RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR THE DISSERTATION

MR. RAMACHANDRA. S. KUDARI

FIRST YEAR M.Sc. NURSING

MENTAL HEALTH NURSING

YEAR 2009 – 2010.

SRI SIDDHARTHA COLLEGE OF NURSING

AGALAKOTE, B.H ROAD,

TUMKUR.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

MR RAMACHANDRA. S. KUDARI

FIRST YEAR M.Sc. NURSINGSRI SIDDHARTHA COLLEGE

OF NURSING,AGALAKOTE,

TUMKUR-572107

2. NAME OF THE INSTITUTION Sri Siddhartha College Of Nursing

3. COURSE OF THE STUDY AND SUBJECT

Degree Of Master Of Nursing

4. DATE OF ADMISSION TO THE COURSE

08th JUNE 2009

5. TITLE OF TOPIC“A study to assess the

effectiveness of pranayama to reduce the stress among senior

citizens at selected area in Tumkur”.

6. BRIEF RESUME OF THE INTENDED WORK

6.1INTRODUCTION:-

“Stress affects overall mind/body health. Everybody experiences

stress”. –Newman

Life starts at 60, as you are passing through first another beautiful

phase in life. The responsibilities are over and the time to be at ease has begun.

In fact, it is a stage when you have so much more time to devote yourself.1

The term senior citizen was coined in the year 1938. Senior citizens

are prone to fall prey to various health hazards. Common senior’s health

problems include obesity, acid indigestion, muscle weakness, stroke, pain

attack, heart burn, diabetes, high cholesterol and high B.P. A good way to fight

against these is to take up some physical exercises. Exercises promote once

health and assists in living life with full zeal and enthusiasm.2

Stress is a mismanagement of time. When we spend too much time in

the past or future, it steals a way our lovely present moments. A pre occupied

mind can never be at rest. Travelling into the past or future can help us learn

from past mistakes or set goals and visions for the future. But if we make the

past or future or permanent home, the problem begins.3

This is also the time to do futuristic planning for a very healthy older

life by initiating yourself into regular yoga, pranayama, meditation and good

hobbies like gardening, swimming, reading and writing.1

You can’t avoid all stress, but you can counteract its negative effects

by learning how to evoke the relaxation response, a state of deep rest that is

the polar opposite of the stress response. The stress response floods your body

with chemicals that prepare you for “fight or flight.” But while the stress

response is helpful in true emergency situations where you must be alert, it

wears your body down when constantly activated.4

The relaxation response brings your system back into balance:

deepening your breathing, reducing stress hormones, slowing down your heart

rate and blood pressure, and relaxing your muscles. In addition to its calming

physical effects, research shows that the relaxation response also increases

energy and focus, combats illness, relieves aches and pains, heightens problem-

solving abilities, and boosts motivation and productivity. Best of all – with a

little practice – anyone can reap these benefits4

The body’s natural relaxation response is a powerful antidote to

stress. Relaxation techniques such as deep breathing, visualization, progressive

muscle relaxation, meditation, and yoga can help you activate this relaxation

response. When practiced regularly, these activities lead to a reduction in your

everyday stress levels and a boost in your feelings of joy and serenity. What’s

more, they also serve a protective quality by teaching you how to stay calm

and collected in the face of life’s curveballs.5

6.2 NEED FOR THE STUDY:-

“Old may be gold”, but going by the condition of the elderly in our

country, it is hard to say that old age is the golden age. A vast majority of the

81 million seniors citizens in India battles failing health, financial constraints,

loneliness, emotional stress and abused in the dusk of their lives, leading many

to end their lives in depression or to lead a pitiable existence. In India the

elderly with 7.7% of total population, face a number of problems, such as

poverty, illiteracy and inadequate knowledge on health care.6

“Old age is an incurable”, observes Seneca. More recently Sir James

sterling rose commented, “you don’t heal old age, you protect it, you promote it,

and you expand it.”Aging is a major life change, which includes physiological

and psychological changes.7

Loss of mental activity, institutionalization, loss of spouse,

confinement to bed because of physical and mental illness are few causes of

stress and anxiety during old age. Because aged person may be unaccustomed to

expressing this feeling openly. Pent up feeling and concerned or reaction to loss

