RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1. Name of the Candidate and

Address

[In Block Letters]

Ms.VIPINA MOHAN

1ST YEAR M.Sc NURSING

ALVA’S COLLEGE OF

NURSING

MOODBIDRI

2. Name of the Institution ALVA’S COLLEGE OF

NURSING, MOODBIDRI

3. Course of the Study,

Subject

1ST YEAR M.Sc NURSING

MEDICAL SURGICAL

NURSING

4. Date of Admission to Course 1/6/2011

5 Title of the Topic

Effectiveness of Jacobson’s progressive muscle relaxation technique on stress

among elderly hypertensive inmates in selected old age homes of Dakshina Kannada

District.

6. BRIEF RESUME OF THE INTENDED WORK:

6.1. Need for the study

An anxious mind cannot exist in a relaxed body

-Edmund Jacobson

Cardiovascular disease is the leading cause of death in the world. Hypertension

or ‘silent killer’ is an important medical and public health issue. Hypertension is a

condition that afflicts 1 billion people worldwide and is a leading cause of morbidity and

mortality. According to estimates there are 31.5 million hypertensives in rural and 34

million in urban population in India1.

Stress is one of the variables that have positive correlation in the development of

hypertension. Stress increases peripheral vascular resistance and cardiac output and

stimulates sympathetic nervous system activity. People exposed to high levels of

repeated psychological stress develop hypertension largely. A report from American

Institute of Stress estimates that 60-90% of all primary care visits involve stress related

hypertension2. Reducing stress can lower high blood pressure. In order to cope with

stress, the person needs to learn how to relax. Relaxation is an active process involving

technique that calms the body and mind. Relaxation techniques such as deep breathing,

meditation, progressive muscle relaxation, biofeedback etc,can help activate this

relaxation response. Progressive muscle relaxation is a technique for reducing anxiety

by alternately tensing and relaxing the muscles3.

An experimental study was conducted to determine the effectiveness of yoga and

exercise therapies (meditation and progressive muscle relaxation technique) to control

BP among 221 hypertensive individuals in Gujarat. The results revealed that progressive

muscle relaxation technique lowered systolic BP by 4.7mmof Hg and diastolic BP by

3.1mm of Hg.The study concluded that if yoga and exercise therapies should follow

together, there is significant reduction in the stress score. 4

A comparative study was conducted to find the effectiveness of Galvanic Skin

Response biofeedback and progressive muscle relaxation training in reducing blood

pressure and respiratory rate among 30 highly stressed individuals in Amritsar. Training

was given for 20 minutes daily for 10 consecutive days. The results revealed that post

training values indicated that progressive muscle relaxation group showed significant

differences for systolic blood pressure[P<0.05] and diastolic blood pressure [P<0.01]

and the study concluded that galvanic skin response biofeedback and progressive muscle

relaxation training resulted in lowering both systolic and diastolic blood pressure.5

In the light of exposure to hypertensive patients, the investigator recognized that

most of the hypertensive patients are stressed especially the older people and they need

some relaxation technique to calm their mind, hence, the present study aimed at

reducing stress among elderly hypertensive patients in selected old age homes by using

Jacobson’s progressive muscle relaxation technique.

6.2.Review of literature

A quasi-experimental study was conducted to evaluate the effectiveness of

progressive muscle relaxation on blood pressure and psychological status among 40

hypertensive subjects in Taiwan. The result revealed that progressive muscle relaxation

training has an immediate effect, reducing the pulse rate 2.35bpm, systolic B.P 5.44 mm

of Hg and diastolic B.P 3.48 mmHg after two weeks of training. After 4 weeks of

progressive muscle relaxation further decrease in pulse rate 2.9 bpm, systolic B.P 5.1

mmHg and diastolic B.P 3.1 mmHg occurred. The study concluded that progressive

muscle relaxation significantly lowered patient’s perception on stress and it enhanced

patient’s perception on health and progressive muscle relaxation is beneficial for

patients with essential hypertension.6

A randomized control trial was conducted to assess the effectiveness of stress

reduction approaches such as transcendental meditation and progressive muscle

relaxation among 127 older African Americans in Sanfrancisco. The results revealed

that progressive muscle relaxation lowered the systolic B.P by 4.7 mm of Hg [P=0.054]

and diastolic pressure by 3.3 mm of Hg [P≤0.02 mm of Hg].The study concluded that

selected stress reduction techniques demonstrated efficacy in reducing hypertension in

this sample of older African Americans.7

An experimental study was conducted to evaluate the effectiveness of relaxation

training as complementary therapy for hypertension control and implications of

evidenced based medicine among nine hypertensive Chinese subjects in Hongkong. The

empirical work examined the effects of 3 relaxation therapies for the reduction of high

