATION
MATERIAL AND METHODS OF THE STUDY
EXPECTED OUTCOMES
BIBLIOGRAPHY / 1
2-3
4-5
6
7
7
8
8
10-11
12
13-14

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