any manifest themselves as a somatic complaints, insomnia, restlessness,

fatigue, blood pressure, hostility and isolation.8

People experiencing stress are more likely to report hypertension,

anxiety or depression and obesity. Women, in particular report feeling the

effects of stress on their physical health more than men. The survey results seem

to tie in with what research shows, that 43% of all old age suffer adverse health

effects from stress. Given the potential health complications related to stress, it

is fair to say stress certainly is a health problem in America.9

Yoga breathing is an important part of health and spiritual practices

in Indo-Tibetan traditions, considered fundamental for the development of

physical well being, meditation, awareness and enlighten. It is both a form of

meditation in itself and preparation for deep meditation. Yoga breathing

(pranayama) can rapidly bring the mind to the present movement and reduce

stress.10

Well, fortunately for all of us these breathing classes have already

been around for thousands of years. They are just known by different name

yoga. “Isn’t yoga all about exotic contortions?” you think to yourself. Well that

is not exactly true .If there is one thing that yoga emphasizes above all health’s,

it is proper breathing. In fact yoga breathing techniques are called pranayama,

the birth of life.11

To gain healthy body senior citizens should adopt some healthy

habits, which can make them happier as well as healthier. They should follow

some senior exercise programmes that help in maintaining physical, mental as

well as emotional balance. Senior citizens can start with some simple exercises

to cope with various problems, such as stress, anxiety and other health

diseases.12

The study was conducted to use of meditation--relaxation techniques

for the management of stress in a working population. A total of 154 New York

Telephone employees Self-selected for stress learned one of three techniques--

clinically standardized Meditation (CSM), respiratory one method meditation

(ROM) or progressive Relaxation (PMR)--or served as waiting list controls. The

meditation groups had a 78% compliance Rate at 5.5 months with treatment

effect seen whether subjects practiced their Techniques frequently or

occasionally. The safe and inexpensive semi-automated Meditation training has

considerable value for stress-management programs in Organizational settings.13

If senior citizens follow a self disciplined life style as suggest, simple

exercise, pranayama and other breathing exercise, with a little practice and stay

determination. It is possible for the senior citizens to have an excellent health.

But unfortunately most of them felt that they didn’t have sufficient time to

consultation and training14.

A brief out the comprehensive lifestyle education programme based

on yoga include pranayama, relaxation techniques, group support reduces risk

factors of stress, anxiety, blood sugar, blood cholesterol for cardio ventricular

disease and diabetic mellitus. The morbidity of geriatric clients with stress

related disorders are dramatic. Under proper yoga and relaxation therapy is the

major contribution to reduce stress related disorder among senior citizens.15

The researcher experience has felt with his experience, geriatric have

less knowledge regarding pranayama on reducing stress, and there is a need to

assess the geriatric person’s knowledge regarding pranayama on reducing stress.

This will be great help to senior citizens for reducing stress and to lead happy

and comfort life.

6.3 STATEMENT OF PROBLEM

“A Study to Assess the Effectiveness of Pranayama to Reduce the Stress

among Senior Citizens at Selected Areas in Tumkur”.

6.4 OBJECTIVES

1. To assess the level of stress before administration of Pranayama among

senior citizens at selected area in Tumkur.

2. To administer the Pranayama among senior citizens.

3. To assess the level of stress after administration of Pranayama among

senior citizens.

4. To compare the level of stress before and after Pranayama among senior

citizens.

5. To associate the level of stress with demographic variables of senior

citizens.

6.5 OPERATIONAL DEFINITIONS

1. ASSESS: - In this study it refers to evaluate the pre and post test stress

scores among senior citizens.

2. EFFECTIVENESS: - In this study effectiveness refers to reducing in

the level of stress as determined by significant difference in pre and

post test stress scores among the senior citizens.

3. PRANAYAMA :-

Pranayama is generally defined as breath control. Pranayama is

comprised of two roots, “prana” plus “ayama”. Prana means “vital

force” or “life force” and ayama are defined as extension or expansion.

