SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION

SUBMITTED TO:

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

IN PARTIAL FULFILLMENT

OF

M.Sc (N) IN OBSTETRICS AND GYNAECOLOGICAL NURSING

SUBMITTED BY:

MISS.JAISY JOSE

M.SC NURSING 1ST YEAR

UNDER THE GUIDANCE OF :

MRS.MADHUSHEELA

LECTURER DEPARTMENT OF OBSTETRICS AND GYNAECOLOGICAL NURSING

NARAYANA HRUDAYALAYA COLLEGE OF NURSING NO: 258/A, BOMMASANDRA INDUSTRIAL AREA ANEKAL TALUK, BANGALORE-99

1 NAME OF THE CANDIDATE AND ADDRESS

MISS.JAISY JOSE

1ST YEAR M.SC NURSING

NARAYANA HRUDAYALAYA COLLEGE OF NURSING NO:258/A,BOMMASANDRA INDUSTRIAL AREA ANEKAL TALUK, BANGALORE-99

2 NAME OF THE INSTITUTION NARAYANA HRUDAYALAYA COLLEGE

OF NURSING , BANGALORE

3 COURSE OF STUDY AND SUBJECTM.SC NURSING 1ST YEAROBSTETRICS AND GYNAECOLOGICAL NURSING

4 DATE OF ADMISSION TO COURSE 04-06-2012

5 TITLE OF THE TOPIC

“ A STUDY TO ASSESS THE EFFECTIVENESS OF THE BENSON’S RELAXATION TECHNIQUE ON REDUCTION OF PAIN AMONG HYSTERECTOMY PATIENTS IN SELECTED HOSPITAL, BANGALORE. ”

PROBLEM STATEMENT:

“ A STUDY TO ASSESS THE EFFECTIVENESS OF THE BENSON’S RELAXATION TECHNIQUE ON REDUCTION OF PAIN AMONG HYSTERECTOMY PATIENTS IN SELECTED HOSPITAL, BANGALORE. ”

ANNEXURE-I

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“ Your pain matters, it is your guide to healing”

Pain is omnipresent; an intolerable sensation serves as a biological

function. It signals the presence of damage or disease within the body. According to Joint

commission on health care organization (JCAHO), 2001, Pain has been introduced as the

fifth vital Sign. (1)

Pain is an unpleasant sensation and often associated with damage to the

body.2 The International Association for the study of pain defines pain as “an unpleasant

sensory and emotional experience with actual or potential tissue damage or described in

terms of such damage pain in what patient says hurt”. Pain motivates us to withdraw from

potentially damaging situation, protect a damage body while it heals and avoid those

situations in future. 3 Most pain resolves promptly once the painful stimulus is removed and

the body has healed, but sometimes pain persists despite removal of the stimulus and

apparent healing of the body and sometimes pain arises in the absence of any detectable

stimulus, damage or disease .4

The relief of pain has been one of the primary reasons for development

of health care. It is well documented that pain if inadequately relieved is deleterious and can

lead to a number of complications in the post operative period. Therefore the pain after

surgery must be relieved totally. 6

Pain is the major economic problem and a major cause for disability that

hampers the lives of many people. It can significantly interfere with a person’s quality of

life and general functioning. In the last decade alone numerous studies have continued to

prove that pain is still not adequately treated in all areas of health care. Inadequate pain

management can lead to many consequences affecting the client or the family,

physiologically, emotionally, and financially to greatly impair quality of life. 7

Surgical pain is an unpleasant sensation that results from a surgical

procedure. Pain is caused by damage done to the tissue by the incision, the procedure itself,

the closing of the wound and any force that applied during the procedure. Surgeries are

associated with more severe steady wound pain and pain on movement in the post- operative

period demanding good post-operative pain management.8

Post operative pain is one of the most common therapeutic problems

in hospitals.7 hysterectomy is one of the most common surgical techniques performed in

women as well as most frequently performed intra-abdominal surgery. Abdominal

hysterectomy is increasing worldwide and the current rate in India is 15-20 % . 9

