PROFORMA FOR REGESTRATION OF SUBJECT FOR
DISSERTATION
SUSAN WESLEY NALLI
I YEAR M. Sc NURSING
PSYCHIATRIC NURSING
YEAR 2011 -2012
IKON NURSING COLLEGE,
BEEMANAHALLI, B.M.MAIN ROAD
BIDADI (H), RAMANAGAR TALUK
BANGALORE - 562109
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / SUSAN WESLEY NALLII YEAR M. SC NURSING
IKON COLLEGE OF NURSING
NO.32 BEEMANAHALLI
BIDADI – 562109
BANGALORE- MYSORE ROAD
RAMANAGARAM TALUK.
2 / NAME OF THE INSTITUTION / Ikon Nursing College ,
Bangalore.
3 / COURSE OF THE STUDY AND SUBJECT / I Year M.Sc Nursing
Psychiatric Nursing
4 / DATE OF ADMISSION / 30/07/2011
5 / TITLE OF THE TOPIC / A Study to Evaluate the Effectiveness of Stress Reduction Programme, on Stress Among Wives of Alcoholics in a Selected Rural Area, Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK:
6.1 INTRODUCTION:
“Mankind has used two powerful weapons to destroy its own powers and enjoyment, Wrong indulgence and wrong abstinence” - Sri Aurobindo
Alcohol use in India is generally regarded as a traditional ‘dry’ or ‘abstaining’ culture. A recent National Household Survey of Drug Use in the country, the only systematic effort to document the nation-wide prevalence of drug use, recorded alcohol use in 51% of adult males. Expectedly, this figure can accurately mirror the wide variation that obtains in a large and complex country like India. The prevalence of current use of alcohol ranged from a low of 7% in the western state of Gujarat to 75% in the Northeastern state of Arunachal Pradesh. Significantly higher use has been recorded among tribal, rural and lower socioeconomic urban.
Alcoholism leaves a severe impact on people. Alcohol use disorders have been prevalent across all societies. The pattern of alcohol use varies depending on age, religion, education, type of drink and other socio-demographic characteristics. The consumption pattern also varies between different cultures and societies and the last 20 years have seen substantial changes. Alcohol use is increasing in developing countries, but reliable data are not available. Since 1970, to 2010, 47% of developing countries in transition and 35% of developed countries have increased their consumption of absolute alcohol per adult World Health Organization.1
Addiction is a family problem and is a major source of stress for family members. Family disruption related to alcoholism is a serious, complex and pervasive social problem. Alcoholism is linked to violence, disrupted family roles, and impaired family communication and partly to physical and psychological illness that occurs
Alcohol causes 4% of the total Disability Adjusted Life Years (DALYs) and alcohol use disorders account for 1.4% of the total burden of disease, according to recent estimates of WHO. In view of the public health importance of alcohol-related health and social consequences, it is important to estimate the amount of alcohol consumed and gather information on the pattern of drinking. Such information is scarce from developing countries.2
Alcohol has been consumed in India for centuries. A number of mythological and religious books have highlighted the role it played in society. The pattern of drinking in India has undergone a change from occasional and ritualistic use to being a social event. Today, the common purpose of consuming alcohol is to get drunk. These developments have raised concerns about the health and the social consequences of excessive drinking. Large or nationally representative epidemiological studies on alcohol consumption have not been carried out in India due to resource constraints. However, there have been a number of studies conducted on smaller populations in different regions of the country.