B.P such as progressive muscle relaxation, stretch release relaxation and cognitive

imagery relaxation. The results revealed that in the context of the study, all relaxation

therapies can reduce B.P, and the study concluded that stretch release relaxation and

progressive muscle relaxation therapies appeared to be more effective in lowering B.P

compared to cognitive imagery relaxation.8

An experimental study was conducted to assess the effectiveness of progressive

muscle relaxation on anxiety among 73 chronically ill patients with diabetes mellitus,

hypertension and low back pain in selected hospitals of Mangalore. Out of that, 35 were

selected and progressive muscle relaxation was given for 2 weeks. The study results

shown that mean pretest score was 52.4 and mean posttest score was 38.14.There was a

significant reduction in anxiety score. The study concluded that progressive muscle

relaxation could be implemented in nursing homes, rehabilitation centers and

community health centers.9

A quasi-experimental study was conducted to determine the effectiveness of

progressive muscle relaxation technique on anxiety among 40 elderly people in

Bangalore. The results shown that mean level of anxiety during pretest was 89.82 and

during posttest, it was reduced to 69.55.The study concluded that there was an

effectiveness found after progressive muscle relaxation technique.10

An experimental study was conducted on progressive muscle relaxation therapy

in essential hypertension and stress among 171hypertensive patients. The analysis of BP

dynamic during 6 week revealed significantly (p<0.001) systolic BP (−10.4±0.8) and

diastolic BP (−7.7+0.6) by the end of one year control group BP returned to the initial

level. BP reduction has been found in 62% of patients in the main group and only 12%

of patients of the control group. The study concluded that relaxation therapy is effective

in reducing BP and stress.11

6.3. Problem statement

The effectiveness of Jacobson’s progressive muscle relaxation technique on

stress among elderly hypertensive inmates in selected old age homes of Dakshina

Kannada District.

6.4. Objectives

The objectives of the study are to;

assess the pretest level of stress among experimental and control group.

assess the post test level of stress among experimental and control group.

evaluate the effectiveness of Jacobson’s progressive muscle relaxation

technique among experimental group.

compare the effectiveness of Jacobson’s progressive muscle relaxation

technique on stress between experimental group and control group.

find out the association between pretest level of stress and selected

demographic variables among both the groups.

6.5. Operational definitions

Effectiveness : In this study, it refers to the extent to which Jacobson’s

progressive muscle relaxation technique has achieved the desired effect on of

stress among elderly hypertensive patients.

Jacobson’s progressive muscle relaxation technique : In this study, it refers to

a relaxation technique in which a person first tenses and releases major muscle

groups of the body in a prefixed and systematic order, usually beginning at the

body and progressing downwards and is performed for about 20-30 minutes

daily for 10 consecutive days.

Stress : In this study,it refers  to the body's reaction to a change that requires a

physical, mental or emotional adjustment or response..

Elderly hypertensive inmates : In this study it refers to elderly person in age

group 50 years and above with essential hypertension.

6.6. Assumptions

The study assumes that;

stress is the risk factor for the development of hypertension.

complementary therapies can reduce stress levels to a certain extent.

6.7. Delimitations

The study is limited to;

elderly hypertensive inmates of selected old age homes

6.8. Hypotheses

The study is based on the following hypotheses, which will be tested at 0.05

level of significance.

H1 -There will be significant difference between mean pretest and posttest level

of stress among hypertensive inmates in the experimental group.

H2 -There will be significant difference in level of stress among hypertensive

inmates in the experimental group and control group.

H3 -There will be significant association between pretest stress level and selected

demographic variables among both the groups.

MATERIAL AND METHOD

7.1. Source of data:

7. Data will be collected from the hypertensive inmates who are having stress in

selected old age homes of Dakshina Kannada District.

7.1.1. Research design :

The research design adopted for the present study is quasi-experimental non-

equivalent control group design.

E O1 X O2

C O1 X O2

E – Experimental group

C – Control group

O1 – Pre technique assessment of level of stress

X – Intervention

O2 – Post technique assessment of level of stress

7.1.2. Setting:

Setting consists of selected old age homes of Dakshina Kannada District.

7.1.3. Population :

Population for the study consists of elderly hypertensive inmates who are having

stress in selected old age homes of Dakshina Kannada District.

7.2.Method of data collection

7.2.1. Sampling procedure :-

Sampling procedure selected is non-probability purposive sampling technique.

7.2.2. Sampling size:-

Sample consists of 60 hypertensive inmates of an old age home who are having

stress with 30 each in experimental and control group.