Hysterectomy is the surgical removal of the womb (uterus). It is one of the

most common of all surgical procedures and can also involve the removal of the fallopian

tubes, ovaries, cervix and part of the vagina to cure or help a number of gynecological

complaints. Following this operation no longer have periods, not be fertile and will not be

able to have any more children.There are two main ways to perform a hysterectomy. The

most common way is to remove the womb through a cut in the lower abdomen. The second,

less common, way is to remove only the womb through vaginally.10

Total abdominal hysterectomy is commonly performed via a

Pfannenstiel incision and causes significant moderate to severe pain that requires

multimodal postoperative pain management . Pain after hysterectomy is often multifactorial

and arises from different sources. The sources of pain may include a combination of incision

pain, pain from deeper visceral structures, and dynamic pain or pain on movement, such as

during straining, coughing, or mobilizing that may be severe. The main aim of multimodal

analgesia is to obtain synergistic or additive analgesia, allowing a smaller dose of each drug

with improved safety profile and less side effects. This can be achieved by combining

analgesics acting at different locations of the pain pathway.11

Pain management after hysterectomy should involve pain assessment.

Analgesics are helpful in reducing pain in hysterectomy patients .the drugs such as

gabapentin , diclofenac , tramadol ,morphine and fentanyl are used.Side effects such as

nausea ,vomiting and pruritis are common.11

Relaxation is more than a state of mind; it physically changes the way our

body functions. When our body is relaxed breathing slows, blood pressure and oxygen

consumption decrease, and some people report an increased sense of well-being. This is

called the "relaxation response." Being able to produce the relaxation response using

relaxation techniques may counteract the effects of long-term stress, which may contribute

to or worsen a range of health problems including depression, digestive disorders,

headaches, high blood pressure , post operative pain and insomnia.12

Relaxation techniques often combine breathing and focused attention

on pleasing thoughts and images to calm the mind and the body. Most methods require only

brief instruction from a book or experienced practitioner before they can be done without

assistance. These techniques may be most effective when practiced regularly and combined

with good nutrition, regular exercise, and a strong social support system. 13

Dr. Benson is a pioneer in mind/body medicine, as well as in

bringing spirituality and healing into medicine. Through his 35 years career, he defined the

relaxation response and continues to lead teaching and research into its efficacy in

counteracting the harmful effects of stress. The recipient of numerous national and

international awards, Dr. Benson lectures widely about mind/body medicine . 13

Increasing the effectiveness of post-operative pain management has a

tremendous impact on a patient’s well-being such as reduced narcotic usage, lower pain

score and higher patient satisfaction. So use of non-pharmacological methods in addition to

analgesics is an excellent mode of pain management.

6.1: NEED FOR STUDY :

Hysterectomy is the most common non-pregnancy related major surgery

performed on women . In India annual incidence of hysterectomy is twenty three lakhs ten

thousand two hundred and sixty three .13 In USA annual incidence of hysterectomy is five

lakhs ninety thousand or 0.22%. In 2003 over sixty lakhs hysterectomies were performed in

US alone. Post-operative hysterectomy pain scares off lots of people. After hysterectomy

doctors are prescribing analgesics and complimentary therapies to manage the post-

operative pain .14

A study investigated pain in 80 hysterectomy patients during the first

two post operative days.The sample had severe pain in first post operative period .They had

moderate to severe pain on second post operative period .Thirty percent of the patients

reported that the pain disturbed their sleep during the first 2 days after the operation . Sixty

five percent patients indicated that pain made it hard for them to sleep in the 1st post

operative period . Some patients lie still when they are in pain , but others inform to the

doctors or nurses and ask for pain killers. If the painkillers cannot relieve their pain ,they

were requesting for them again.15

In India 33.3% of Hysterectomy performed in the age group of 20-

25 yrs, 22.2% in the age group of 25–30 yrs, 38.8% in the age group of 30-35 yrs, and 5.5%

in the age group of 35-40yrs.About 10% of Hysterectomies are performed to treat cancer of