Alcoholism in marriage, compulsive caretaking often grows alongside the deteriorating self-care of the compulsive drinker. An alcoholic spouse may neglect or abuse his or her family, deplete financial resources, and create legal problems for the family.3
Alcohol abuse increases the feelings of marital distress. Individuals in marriages in which one or both spouses is an alcoholic report higher levels of marital distress or trouble than do married individuals who are not married to alcoholics. 4
Marital satisfaction is related strongly to a couple's ability to communicate effectively. But heavy alcohol use is associated with more negative and hostile communication, more expressions of anger, and less warmth and unity in the relationship. These factors decrease a couple's satisfaction in their marriage and create greater tension. Alcohol abuse decreases marital satisfaction because it decreases the drinking spouse's ability to participate in everyday household tasks and responsibilities. This inability leads to greater stress on the non-drinking spouse and decreases satisfaction in the marriage.5
Alcohol abuse increases the psychological distress of the non-drinking spouse. An adult's alcohol abuse also is related to children's increased social, emotional, behavioral, and academic problems, which, in turn, leads to more stress in the family and less marital satisfaction.6
Differences between spouses in their drinking behaviors decrease marital quality and increase the likelihood of divorce. One reason for this increased likelihood is that drinking has an impact on the amount of time that partners spend together, especially if the alcoholic frequently drinks away from home. The more time spent apart, the less satisfied the nonalcoholic spouse becomes and the greater the potential for divorce.7
With alcoholism and marriage, alcoholic spouses tend to use more negative and damaging communication (e.g., criticizing, blaming, and contempt), express more anger, and show lower levels of warmth when trying to solve a problem than do nonalcoholic spouses. This kind of negative communication discourages the use of positive problem solving skills such as open discussion and encouragement. 8
Alcoholism is not simply an individual problem. Families often play a significant role in the "cause" and "cure" of alcohol abuse. For this reason, research shows that therapy that involves the spouse and possibly other family members is more helpful to overcoming alcoholism than is only treating the individual who has the alcohol problem.9
6.2 NEED FOR THE STUDY
Level of stress may be dependent upon the extent to which the alcoholic and their spouse hold dissimilar perceptions about problems, the links between the drinker’s own concerns and the pressure exerted by the spouse can be particularly troublesome when the individual’s own evaluation is not supported by this partner.
The Stress Reduction Program, founded by Dr. Jon Kabat-Zinn in 1979, has been featured in the Bill Moyers’ PBS documentary Healing and The Mind, on NBC Dateline, on ABC’s Chronicleand in various national print media.10
Lifestressors are defined as relatively discrete life events or experiences that are perceived as exceeding the individual’s resources and are perceived as a negative threat or harm. This definition refers to discrete life events that occur in the context of work, family e.g., separation, extramarital affair, or other interpersonal relationships e.g., moving to a new residence, an arrest. There are several additional classes of stressors, including daily hassles e.g., waiting in lines, paying bills and chronic stressors e.g., racial discrimination, a family member’s chronic medical condition, all of which may have some impact on an individual’s psychological and physical well-being. This paper attempts to examine the association between daily / chronic life stressors and spouse of alcoholics. 11
The second national family survey conducted at kollaram dist, kerala, India results indicate that among the Indian population, 17% of men right from the age of 15 and above are consuming alcohol. Addiction is a family problem and is a major source of stress for family members. Family disruption related to alcoholism is a serious, complex and pervasive social problem included with stress. 12
The consequences of alcoholism all too often result in chaotic, disorganized and dysfunctional families. Families of alcoholics experience guilt, shame, resentment, insecurity, delinquency, financial troubles, isolation, fear and violence. Husbands were hospitalized for the first time for de addiction (not the National association for children of alcoholics, USA states that alcoholic families demonstrate poorer problem solving abilities than non-alcoholic families both among the parents and within the family as a whole. These poor communication and problem solving skills may be mechanisms through which lack of cohesion and increased conflict develop and escalate in alcoholic families.13
There is substantial evidence for the negative effects of alcohol misuse not only for the drinkers themselves, but also for their families Alcohol is known as family disease because it is responsible for more family problems than any other single cause. Each member of the family may be affected by alcohol differently. Adjustment to an alcohol problem of husband may result in an increase in the family’s emotional and physical illness and altered familial function. The most negatively affected family members are spouse and children of an alcoholic. 14
Identity of alcoholics spouse seems to lie solely in their status as wives of alcoholics. They have to endure years of isolation, blame of relatives, lack of friends, little money, violence, unsatisfactory sexualrelations. The spouses of drinkers suffer from elevated rates of depression, anxiety and somatic complaints, report low levels of relationship satisfaction, and often aresubjected to verbal and physical abuse. 15
Hence in India, the survey conducted reveals the problems associated with intake of alcohol, include, spousal assaults 62%, spousal abuse 50%, traffic fatalities 45%, child abuse 38%, rapes 32%, murders 49%, suicides 20%.in the percentages listed, the weight age is much focused on the spousal abuse, and assaults .The need for handling the stress among the family members, and especially the wives who undergo, the psychological stress
This study will help community health nurses, and psychiatric nurses to identify, various coping strategies adopted by wives of alcoholics and will helpthem to strengthen the healthy adaptive coping strategies and rectify the maladaptive coping strategies and help tto perceive the stressful situations as manageable and challenging.