Thus the word pranayama means “extension on expansion of the

dimension of prana”

3. SENIOR CITIZENS:- Senior citizens who is above 60 years of age.

4. STRESS:-Stress is prolonged unpleasant emotional state such as fear

or anger. In this study the researcher states stress as disturbances in

psychological wellbeing which will be measured by stress assessment

scale.

6.6 ASSUMPTION

The study will base on the following assumptions:

1. The stress will be more among senior citizens.

2. Pranayama may be helpful to reduce the stress among senior citizens.

6.7 HYPOTHESIS

H1- The mean post test stress level will be significantly less than the

mean pre-test stress among senior citizens.

H2- There will be significant association with level of stress and

demographic variables of senior citizens.

6.8REVIEW OF LITERATURE

A study was conducted to reduce stress and improving cognition in

healthy aging adults. Aging are vulnerable to the effects of a negative

emotional state. The relaxation response (RR) is a mind body intervention

that counteracts the harmful effects of stress. Fifteen adults participated and

were randomly assigned to a RR training or control groups. Manage was

71.3 years and mean education level was 17.9 years. Reaction time on a

simple attention/psychomotor task was significantly improved (p<0.0025)

with RR Training, whereas there was no significant improvement on

complex tasks of attention, verbal or visual declarative memory tests. Self-

reported state Anxiety levels showed a marginally significant reduction

(p<0.066).16

The study was conducted to reduce stress by mindfulness meditation

Mindfulness meditation defined, and the practices of breathing meditation,

eating meditation, walking meditation, and mindful yoga are described. Data

analysis examined compliance, medical and psychological symptom reduction,

and changes in self-esteem, statistically significant decreases in medical and

psychological symptoms and improvement in self-esteem was found. The article

includes a discussion of factors to be considered when establishing a

mindfulness meditation based stress reduction programme in a health care

setting.17

This study was conducted to decrease stress with the Transcendental

Meditation (TM) program with Lower blood pressure. The objective of the

present study was to evaluate, over the long term, all-cause and cause-specific

mortality in older subjects who had High blood pressure and who participated in

randomized controlled trials that included the TM program and other behavioral

stress-decreasing interventions. There were 202 subjects, including 77 whites

(mean age 81 years) and 125 African-American (mean age 66 years) men and

women These results suggest that a specific stress-decreasing approach used in

the prevention and control of high blood pressure, such as the TM program,

may contribute to decreased mortality from all causes and cardiovascular

disease in older subjects who have systemic hypertension.18

A study was conducted to assess the associations between head ache and

stress, alcohol drinking, exercise, sleep and co morbid health conditions in

Japanese population. A cross-sectional survey of 12,988 subjects aged 20 – 79

years (5908 men and 7090 women) receiving health checkups at a Tokyo clinic.

They filled out a self-administered structured questionnaire, and 5.4% of the

men and 15.4% of the women reported having headaches. Younger subjects

were more prone to having headaches. The likelihood of having headaches

increased with stress level and decreased ability to relieve stress in both

genders. A multivariate stepwise logistic analysis showed that age, self-

estimated degree of stress, reported number of additional poor health conditions,

and less alcohol consumption were independently correlated with having

headaches.19

The study was conducted to evaluate the feasibility, acceptability and

effectiveness of an initiative to train General practioners in a set of evidence

based meditation skills General practitioners attended a seminar comprising a 1

hour lecture on GP wellbeing, a 45 minute session on meditation, meditation

skills practice in groups with an experienced instructor, a larger group review

and the provision of take home kits. At the seminar's conclusion, GPs were

offered the option of meditating at home twice daily. Measures were taken

before and after the seminar and after 2 weeks home practice. The measures

included the Kessler Psychological Distress Scale - 10 (K10), personal

experience rating by visual analogue scale, and diary card. A meditation

workshop for GP wellbeing is practical, feasible and appealing to GPs.