the cervix, ovaries and uterus. The most frequent reason for Hysterectomy in U.S.A. is to

remove fibroid tumours accounting for 30% of surgeries. Treatment of endometriosis is the

reason for 20% of Hysterectomies. Another 20% of Hysterectomy are because of heavy

abnormal vaginal bleeding. The remaining 20% are performed for prolapsed uterus, pelvic

inflammatory diseases.16

Relaxation techniques can potentially reduce symptoms or

improve outcomes in the following conditions Premenstrual syndrome ,Pain ,post operative

patients, Irritable bowel syndrome, anxiety, infertility, high blood pressure, high

cholesterol, diabetes, panic disorders,chronic tension, headaches,

fibromyalgia,insomnia,psoriasis, arthritis,hyperactivity in children, as in attention deficit

hyperactivity disorder (ADHD)17

Relaxation techniques are helpful tools for coping with

stress and promoting long-term health by slowing down the body and quieting the mind.

Such techniques generally entails for refocusing attention (for example, noticing areas of

tension), increasing body awareness, and exercises (such as meditation) to connect the body

and mind together. In fact, more than 3,000 studies showed the beneficial effects of

relaxation on health and well being. Relaxation has also been suggested in patients after

surgery to speed up recovery, require less pain medication, lower blood pressure, and reduce

postoperative complications. Relaxation techniques are sometimes used by people with

insomnia or other sleep disorders.17

Rhythmic breathing exercise is a relaxation technique, which is

done in the same way as deep breathing, but it is timed to the rhythm of one’s heartbeat. It

increases oxygen supply, re-establishes the body’s own natural rhythm and can bring great

change in both physical and mental state. Relaxation techniques stimulate the relaxation

response in the body. It is proved that its more effective when it is done continuously.18

A study was conducted to assess the efficacy of Bensons

relaxation technique on post operative pain in coronary artery bypass graft patients.Samples

size was eighty , randomly divided into 2 equal groups. Benson’s relaxation with

analgesics in experimental group and analgesic drug in control group.The tool used were

visual analogue scale for pain .Pain was assessed before and after the intervention . The

findings of this study showed the mean of pain severity before and after relaxation in the

intervention group was reduced and were significant difference (P=0.0001). This study

concluded that Benson's relaxation technique not only can reduce postoperative pain in

coronary artery bypass graft pain, but also effected vital sign specifically respiratory rate

and increased patients peacefulnsess (satisfaction). Therefore can be used as a

complementary therapy .19

Alternative and complementary therapies to relieve discomfort

and pain have been popular for years mainly as adjuncts to drug therapy. Alternative and

complementary therapy is a non- pharmacological approach to health care and healing. It

involves interventions that are said to induce healing from within the client or improve the

internal environment so that the body, mind or spirit can heal, often referred to as natural

healing. This therapy includes distraction, imagery, relaxation, hypnosis, massage, music

therapy, aromatherapy, acupuncture, acupressure, prayer, meditation etc20

There for the researcher from her experience in working in gynecology

ward has found that patient who are undergone hysterectomy will be in severe pain

eventhough patients are getting analgesics . Since there are no studies done regarding

reduction of pain in hysterectomy patients by using Bensons relaxation technique ,so I

would like to do this study.

6.2: REVIEW OF LITERATURE:

A thorough literature review focusing on prior researches

related to the topic of the study, gives a strong foundation on which to base the

knowledge. Thus the survey of literature is one of the vital parts of any research

endeavour. The literature related to the present study is organised under the following

headings.

IT MAINLY DIVIDED IN TO THREE:

SECTION A : Review of literature related to hysterectomy pain .

SECTION B : Review of literature related to effectiveness of Benson’s relaxation

technique .

SECTION C : Review of literature related to other complimentary therapies in

hysterectomy.

SECTION A : REVIEW OF LITERATURE RELATED TO

HYSTERECTOMY PAIN

Following studies are done to assess the pain among hysterectomy

patients.