6.3 STATEMENT OF THE PROBLEM
A Study to Evaluate the Effectiveness of Stress Reduction Programme,on Stress among Wives of Alcoholics in a Selected Rural Area, Bangalore
6.4 Objectives of the study:
- To assess the stress level before administering the programme.
- To assess the stress level after administering the programme.
- To determine the effectivenessof stress reduction programme by comparing the stress levels before and after the programme.
- To associate the pre test stress level among the wives of alcoholics with their selected demographic variables
6.5 OPERATIONAL DEFINITIONS:
EFFECTIVENESS:
Producing a strong impression or response, that is expected out of it.
STRESS:
It is the body's reaction to a change that requires a physical, mental or emotional adjustment or response. It can come from any situation or thought that makes you feel frustrated, angry, nervous, or anxious.
STRESS REDUCTION PROGRAMME
Stress reduction programme refers to various strategies that counteract the response which produces stress and produces a sense of relaxation, which include, Jacobson’s s relaxation technique, behavioral approaches like identification of stressors, Meditation practices, gentle stretching and mindful yoga Group, dialogue and discussions aimed at enhancing awareness in everyday life.
WIVES OF ALCOHOLICS:
Spouses of persons who have lost all choice in the matter of how much they will drink once they he gets started. Eventually they findthemselves drinking too much again on one or more occasions, despite promising not to drink
6.6 ASSUMPTIONS
1. Wives of alcoholics may experience a higher level of stress.
2. EffectiveStress Reduction Programme may enhance reduction of stress among wives of alcoholics
6.7 HYPOTHESES:
H1: There will be a significant difference between stress levels before and after the stress reduction programme.
H2: There will be a significant association between pre test stress levels among the wives of alcoholics with their selected demographic variables.
6.8 REVIEW OF LITERATURE:
A literature review helps to lay the foundation for a study and also inspires new ideas. The literature review leads the reader through development of knowledge about choosen topic up to the present time to indicate why this current research topic was necessary.