7.2.3. Inclusion criteria:-

Elderly inmates of old age homes who are;

having blood pressure above 140/90 mm of Hg.

having stress.

able to follow instructions.

above 50 years of age.

able to understand Kannada or English.

7.2.4. Exclusion criteria:-

Patients who are;

bed ridden

not able to perform relaxation exercise regularly

psychologically unstable

7.2.5. Instruments used:-

Demographic Proforma

Modified Holmes and Rahe stress rating scale

7.2.6. Data collection method:-

Administrative permission will be obtained from the old age homes prior

to the study.

Subjects will be selected using non probability purposive sampling

technique.

The informed consent will be taken from the subjects.

Data will be collected for the period of 1 month.

The stress among hypertensive inmates will be assessed using Modified

Holmes and Rahe stress rating scale.

The investigator after undergoing a course on Jacobson’s progressive

muscle relaxation technique will administer the technique to the study

subjects for 10 consecutive days.

The level of stress will be reassessed using the same rating scale after

intervention.

7.2.7. Plan for data analysis:

Data will be analyzed using both descriptive and inferential statistics.

Demographic data will be analyzed using frequency and percentage.

Assessment of level of stress among hypertensive inmates will be

analyzed by computing frequency, percentage, mean, median, mean

percentage and standard deviation.

Paired‘t’ test will be used to evaluate the effectiveness of Jacobson’s

progressive muscle relaxation technique among experimental group.

Comparison of pretest and posttest level of stress among experimental

and control group will be done using independent‘t’ test.

Association between pretest level of stress scores and selected

demographic variables will be analyzed using chi square test.

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, administration of modified Holmes and Rahe Jacobson’s progressive

muscle relaxation technique to the elderly hypertensive inmates after obtaining informed

consent.

7.4. Has ethical clearance obtained?

Yes, ethical clearance has been obtained from the ethical committee.

8 LIST OF REFERENCES

1.Wesa MK, Grimm HR. Recommendations and guidelines regarding the preferred

research protocol for investigating the impact of an optimal healing environment on

patients with hypertension. J ALTERN COMPLEM MED 2004;10:245-50

2.Stress and high blood pressure. 2011;[2]. Available at

http//www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-easing –

stress. Accessed on August , 2011.

3.Progressive muscle relaxation. 2010;[1]. Available at

http//in.wikipedia.org/wiki/progressive_muscle_relaxation. Accessed July, 2010.

4.Yeligar RR, Shah AK. The most reliable approach to kill ‘a silent killer’. IJPSR 2010

July;18(1-3):[2]. Available from: http//www.ijpsr.com. Accessed July, 2011.

5.Khanna A, Paul M, Sandhu SJ. A study to compare the effectiveness of GSR

biofeedback training and PMRT in reducing BP and respiratory rate among highly

stressed individuals. J PHYSIOL PHARMACOL 2007;51(3):296-300.

6.Sheila S, Barbara I, Shyan HL, Lin CM. Effects of progressive muscle relaxation on

blood pressure and psychosocial status for clients with essential hypertension in Taiwan.

HNP 2003 January/February;17(1):[1].

7.Schneider HR, Staggers F, Alexander NC, Shepherd W, Rainforth M, Kondwani K ,et

al. A randomized controlled trial of stress reduction for hypertension in older African

Americans. Am J Hypertens 2005;18:[1]. Available from:

http//hyper.ahajournals.org/cgi/content/full/26/5/820-. Accessed June 15, 2007.

8.Yung P, French P, Leung B. Relaxation training as a complementary therapy for mild

hypertension control and the implications of evidence based medicine. Complement

Ther Nurs Midwifery 2001 May;7(2):Available from:

http//www.ncbi.nlm.nih.gov/pubmed/11855773. Accessed March 12,2002.

9.Verma N. A study on effectiveness of progressive muscle relaxation on anxiety among

chronically ill patients in selected hospitals of Mangalore. (Unpublished masters

dissertation in Rajiv Gandhi University of Health Sciences,Bangalore);2009 May.

10.Thomas G. A quasi experimental study to determine the effectiveness of progressive

muscle relaxation on anxiety among elderly people in selected old age homes at

Bangalore.(Unpublished masters dissertation in Rajiv Gandhi University of Health

Sciences,Bangalore;2006 May.

11.Alvazian TA, Zaitsev VP. Predictors of the efficacy of relaxation therapy in

hypertension. Ter Arkh 1991;63(9):Available from:

http//www.ncbi.nlm.nih.gov/pubmed/1759200.Accessed May 2010.