RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE.ANNEXURE IPROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1Name of the candidate and address (in block letters)

SHINELAL S.V.FIRST YEAR M.Sc NURSING

SAHYADRI COLLEGE OF NURSING

FALNIR ROAD, KANKANADY

MANGALORE- 575 002

2Name of the institution

SAHYADRI COLLEGE OF NURSING

FALNIR ROAD

KANKANADY

MANGALORE- 575 002

3Course of the Study and Subject

M.Sc NURSINGMENTAL HEALTH (PSYCHIATRIC) NURSING

4Date of admission to the course

5th JUNE 2009

5Title of the topic

sxA STUDY TO ASSESS THE Effectiveness Of GUIDED IMAGERY On Stress Among Elderly In Selected Old Age HomeS At Mangalore, KARNATAKA.

6.

7.8.

Brief resume of the intended worK

Introduction

it is possible for thought-processes to become conscious through a reversion to visual residues [and] in many people; this seems to be a favorite method. Thinking in picturesapproximates more closely to unconscious processes than does thinking in words, and it is unquestionably older than the latter both ontogenetically and phylogenctically.Sigmund Freud- The Ego and the Id Imagery is the most fundamental language we have. Everything we do, the mind processes through images. Imagery is the language that the mind uses to communicate with the body. When we recall events from our past or childhood, we think of pictures, images, sounds, pain, etc. It is hardly ever be through words. Images and other senses are the means used by the brain to communicate with our other organs. Imagination can be a powerful tool to help combat stress, tension, and anxiety.Imagining being in a certain environment or situation can activate the senses, producing a physical or psychological effect. 6.1 Need for the Study

A man's life is normally divided into five main stages namely infancy, childhood, adolescence, adulthood and old age. In each of these stages an individual has to find himself in different situations and face different problems. In old age physical strength deteriorates, mental stability diminishes. The world's elderly population is 650 million. By 2050, the "greying" population is forecast to reach 2 billion. By 2050 about 80% of the elderly will be living in developing countries.There are 81million older people in India. The Indian family has traditionally provided natural social security to the old people. However, in more recent times, the traditional role of the family is being shared by institutions such as old age homes. It is often assumed, and sometimes argued, that the absence of familial care and surroundings induce stress among the residents of old age homes. Researchers at Edinburgh University have found that stress is a major cause of depression and Alzheimer's disease in old age .They have identified an area of the brain which shrinks in old age resulting in depression and Alzheimer's disease. The shrinkage of a region of the brain called the anterior cingulate cortex result in the release of high levels of stress hormones. Many people use imagery daily without realizing it. Imagery entails the use of imagination to alter perceptions of events, surroundings or experiences. Guided imagery is considered a part of the growing field of psychoneuroimmunology. The new science of psychoneuroimmunology seeks to clarify the connection between the mind and emotions, the brain and central nervous system, and the bodys cellular responses. Guided imagery is particularly helpful for stress management and for reducing symptoms related to anxiety, pain and other mental health conditions. Many guided imagery scripts include common elements such as asking the patient to sit or lie in a comfortable position, quieting the mind, removing negative thoughts and images, and calling to mind a vivid image or scenario that is calming and relaxing. A randomized pilot study was conducted by Baird CL, Sands LP to test the effectiveness of guided imagery with relaxation (GIR) to improve health-related quality of life (HRQOL) in women with osteoarthritis. A two-group (intervention versus control) longitudinal design was used to determine whether GIR leads to better HRQOL in these individuals and whether improvement in HRQOL could be attributed to intervention-associated improvements in pain and mobility. Twenty eight women were randomized to either the GIR intervention or the control intervention group. Using GIR for 12 weeks significantly increased women's HRQOL in comparison to the women who used the control intervention, even after statistically adjusting for changes in pain and mobility. GIR may be an easy-to-use self-management intervention to improve the quality of life of older adults with osteoarthritis.1 Results of a study conducted at the Cleveland Clinic Foundation and published in 1999 found that cardiac surgery patients who used a guided imagery tape prior to surgery experienced less pain and anxiety. 2 The investigator came across that the elderly in old age homes face stress from various situations, which are different from those that are faced by adults. Guided imagery has been found to provide significant stress reduction benefits, including physically relaxing the body quickly. In India, studies in nursing regarding guided imagery among elderly as a method of stress reduction are few. So, the investigator felt that the guided imagery on stress among elderly in old age homes would provide significant stress reduction benefits and more over it would enrich the nursing literature also.6.2 Review of Literature