Quantitative feedback from the workshop indicates its potential as an effective

mental health promotion and prevention strategy.20

The study was conducted to explore the short-term impact of a

comprehensive but brief lifestyle intervention, based on yoga, on subjective

well being levels in normal and diseased subjects. The outcome measures were

'subjective well being inventory' (SUBI) scores, taken on the first and last day

of the course. The inventory consists of questions related to one's feelings and

attitude about various areas of life, such as happiness, achievement and

interpersonal relationship. There was significant improvement in the subjective

well being scores of the 77 subjects within a period of 10 days as compared to

controls. These observations suggest that a short lifestyle modification and

stress management educational program leads to remarkable improvement in

the subjective well being scores of the subjects and can therefore make an

appreciable contribution to primary prevention as well as management of

lifestyle diseases.21

The study was conducted to compare yoga and relaxation as treatment

modalities at 10 and weeks from study baseline to determine if either of

modality reduces subject stress, anxiety, and blood pressure and improve quality

of life. Yoga was found to be as effective as relaxation in reducing stress,

anxiety and improving health status on seven domains of the SF-36. Yoga was

more effective than relaxation in improving mental health. At the end of the 6

week follow-up period there were no differences between groups in levels of

stress, anxiety and on five domains of the SF-36.22

The study was conducted to evaluate the effectiveness of two brief

preventive stress reduction programs--a cognitive focused program and a

combined intervention of physical exercise and relaxation--on sickness absence

in stressed and non-stressed employees working in various jobs There is no

substantial difference in effectiveness between the cognitive and physical

interventions.23

The study was conducted to across the aim of the study was to study the

short-term impact of a comprehensive but brief lifestyle intervention, based on

yoga, on anxiety levels in normal and diseased subjects. The observations

suggest that a short educational program for lifestyle modification and stress

management leads to remarkable reduction in the anxiety scores within a period

of 10 days.21

The study was conducted to test the effects of two stress management

interventions on blood pressure (BP) and stress-related variables the participants

in the two stress management groups participated in a 10-week intervention; the

delayed treatment control group received BP monitoring during the 10-week

period. Measures included BP, the State-Trait Anger Expression Inventory,

Personal Strain, and Coping Resources. Although no significant Group x Time

effects were found in BP, anger, or personal strain, several of the outcome

measures appear to be sensitive and showed cell means in the hypothesized

direction. Further study of the effects of stress management interventions on BP

and stress, with a larger sample, is warranted.24

6. MATERIALS AND METHODS:

7.1 Sources of data: - Senior citizens who were living in selected area of

Tumkur.

7.2 Methods of collections of data.

i. Research design: - one group per test and post test experimental research

design.

ii. Research variable:-

Independent variable: Level of stress among senior citizen.

.Dependent variable: Relaxation technique on Pranayama.

Attributed variable: Socio demographic characterises such as:

age, sex, marital status, religion, education, number of children

etc.......

iii. Setting: - Selected areas in Tumkur.

iv. Population: All senior citizens with the age group of 60 years and above.

v. Sample Size: sample size is – 60 samples (n=60).

vi. Criteria for sample collection.

Inclusive criteria:-

1. Senior citizens who are staying at selected area in Tumkur.

2. Senior citizens who are at the age group of 60 years and

above.

3. Senior citizens who are willing to participate in the study.

Exclusive criteria:-

1. Senior citizens who are physically ill and mentally ill.

2. Senior citizens who do not know read Kannada.

vii. Sampling technique: Sampling technique adopted for selection of

sample is Purposive Sampling.

viii. TOOL FOR DATA COLLECTION

Tool used for the study consists of two parts that are described below:

Part- 1: Demographic variables of Senior citizen at selected areas in Tumkur.

Part-2: four point Likert Scale will be prepared and used for assessing the stress among senior citizens.

ix. METHODS OF DATA COLLECTION:

The researcher will use rating scale for collecting data. An informed

consent will be obtained from the subjects and the process of the study

will be explained to the subjects. A structured demographic

questionnaire, rating scale will be administered to the subjects through

the interview schedules to assess the demographic status and the level of

knowledge.

x. METHOD OF DATA ANALYSIS AND PRESENTATION:

The researcher will analysis the data obtained by using Descriptive and

Inferential statistics.