A quantitative study was conducted to assess the severity of pain

during the first 2 days after hysterectomy surgery . Eighty women were selected from 4

hospitals. Average pain was moderate on both days, but paired t tests indicated that pain

increased significantly during ambulation on day one (P = .009, sensation; P < .001,

distress) and on day two (P = .007, sensation; P = .030, distress). They both (P = .001)

decreased significantly during rest on day 2, but not on day one. Analysis of quartiles

indicated that one fourth of the sample suffered severe sensation pain at all points on day

two (60 to 74 mm on a 100-mm visual analogue scale), and moderate to severe sensation on

day 3 (40 to 60 mm on a visual analogue scale). The lowest quartile had mild pain on both

days (11 to 28 mm on day 1, and 7 to 14 mm on day two. Study revealed that postoperative

patients have moderate to severe pain that is relieved with patient-controlled analgesia and

use of non pharmacologic interventions.21

A double blind comparison study was conducted to assess the

postoperative pain after abdominal hysterectomy . Fourty patients were randomly selected

into 2 groups , group P received an infusion of normal saline 5 mL/h via a catheter placed

intraperitoneally at the end of hysterectomy,group L received 0.25% levobupivacaine

anaesthesia. Incisional pain, deep pain, and pain on coughing were assessed after surgery by

using a visual analog scale. Pain at the incision site, deep pain, and pain on coughing were

all significantly less in group L compared with group P at 1-2 h after surgery. After 4 h, the

mean visual analog scale pain scores at rest and during coughing remained less than 3cm

during most time periods. Total ketobemidone consumption during 4-24 h was significantly

less in group L compared with group P (mean, 19 versus 31 mg, respectively). A less

frequent incidence of postoperative nausea, was also found during 4-24 h in group L

compared with group P (P < 0.025). The study concluded that abdominal hysterectomy is

associated with moderate to severe postoperative pain. 22

As study showed a survey of 250 who had undergone a recent

surgical procedure. Approximately 80% of patients experienced pain after surgery. Of these

patients, 86% had moderate to severe pain. Pain after hysterectomy is often multifactorial

and arises from different sources.23

Above studies tells about the nature of pain in

hysterectomy patients. The studies concluded that patients who are undergone

hysterectomy experienced severe pain.

SECTION B : REVIEW OF LITERATURE RELATED TO

EFFECTIVNESS OF BENSON’S RELAXATION TECHNIQUE

Dr. Benson’s quick and easy relaxation techniques have immense

physical benefits, from lowering blood pressure to a reduction in post operative pain. By

learning to invoke the relaxation response once or twice a day for just ten minutes at a

sitting, one can effectively lower blood pressure and gain tranquility in their emotional life,

making them more successful both in the workplace and at home . Following studies shows

that Benson’s relaxation technique is very helpful in reducing pain. Bensons Relaxation

techniques (also called relaxation response techniques) used to release tension by deep

breathing . Relaxation techniques are also used to induce sleep, reduce pain, and calm

emotions . .24

The term "relaxation response." first coined in the mid 1970s by a Harvard

cardiologist named Herbert Benson, refers to changes that occur in the body when it is in a

deep state of relaxation. These changes include decreased blood pressure, heart rate,

muscle tension, and reducing pain in post operative patients and rate of breathing, as well as

feelings of being calm and in control. Learning the relaxation response helps to counter ill

effects of the fight or flight response and, over time, allows the development of a greater

state of alertness . It is now a recommended treatment for many stress related disorders and

reducing pain in post operative patients .24

An experimental study was conducted to assess the

effectiveness of two different relaxation techniques in the management of post-operative

pain. Fourty women aged between 21-65 years who were undergoing elective

cholecystectomy were randomly assigned to four groups. One experimental group received

rhythmic breathing exercise (RB), and other received Benson's Relaxation Technique

(BRT). In the control group one (CA) received a taped recording of a history of the hospital,

and other (CB) received routine peri-operative care which all groups received. Data were

analyzed using multivariate and univariate analyses of variance. The BRT group was

significantly different from the control group on a combined sensation and distress factor