A study was carried out in Kolar district to assessthe psychological stress among a sample of sixty 30 wives of alcoholics and 30 wives of non-alcoholics, for a period of one month January 2010. Interview Technique was used to collect data on an average the data reveals that all were aged less than 50 years and majority (43.33%) were between the age group of 20-30 years. Out of 30 sample subjects 83.33 percent belong to nuclear family. About 46.66 percent of the sample was married for more than 10 years and 46.66 percent have more than 3 children. 76.66 percent of the sample had monthly income of Rs. 1000-2000. Comparison of stress level scores among wives of alcoholics wives of non alcoholics show that there is a significant difference (p<0.05) between the stress level scores of the wives of alcoholics and the wives of non-alcoholics.16
A Study was conducted to assess the coping strategies among the women who were formerly married to alcoholics were interviewed in order to assess the stressfulness of their marriage, stressfulness of their childhoods, and their closeness to divorce. In support of sociological predictions, the more stressful the marriage the closer the wife was to divorce. There was no evidence of coping strategies, during the study.Contrary to psychoanalytic predictions, personality disturbance, indexed by stressfulness of childhood, did not correlate with closeness to divorce. Factor analytically derived subscales of marital and childhood stressors showed a significant psychosocial interaction; In addition, influence by others to separate, positive attitudes toward divorce, fear of violence, and little or no good period early in marriage all correlated positively with closeness to divorce. Possible alternative explanations for the present results and needed future research are discussed.17
The study was conducted to find out the association between drinking and psycho social stress. The data being analyzed come from a multi cluster random household sample of couples interviewed as part of the second wave of a 5-year national longitudinal study. The overall survey response rate for the second wave is 72%. Participants are couples 18 years of age or older (N = 387). Results show that. The associations are also present among women. However, data for women show an additional path linking higher levels of stress.. Acculturation, directly or through acculturation stress, increases the likelihood of woman among men who have this habit of drinking.18
A study was conducted to evaluate the marital instability in alcoholic spouse relationships associated with a degree of stress, as a function of drinking pattern and location the relation between alcohol consumption and marital stability was assessed longitudinally in two groups of male alcoholics: in-home and out-of-home drinkers. Through theuse of univariate and bivariate time-series analyses, the study identified a causal relation between alcohol consumption and marital stability and a significant impact of drinking location on obtained relations. Findings are discussed in terms of Steinglass's suggestion that alcohol can have adaptive consequences for the marriage and family life of alcoholics and has marked stress increase .19
A study conducted to examine the stress levels of the wives of alcoholics revealed a significantly greater result being five to seven times more prevalent for clinically elevated aggression and substantially more frequent—for the alcoholic husbands and their wives than for a demographically matched, nonalcoholic comparison sample. Verbal aggression was greater when the alcoholic husband drank more frequently Further, frequency of drinking was positively correlated with verbal aggression.20
A study was conducted to assess the stress levels among a sample of 586 married couples, and to assume the current alcohol dependence and heavy drinking. In addition, marital quality ratings in concordant and discordant couples were compared. Spouse concordance was significant for lifetime alcohol dependence and for both lifetime and current heavy drinking. Marital quality varied as a function of current heavy drinking and alcohol dependence such that members of couples in which neither spouse drank heavily reported better marital quality than other couples. Furthermore, although marital quality did not differ significantly between concordant and discordant couples, couples concordant for current heavy drinking consistently reported poorer marital quality than other couples.21
A controlled randomized study was conducted to assess the effectiveness of the abuse of alcohol. A theoretical discussion based on clinical observations can be dated back to the 1950's. knowledge is still incomplete, but the review indicates that loneliness may be significant at all stages in the course of alcoholism: as a contributing and maintaining factor in the growth of abuse among the wives, who suffer a lot, based on the predicting factors, of which, they cannot leave the children, and resist all their life in spending time with the unwatchful relation of such husbands. There are also associations with a broad array of psychopathology. In comparison to people with other health problems, the supportive value of the social network of alcoholics appears to be more wavering.22
A study was conducted with One hundred spouses of alcoholics (experimental group) were selected whose husbands were taking treatment from S.S.L. Hospital of B.H.U., Presumptive stressful life event scale (PSLES) was used in the present investigation to assess the stressful life events of spouse of alcoholic This scale is based on Holmes and Rahe’s Social Readjustment Rating Schedule. 73.0 % wives of alcoholics were facing physical abuse while spouse of non-alcoholics were facing only 17 %. Different types of emotional problems present were 89 % in alcoholic’s spouse while 32% present in spouse of non-alcoholic. Spouse of alcoholics had 68.0% financial problem whereas only 35% spouse of non alcoholics were facing financial problem. This study brings to light on vulnerability of psychosocial stresses among wives of alcoholics. There is need for sustained and committed efforts to remove alcohol abuse as well as screening for spouse psychosocial Stress.23