Review of literature is the summary of current theoretical and scientific knowledge about a particular problem, and resulting in a synthesis of what is known and not known.3 A study was conducted by Carter E to assess the effect of non-individualized guided imagery CDs, or prepackaged guided imagery (PPGI) on life stress and stress related symptoms. The PPGI used in this instance was a series of CDs with associated written material developed for a range of personal issues by practicing professionals. It indicated that the use of these CDs results in quick reduction of stress-related issues for all participants. Marked improvements were identified in general feelings of well-being (91%), positive thoughts (82%) and ability to cope in stressful situations (73%). Decrease in incidence ratings were greatest in insomnia, anger and negative thoughts.4

A study was conducted by Weber S to investigate the effects of relaxation exercises especially guided imagery on anxiety levels in psychiatric inpatients. Convenience samples of 39 subjects were studied. Anxiety levels were measured prior to and post interventions with the state portion of the State-Trait Anxiety Inventory. Progressive muscle relaxation, meditative breathing, guided imagery, and soft music were employed to promote relaxation. A significant reduction in anxiety level was obtained on the post-test. 5 A study was conducted by DianeLT, JamesMC, et al on colorectal surgery patients. Patients were randomly assigned into one of two groups. Group 1 received standard perioperative care, and group 2 listened to a guided imagery tape three days preoperatively; a music-only tape during induction, during surgery, and postoperatively in the recovery room; a guided imagery tape during each of the first six postoperative days. Before surgery, anxiety increased in the control group but decreased in the guided imagery group (median change, 30; P < 0.001). 6 A study was conducted by Antall GF, Kresevic D on a sample of 13 patients aged 55 and above. The purpose of this study was to test the effects of guided imagery intervention in the older adult patient who has undergone joint replacement surgery. The control group received usual care and a music audio tape. The experimental group received usual care and a guided imagery audio tape intervention. This study demonstrated positive outcomes for pain relief, decreased anxiety, and decreased length of stay. 7 A study was conducted by Apostolo JL , Kolcaba K on the efficacy of guided imagery intervention for decreasing depression, anxiety, and stress on 60 short-term hospitalized depressive patients in Portugal. The experimental group listened to a guided imagery compact disk once a day for 10 days. The Psychiatric Inpatients Comfort Scale and the Depression, Anxiety, and Stress Scales (DASS-21) were self-administered at two time points: prior to the intervention (T1) and 10 days later (T2). Comfort and DASS-21 were also assessed in the usual care group at T1 and T2. Repeated measures revealed that the treatment group had significantly improved comfort and decreased depression, anxiety, and stress over time. 8 6.3 Statement of the Problem

A STUDY TO ASSESS The Effectiveness Of GUIDED IMAGERY On Stress Among Elderly In Selected Old Age HomeS At Mangalore, KARNATAKA.6.4 Objectives of the Study To assess the level of stress among elderly staying in old age homes before and after administering guided imagery.

To determine the effectiveness of guided imagery in terms of reduction in stress among elderly staying in old age homes.

To assess the association between the mean stress level and the selected variables among elderly.6.5 Operational Definitions

Effectiveness: According to Oxford Dictionary effectiveness refers to producing the intended result. In this study, effectiveness refers to the extent to which the guided imagery will help to achieve a reduction in stress in elderly as measured by modified stress scale.

Guided imagery: Merriam-Websters dictionary defines guided imagery as any of various techniques (as a series of verbal suggestions) used to guide another person or oneself in imagining sensations and especially in visualizing an image in the mind to bring about a desired physical response (as a reduction in stress, anxiety, or pain). In this study, guided imagery refers to guiding the elderly individuals through a sequence of pleasant situation with the use of a recorded audio cassette for 15 minutes once a daily for 5 days to achieve relaxation through reduction in stress.Stress: A particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her wellbeing ( Lazarus & Folkman-1984 ) In this study stress refers to when elderly individuals perceive that they cannot adequately cope with the demands being made on them or with threats made to their well being as measured by modified stress scale.Elderly: The age of 60 or 65, roughly equivalent to retirement ages in most developed countries, is said to be the beginning of old age.(WHO) In this study elderly refers to 65 and above who are living in selected old age homes at Mangalore.Old age home: Old age home is the home which is specially made for the elderly to fulfill their physical, psychological, social and spiritual needs of an individual. In this study old age home refers to an institution run by private agencies which gives care, shelter and food for the geriatric clients which is situated in Mangalore, Karnataka.6.6 Assumptions Elderly will have stress.