(p=0.011). The study concluded that both relaxation technique had similar effectiveness. 25

A quantitative study was conducted to determine the effect

of Benson Relaxation Technique (BRT) combined with medication on disease activity in

patients with rheumatoid arthritis. Fifty consecutive matched patients were selected and

allocated into two groups, either an experimental or a control group. Patients in the

experimental group received Benson’s relaxation technique combined with medication and

patients in the control group were given only medication. Clinical symptoms, laboratory

findings, anxiety, depression and feeling of well-being were measured before and after

intervention to evaluate the effect of Benson’s relaxation technique. There was a significant

difference between the two groups in anxiety ,depression and feeling of well-being. Changes

in clinical symptoms and laboratory findings were not large enough to be statistically

significant between the two groups, but they indicated decline in disease progress. The

results demonstrated that Benson’s relaxation technique can be an effective technique in

reducing disease process in patients suffering from rheumatoid arthritis . 26

Another study was to assess the efficacy of Bensons

relaxation technique on post operative pain in coronary artery bypass graft patients.

Samples size was eighty , randomly divided on 2 equal groups. Benson’s relaxation with

analgesics in experimental group and analgesic drug in control group . The tool used were

visual analogue scale for pain .Pain was assessed before and after the intervention . The

findings of this study showed the mean of pain severity before and after relaxation in the

intervention group was reduced and were significant difference (P=0.0001). Also, Mann-

Whitney test showed that there was a significant difference in mean of pain severity

between two groups after relaxation P≤0.0001).This study concluded that Benson's

relaxation technique not only can reduce postoperative pain in coronary artery bypass graft

pain, but also effected vital sign specifically respiratory rate and increased patients

peacefulness (satisfaction). Therefore can be used as a complementary therapy .27

The above studies studies concluded that Bensons relaxation technique

is a excellent complimentary therapy to reduce pain .Since there was no studies to assess the

effectiveness of Benson’s relaxation technique in reducing pain among hysterectomy patients

so I prefer to do this study.

SECTION C: REVIEW OF LITERATURE RELATED TO OTHER

COPLIMENTARY THRAPY IN HYSTERECTOMY

Complementary strategies based on sound research findings are

needed to aid in postoperative pain relief. The goal for postoperative pain management is to

reduce or eliminate pain and discomfort with a minimum of side effects as cheaply as

possible.

A quantitative study was to investigate the effect of three non

pharmacologic nursing interventions: relaxation, music, and the combination of relaxation

and music on pain following hysterectomy surgery. Sample size was 311 patients, ages 18

to 70, from five hospitals, were randomly assigned. Three intervention groups or a control

group and were tested during ambulation and rest on postoperative days one and two. Pain

sensation and distress were measured using visual analogue scales. Multivariate analysis of

covariance of post test sensation and distress were used with pretest control and a post test

control . The intervention groups had significantly less post test pain than the control group

(p =.022-.001) on both days. Nurses who care for hysterectomy patients can provide soft

music and relaxation and instruct patients to use them during postoperative ambulation and

also at rest on days one and two.28

Another study determined the effect of head and neck massage on

anxiety, pain, and discomfort for hysterectomy patients. Sample consisted of 48

hysterectomy patients at K hospital. Experimental group (n=23) received head and neck

massage at 8 minutes per massage for five times: (at admission, before sleeping on

preoperative day, at 4 hours after operation, before sleeping on operation day, before

sleeping on the first postoperative day). Control group (n=25) received conventional

treatment. As an effectiveness of this intervention, state of anxiety and BP was measured

before sleeping on preoperative day. Pain and discomfort were measured before sleeping on

the day of surgery and then on the first postoperative day. State of anxiety score and BP at

post-treatment decreased significantly in the experimental group. Pain score in experimental

group was lower than that in control group, with no significant difference; whereas,