Descriptive statistics – Mean and Standard deviation will be used

to assess the level of stress before and after the structured teaching

program.

Inferential statistics-

a) Paired t – test will be used to compare the level of stress

before and after structured teaching programme.

b) Chi- square test used to determine association between the

levels of stress among senior citizens.

xi. PROJECTED OUTCOME:

Senior citizens residing at selected areas in Tumkur will gain adequate

knowledge regarding Pranayama to reducing their stress and will be able

to practice in their day to day life.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CONDUCTED ON

PATIENTS OR OTHER HUMAN ANIMALS

Yes; this study involves the intervention of structured teaching

programme.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUION?

Ethical clearance will be obtained from Institutional Ethical Committee

(IEC) and the prior permission will be obtained from senior citizens of data

collection. A pilot study will be conducted to assess the feasibility and main

study will be conducted after getting the consent from the senior citizens.

8. REFERENCE LIST:

1)http:/seniorjournal.com / NEWS/features/ 6-02-23-Newssurveyon stress.htm.

2)http:/yogashaasgra.blogspot.com/2008/10/yoga-for-senior-citizens.html.

3)the royal Sussex County Hospital in Brighton, England/experiencefestival.com/mindfulness-besed_stress_reduction.

4)http:/www.med.umich.edu/pain reach/pts/relax.

5)http:/www.addthis.com/Bookmaskthp.

6)Oldage is the golden age.2006December:17(cited2007 march27).From URL;http;/www.the Hindu.com Bangalore.

7)park text book of preventive and social medicine,17Edditon.banarasidasbhanot Publication;1991.p.134.

8)Blazer D S .Epidemology of psychiatric desorderes in late life, Text book of geriatric psychiatry,second edditon,Washington,American psychiatric press;1996.

9)Tucker Sutherland.feb 23.2006.http;/senior journal.com.

10. Brown RP,Gerbarg PL.yoga breathing, medication and longevity.2009 August;1172;54-62.

11http;/www.yoga wiz/biug/yoga.

12Ajanta Bhattcharyya published;1/28/2009.http:/www.buzzle.com/artiles/exercises-for-senior-citizens.html.

13Carrington P, collings GH jr, Benson H , Robinson H,journal of occupational Medicine.1980 April;22(4);221-31.

14LokhotiaRN,”selfdisciplined life style management by senior citizen for wellness”,Helpage India research and development journal, 13 eddition, New Delhi;helpage India publisher;May2007;30-31.

15Bijlani RL,Vempati RP,yadav RK ,ROY RV,Gupta v.et al. A brief but Comprehensive life style education programme based on yoga reduces risk factor for cordio vascular disease and diabetic mellitus. Altern comp,lement Med.2005,April;11(2);267-74.

16Galvin JA Benson H deckro GR, fricchione GL, dusek JA. Deaconess Medical Center, Harvard Medical School,Boston,MA02215,USA.

17Roth B, Creaser T. Stress Reduction Programme, Community Health Center,CT, USA.he journal of nurse practioner1997 March;22(3);150-2,154,157 passim.

18 Schneider RH , Alexander CN, S taggers F ,et Amercan jounernal of cardiol.2005 may 1;95(9);1060-4.

19Yokoyama M, Yokoyama T, Funazu K Yamashita T,Journal of Headche pain.2009 jun;10(3);177-85pub; 2009 march27.

20Manoch R Gordon A, blck D, Malhi G, Seidler R.Australian Family Phtsician.2009jun;38(6);454-8.

21Sharma R, gupta N, Bijlani RL, Indian journal of Physiology and Pharmacology.2008april-Jun;52(2);123-31.

22Smith C, Hancock H, Blake-Mortimer J, Eckert K complement therapeutic Medicine2007jun;15(2);77-83,pub in 2006 jun 21.

23Vanrhenen W, Blonk RW, Schaufeli WB,Vanbijk FJ.International Arch Occupational Environmental Heath.2007may;80(6)505-15.Published2006 Nev9.

24Webb M, Beckstead J, Meininger J , Robinson S College of Nursing University of South Florida,tampa;33,612,USA.