Elderly use coping mechanisms to combat stress.

Stress affects the quality of life in elderly

Guided imagery provides relaxation.6.7 Delimitations

The study will be delimited to the elderly in selected old age homes at Mangalore only.6.8 Hypotheses All hypotheses will be tested at 0.05 level of significance.

H1: The mean post test stress score will be significantly lower than that of mean pre-test score. H2: There will be significant association between the mean pre- test stress score and the selected demographic variables.MATERIALS AND METHODS7.1 Source of DataThe data will be collected from elderly (both males and females) who are living in the selected old age homes at Mangalore.7.1. Research Design Quasi experimental- pre-test post-test control group design will be used for the study.Subject

Pre-test

Treatment

Post-test

experimental group

O1XO2control groupO1-O27.1. 2.Setting The study will be conducted in the selected old age homes at Mangalore.7.1. 3.Population

The population of the study would consist of elderly who are staying in the selected old age homes at Mangalore.7.2 METHOD OF DATA COLLECTION7.2 .1 Sampling Procedure

The old age homes will be selected using convenience sampling technique.

7.2 .2 Sample Size

The sample for the present study would consist of 30 elderly for the experiment group and 30 for control group living in the selected old age homes at Mangalore.7.2 .3 Inclusion Criteria for Sampling Elderly who are living in the selected old age homes. Elderly who are available during the study.

Elderly who are willing to participate in the study.7.2.4 Exclusion Criteria

Elderly who are suffering from psychosis and organic brain disorder. Elderly who are suffering from low blood pressure. Elderly with post traumatic stress disorder. Elderly who are hospitalized.7.2.5. Instruments intended to be usedBaseline demographic proforma

Modified stress scale7.2.6. Data Collection Method

After obtaining administrative sanction from the concerned authority of the selected old age homes, the investigator will select the elderly people. The purpose the study will be explained to them and informed consent will be obtained. The pilot study will be conducted to assess the effectiveness of imagery in elderly.Pre-test will be conducted with the questionnaire and modified stress scale. Intervention (guided imagery) will be administered to experimental group only. Posttest will be conducted with the same stress scale to both control and experimental group. After the completion of research study, guided imagery will be administered to control group. The entire data collection will last over a period of 30 days.7.2.7. Plan for Data Analysis

Based on the objectives, data analysis will be done using descriptive and inferential statistics. Descriptive statistics such as mean, percentage and frequency will be used to depict the demographic data as well as the stress scores. In Inferential statistics. t test will be used to find the effectiveness of the guided imagery and chi square will be used to find the association between mean stress score and the demographic variables. The data will be presented in the form of tables, graphs and diagrams.7.3. Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.

Yes, the investigator needs to assess the effectiveness of guided imagery on stress among elderly in selected old age homes at Mangalore.7.4. Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance will be obtained from the research committee of the College of Nursing prior to the conduction of the study. Administrative permission will be obtained from the concerned authorities and written consent will be obtained from the sample and confidentiality will be assured.List of References1. Baird CL, Sands LP. Effect of guided imagery with relaxation on health related quality of life in older women with osteoarthritis. Research in Nursing and Health. 2006; 29(5):442-4512. http://www.healthline.com/galecontent/guided-imagery?print=truessed-(Accessed on 24.11.2009)

3. Burns. N., Grove SK. Understanding Nursing Research. 4th ed.Texas: Saunders; 2007. p.553

4. Carter E. Pre-packaged guided imagery for stress reduction. Counseling, Psychotherapy and Health. 2006; 2 (2): 27-395. Weber S. The effects of relaxation exercises on anxiety levels in psychiatric inpatients. Journal Of Holistic Nursing.1996; 14(3):196-2056. DianeLT, JamesMC, ScottAS, JeffreyA,Grass, VictorWF. A significant advance in the care of patients undergoing elective colorectal surgery. Diseases of the Colon and Rectum.1997; 40(2):172-178

7. Antall GF, Kresevic D. The use of guided imagery CDs to manage pain in an elderly orthopedic population. Orthopedic Nursing. 2004; 23(5):335-3408. Apostolo JL, Kolcaba K. The effects of guided imagery on comfort, depression, anxiety, and stress of psychiatric inpatients with depressive disorders. Arch Psychiatric Nursing. 2009; 23(6): 403-411

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