Discomfort level decreased significantly in the experimental group. Results indicated that

head and neck massage could be an effective intervention for reducing preoperative anxiety

and postoperative discomfort in hysterectomy patients.29

Another study to assess the effect of music on

hysterectomy patients .Sample size was 110 and were allotted randomly in to experimental

and control group . A less post operative pain was found in experimental group compared

with control group P less than 0.025 .study concluded that music is an excellent

complimentary therapy to reduce pain in hysterectomy patients .30

An experimental study was conducted to test the impact of foot

massage on the level of pain heart rate and blood pressure among patients with abdominal

surgery . Sample comprised 30 abdominal surgery patients selected by purposive sampling

method. Pre-assessment pain intensity, heart rate, and blood pressure were recorded. Foot

massage with low stroke manipulations was applied on each leg of the subject for 10

minutes. Pain intensity, heart rate, and blood pressure were recorded immediately after the

intervention and again after 10 minutes. The result showed that there was a significant

difference between pre- and post-foot massage pain score, heart rate, and blood pressure

(P<0.05). The study concluded that foot massage is an effective non pharmacologic

measures in reducing postoperative pain.31

Above studies shows that complimentary therapies are

excellent in reducing pain among hysterectomy patients.

6.3: OBJECTIVES OF THE STUDY:

1)To assess the level of pre interventional pain among hysterectomy patients as

measured by numerical pain scale.

2)To compare the level of pre interventional and post interventional pain between

experimental and control group among post hysterectomy patients

3)To find the association between selected demographic variable and level of pre

interventional pain among hysterectomy patients

6.4: ASSUMPTION:

Pain is complex, subjective experience for every individual.

Women who have undergone abdominal hysterectomy will have pain for some days.

Benson’s relaxation technique is one of the effective non pharmacological methods

pain relief.

6.5: HYPOTHESES :

H1- There will be a significant difference in the level of pain between the experimental

and control group after the intervention at 0.05 level of significance.

H2- There will be a significant association of the level of pain of post hysterectomy

women with their selected baseline variables at 0.05 level of significance.

6.6: OPERATIONAL DEFINITIONS:

Effectiveness

It refers to a degree to which something is successful in producing a desired result or

success.

In this study it refers to the ability of Bensons relaxation technique , as a complementary

therapy, to bring about a change in the pain level among post hysterectomy patients, as

measured using a Numerical Pain Intensity Scale rated by the patient.

Benson’s relaxation technique

Bensons Relaxation techniques (also called relaxation response techniques) used to

release tension by deep breathing. It refers to a form of meditation which focuses on

breathing. In this technique women will be allowed to sit quietly in a comfortable

position. Make them to close their eyes. Keep the muscles relaxed. Make them to

breathe through the nose and breathe out slowly .As breath out say the word “one”

silently. Continue this for 20minutes.

Pain

It is an unpleasant sensory and emotional experience associated with actual or potential

tissue damage, or described in terms of such damage”.

In this study, pain refers to the unpleasant experience perceived by the post

hysterectomy patients, as measured by the scores rated by them on a Numerical Pain

Intensity Scale associated with surgery as expressed by patient.

Post hysterectomy patients

Refers to those patients who have undergone hysterectomy and admitted in

gynaecology ward in selected hospital, Bangalore.

6.7: DELIMITATION:

The duration of study is only for a period of six weeks.

The study is limited to the patients who have undergone hysterectomy in selected

hospital , Bangalore.

ANNEXURE-11

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA:

The data will be collected from patients those who admitted for

hysterectomy surgery in selected hospitals , Bangalore.

7.2 RESEARCH METHODOLOGY

7.2.1 RESEARCH APPROACH: Quantitative research approach

7.2.2 RESEARCH DESIGN: A quasi-experimental pre-test post-test control group design

will be used for the study.

7.2.3 SAMPLE:

Sample size: The total sample size in this study is 60. About 30 samples will be in

experimental group and 30 will be in control group .

7.2.4 SAMPLING TECHNIQUE : The sampling procedure used in this study will be the

non-probability purposive sampling technique.

7.2.5 SAMPLING CRITERIA :

Inclusion criteria:

Patients who have undergone hysterectomy in selected hospital

Patients who are in second post-operative day.

Patients who are alert, conscious and co-operative.

Patients who are able to follow the Relaxation techniques

Exclusion criteria:

Patients with post-operative complications (who are shifted to surgical ICU).

Patients with epidural analgesia.

patients who had undergone laproscopic hysterectomy

7.2.6 VARIABLES:

Independent variables:Bensons relaxation technique

Dependent variables: pain

7.2.7 SETTINGS :

A 500 bedded multi speciality hospital in which monthly 40 patients are undergoing

hysterectomy , admitted in gynecology ward ,Bangalore

7.2.8 DATA COLLECTION TECHNIQUE:

Description of Tool:

The tools developed were structured interview for the demographic

variables, 1-10 numerical pain intensity rating scale to assess pain level and bio

physiological measurements (B.P, pulse rate & respiration).

Intervention Protocol:

Follow 6-steps of relaxation response

Sit quietly in a comfortable position.

Close the eyes.

Keep your muscles relaxed.

Breathe through your nose. Become aware of your breathing.

Breathe easily and naturally. Breathe through your nose. Become aware of your

breathing. As you breathe out (exhale), say the word, “ONE”, silently to yourself.

For example: breathe IN…OUT, “ONE”, -IN…OUT, “ONE”, etc. Breathe easily

and naturally

Continue for 10 to 20 minutes . Open your eyes to check the time, but do not use an

alarm. Sit quietly for few minutes, at first with eyes closed, then with eyes opened.

Do not stand up for a few minutes. )

Do not worry about whether the successful in achieving a deep level of relaxation.

Maintain a passive attitude and permit relaxation to occur at its own pace. When

distracting thoughts occur, try to ignore them by not dwelling upon them and return

to repeating "ONE." With practice, the response should come with little effort.

Data Collection Procedure:

After obtaining administrative permission from the selected hospital post hysterectomy

patients will be selected based on the inclusion and exclusion criteria by the purposive

sampling technique. The samples will allocated into the experimental and control group.

The purpose of the study will be explained to the participants and informed consent will

be obtained.

An interview schedule will be used to elicit the demographic variables.

PHASE 1

Pre-test: Pain levels will be assessed in both control and experimental groups by using

the numerical pain intensity scale.

PHASE 2

Intervention: In the experimental group on the second post- operative day will advice

them to do Bensons relaxation technique for 20 minutes.

PHASE 3

Level of pain will be assessed by using the Numerical Intensity Pain Scale after

interventions.

7.2.9 DATA ANALYSIS TECHNIQUE:

Data will be analysed in terms of objectives . Plan of data analysis include

descriptive and inferential statastics.

Demographic data will be analysed by computing frequency ,percentage .

Pain level of hysterectomy patients will be analysed by computing frequency and

percentage .

Effectiveness of Benson’s relaxation technique will be analysed by computing paired

‘t’ test .

Association between pain and selected variable will be anlysed by ‘chi –square’ test

7.3 Does the study required any investigation or intervention to be conducted on

patients or other humans or animals? If so describe briefly.

Yes, the study requires investigation among patients undergoing hysterectomy

surgery in the form of assessing their pain by using numerical pain scale. The study

requires intervention Benson’s relaxation technique to reduce the pain among hysterectomy

patients , in selected hospital.

7.4 Has the ethical clearance been obtained from your institution?

Yes, ethical clearance has been obtained from the institution

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9 Signature of the candidate :

10 Remarks of the guide :

11 11.1 Name and Designation of the Guide:

Mrs Madhusheela

Lecturer

Narayana hrudayalaya college of nursing

Signature :

11.2 Co-Guide(if any)

Signature :

11.3 Head of Department:

Mrs.C Sangeetha

Associate Professor

Obstetrics and Gynaecological Nursing

Narayana Hrudayalaya College of Nursing

Signature :

12

12.1 Remarks of the Chairman and Principal

Signature: