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INDIAN JOURNAL OF NURSING STUDIES

Editorial

Guest Editorial: Therapies in Mental Health - Dr. Kanwaljit Kaur Gill Concept Article: Trends in Mental Health Care in India - Dr. Ramchandra

Research Papers

Cognitive Behaviour Therapy fo Patients with Depression Effect of Psycho Education on Drug Compliance

- Asha Chacko, Blessy Antony, M.K. Acharya - Bharti S. Batra, Blessy Antony, M.K. Acharya Effect of Memory Retraining Among Elderly Diagnosed with Mild Dementia - Sweta Bhoskar, Blessy Antony, M.K. Acharya Parent Effectiveness Training for Parents having Children with Behavioral Problems Effectiveness of Rational Emotive Behavior Therapy among Anxiety Patients Effectiveness of Self Instructional Module (SIM) on Knowledge and Attitude Regarding Electro Convulsive Therapy (ECT) among the Relatives of the Mentally Ill Patients Effectiveness of Teaching Learning Module for School Teachers on Knowledge Regarding Behavioral Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD) Planned Teaching Programme on Knowledge Regarding Ill Effects of Tobacco Consumption among the Forth Class Workers - Jyoti Shrivastava, Blessy Antony, Anila Gangrade Identification of Perceived Stressors among Hospitalized Patients Planned Teaching Programme on Knowledge Parents Regarding Selected Emotional and Behavioural Problem in Children - Vinu Nair, Blessy Antony, Anila Gangrade Effectiveness of Relaxation Techniques on Level of Care Burden among Parents of Thalassemia Children - Archana Masih, Blessy Antony, M.K. Acharya Case Vignette: Multidisciplinary Behaviour Intervention Centre Beyond Nursing: Reflection on Healing and Regeneration

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- Deepika Pathak, Vinu Nair, M.K. Acharya

- Sini Punnoose, Blessy Antony, Anila Gangrade

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- Siva Suramanina, Muthukumari

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- Annapoorna S.H., K. Jeyabarathi

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- Shailendra Ghosh, BLessy Antony, Dr. Pankaj Jain

70-74 75-79 80-82 83

Choithram College of Nursing Manik Bagh Road, Indore (M.P.) - India

Ph. +91-731-2471075, 2764009, Email: [email protected] Website: www.cconursing.com

Many of us take our health for granted, more so our mental health. We think nothing can go wrong with us. We are more sure of our mind than of our bodies. If a minor illness occurs to our bodies we take measures to tackle it. Such as if we have fever, we take a paracetamol tab, and/or take rest. If it still continues giving us trouble, we seek medical help. But if we feel some disturbance in mind, such as we feel depressed and cannot concentrate in our work or feel anxiety that affects out work or relationships, neither we take any steps to correct it nor seek specialist's help. By the time we recognize it and realize that it needs attention, usually the problem has become so established that it affects our life and work and requires specialist's intervention. Therefore, we must address mental health with similar urgency as physical health. Mental illnesses need to be recognized early, and referred appropriately. How important mental health is, can be seen in the projections made by WHO. It has been estimated that in 2020, one of the ten leading causes of death will be suicide. Most of the causes of death are preventable and suicide is definitely so. It is also being projected that in 2020, the three leading causes of disability through out the world will include heart disease, major depression and traffic accidents. Behavior is once again an important underpinning of these three contributors of disability. Behavior and Social Science research can lower the impact of these causes of morbidity and mortality. Nurses play their role in prevention and promotion of mental health. Nurses also conduct screening, do assessment and refer clients who present with abnormal behavior patterns. Nurses in order to provide quality care should draw upon the authentic research base. This will ensure that time tested care is provided to their clients because nurses are accountable to their clients to provide the highest quality of care based on knowledge that is considered for the best practices. This issue of Indian Journal of Nursing Studies includes studies which were done by scholars keeping in mind their evidence based practicability for ensuring best practices in mental health care. Study by Asha Chacko on 'effect of cognitive behavior therapy on patients with depression', Sweta Bhoskar's study on 'effect of memory retraining in elderly diagnosed with mild dementia', and Sini Punnose's study on' effectiveness of emotive behavior therapy on patients with anxiety', proved that if the nurses apply these well known small steps in one to one therapeutic relation with the patients, the patients and the family members can cope up with the day to day problems concerning mental illnesses much easily. Deepika Pathak's study of training for parents of children with behavior problems, Archana Masih's study of effect of relaxation techniques on relief from care burdan of parents of thalasemic children and Annapurna's study to find the effect of TLM on school teachers, have their great utility for the affected groups and care takers. Other studies by Bharati Batra, Shailendra Ghosh, Jyoti Shreevastva, Vinu Nair and Shiva Subramanian.N can be used by clinical nurses, nurse educators and nurses and other health workers in community health settings for application and reference in their respective work field. Dr Kanwaljeet Gill's guest editorial throws light on various therapies which as adjunct with medicines or all by themselves, can help improve the outcomes of many neuropsychiatric disorders. Dr Ramachandra of NIMHANS, in his concept article, "Trends in mental health care in India" acquaints us with the past and present of trends of health care of mentally ill in India. He also discusses as to how nurses can contribute in lessening the burden of mental illness. Dear readers! The IJNS is in your hands. Make the best use of the material contained in it to do justice to the hard work done by the editorial team, who along with their routine teaching and other responsibilities managed to complete this Herculean task.

Dr. Usha Ukande

Editor-in- Chief 9425438183

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

Guest Editorial

Therapies in Mental Health

Dr. Kanwaljit Kaur Gill

Professor and Principal, SKSS College of Nursing,Sarabha, Ludhiana. Mental Health disorders affect millions of people today. Treatments for these problems vary greatly. Psychological therapies encompass a broad range of interventions, including talking therapies, which follow different theoretical models (e.g. cognitive behavioural, psychodynamic and systemic models), as well as different forms of delivery, for example individual, group and family treatments. Not only can psychological therapies reduce symptoms just as medication, they can also lead to other outcomes like helping a person to cope with an adverse change in circumstances (one of the main goals of counselling), helping people to make lasting changes in their personality (a frequent goal in long-term treatments) and to improve their ability to develop and sustain relationships. Here is a light on some of the various therapies. COGNITIVE BEHAVIOR THERAPY (CBT): This psychotherapy aimed at changing way of thinking. Several approaches to cognitive-behavioral therapy are: Rational Emotive Behavior Therapy, Rational Behavior Therapy , Rational Living Therapy, Cognitive Therapy , Dialectic Behavior Therapy It helps people in changing their thinking patterns, behavioural components, builds confidence and produces a more rational perception in the person`s mind about their own abilities and competencies. In addition, it is a way of using the facts, which a person discusses about his life and analyzing the way he or she narrates them. This fact helps to understand the thought process of a person. In addition, at the same time, behavioural therapy works to change their reactions in situations, which trigger anxiety and stress. In fact, the cognitive part of the therapy refers to thinking or learning which can be taught to the person. He then needs to take what he has been taught and practice it at home. Therefore, he will free himself from stress and anxiety. CBT is a collaborative effort between the therapist and the client. Client role - define goals, express concerns, learn & implement learning. Therapist role - helps client to define goals, listen, teach and encourage. RATIONAL EMOTIVE BEHAVIOUR THERAPY (REBT): Rational emotive behaviour therapy focuses on uncovering irrational beliefs, which may lead to unhealthy negative emotions and replacing them with more productive rational alternatives. The basic aim of REBT is to leave clients at the completion of therapy with the freedom to choose their emotions, behaviours and lifestyle (within physical, social and economic restraints). Methods of self-observation and personal changes will help them to maintain their gains, realistic thoughts, emotions, and behaviours in proportion to the events and circumstances an individual experiences. It works on 'Here and Now orientation'. We all express ourselves differently, but the irrational beliefs that upset us can be placed under three major headings. Each of these core beliefs contains an absolutistic 'must' or demand. These three major musts can be summarized as follows: 1. I must do well and win the approval of others for my performances or else I am no good. It leads to anxiety, depression, shame and guilt. 2. Other people must treat me considerately, fairly, kindly and in exactly the way, I want them to treat me. If they do not, they are no good and they deserve to be condemned and punished. It leads to rage, passive aggression and acts of violence. 3. I must get what I want, when I want it; and I must not get what I do not want. It is terrible if I do not get what I want, and I cannot stand it. It leads to self-pity and procrastination. Finally, the emphasis is on profound and lasting change in the underlying belief system of the client, rather than simply eliminating the presenting symptoms. The client is left with self-help techniques that enable coping in the long-term future. PSYCHOEDUCATION ON COMPLIANCE OF DRUGS: It is common that patients do not take medicines regularly. There are some factors associated with non- compliance. Such as: long-term, or complex drug regimens, inadequate and inconvenient clinics, patient dissatisfaction with therapist, inadequate supervision and patient characteristics such as previous non-compliant behavior, difficulty with authority figures, lack of

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understanding of prophylaxis, and a wish to remain sick. Psycho education is proved one of the successful intervention strategies for improving compliance. This satisfy patient's and relative's needs for information about the disease and possible treatments. They provide emotional relief and help in coping with the disease as well. MEMORY RETRAINING IN ELDERLY: Memory retention and recall are associated with specific chemical changes in the brain and can be affected by organic brain disorders and various psychological disorders. Memory retraining is a training programme in which new skills are established or the efficacy of the existing cognitive function (memory) is enhanced by the process of gradual learning. Some common methods for retention of memory in elderly are: ORIENTATION: give orientation to time, place and person, BLUEBERRY JUICE, Eat more fruit and vegetables, Limit saturated fat, and Get omega-3s. PARENTAL TRAINING FOR CHILDREN HAVING BEHAVIORAL PROBLEMS AND ADHD: Parent training represents a therapeutic approach in which parents are taught how to increase desirable child behavior, reduce child's misbehavior, improve parent-child interactions, and bring about a positive family atmosphere. Important points for parents are: Provide constant practice, show your appreciation, correct the child in positive way, plan out to reduce disturbing behavior, use colorful aids, use concrete material to demonstrate, serve as a model, lead them from success to success, teach one skill at a time and Keep your tempo limited. Behavior Therapy is effective in the management of symptoms of ADHD in children. A reward system is implemented with input from the child and new behaviors are taught to replace the old. When setting up a behavioral program, it is important to remember the "Three C's." clarity of expectations, consistency and calmness. The goal of behavior therapy is to increase the frequency of desirable behavior. Therapist should keep in mind the following: Manage Parent- child conflict, use positive reinforcement, design a good behavior plan and use negative consequences to reduce misbehavior. RELAXATION TECHNIQUES: Relaxation therapies give the body/mind the chance to do its own healing. The body and mind can heal itself given the right conditions. Relaxation therapy restores harmony. It is the releasing of physical and mental tensions. Some people need help and training to understand how to release the physical and mental tensions. Relaxation therapy has a range of techniques to create a profound level of relaxation and through them, into an enhanced psychological integration. Some of the methods and techniques go back thousands of years, while others are still being developed. But they are all based on the effect that the mind has on the body. Relaxation therapies are non-intrusive and gentle and can help treat Arthritis, asthma, anxiety, depression, high and low blood pressure, mental and physical problems caused through stress and panic attacks. Some easy relaxation techniques can help to deal with stress. Some of them are mentioned below: 1.Yoga, 2. Aromatherapy, 3. progressive muscle relaxation, 4. imagination, 5. Cardio exercises, 6. Massaging, 7. Touch therapy, 8. Breathing techniques and 9. Meditation. Psychotherapeutic interventions are provided as components of a holistic care package, with comprehensive care plans, including physical and social treatments. There are many other therapies such as existential therapy, dialectical behavior therapy(DBT), structural yoga therapy, psychotherapy, somatic psychotherapy, brief strategic family therapy, ego state therapy, adolescent group therapy, and inner child therapy are used now a days by nurses in research especially in experimental research and observing their effect. Thus they are widening the area of practice for nurses. REFERENCES: 1. Bernard, M. E. (1986). Staying Rational In an Irrational World: Albert Ellis and Bond, F.W. & Dryden, W. (2002). Handbook of Brief Cognitive Behaviour Therapy. Chichester. John Wiley & Sons Ltd. 2. Dryden, W. (1995). Brief Rational Emotive Behaviour Therapy. Chichester. John Wiley & Sons. 3. Ellis, A. & Dryden W. (1997). The Practice of REBT (Second edition). London. Free Association Books. 4. National Association of Cognitive-Behavioral Therapists, http://www.nacbt.org/whatiscbt.htm 5. "Guidance on the use of electroconvulsive therapy" . National Institute for Clinical Excellence. 2005-11-01. pp. 5, 6. Retrieved 2008-07-26. 6. Tasman & Kay. Essentials of Psychiatry. 2006 , John Wiley & Sons Ltd.

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Concept Article

Trends in Mental Health Care in India

Dr. Ramachandra

Associate Professor, Department of Nursing, NIMHANS

Mental disorders account for nearly 12% of the global burden of the disease. By 2020, they will account for nearly 15% of disability-adjusted lifeyears lost to illness. The burden of mental disorders is maximal in young adults, the most productive section of the population. Developing countries are likely to see a disproportionately large increase in the burden attributable to mental disorders in the coming years. People with mental disorders face stigma and discrimination in the society. Over the past five decades, services for the mentally ill in India have steadily improved. From a predominantly asylum care moved to mental hospitals and general hospitals and primary health centres. Apart from involvement of medically qualified psychiatrists the need for nurses with psychiatric diploma has been recognized. This paper briefly reviews the improvement in mental health care facilities and discusses the significance of current trend.

The pressure to reform these asylums coincided with the raise in humanitarian concerns where 'asylums' rechristened as 'mental hospitals' in the early part of the 19th century. The Indian Lunacy act was introduced in 1912. Later, a high profile committee under the chairmanship of Sir Joseph Bhore, was appointed to plan the development of health services in independent India. The committee felt that the mental health services in the country were grossly inadequate. The committee recommended starting of additional mental hospitals and creating facilities for training in mental health care for medical & non-medical persons in the country. Phase-II Several important developments occurred during the first two decades after independence. The Indian psychiatric society was founded in 1947. A major landmark of this period was the opening of the All India Institute of Mental Health in 1954 in Bangalore, which twenty years later became the National Institute of Mental Health and Neuro Sciences (NIMHANS). NIMHANS, is the largest centre for training of psychiatrists; clinical psychologists, psychiatric social workers and psychiatric nurses in India. Many new hospitals were built in different places such as Amritsar (1947) Hyderabad (1953) Srinagar (1958), Jamnagar (1960) and Delhi (1966). This phase was rightly called as an era of mental hospitals in free India. Today, there are more than 40 mental hospitals of varying sizes in different parts of the country, with a total bed strength of about 20,000. While some states such as Maharashtra & Kerala have 3 or more mental hospitals, many states do not have even one. During this period several revolutionary reforms were tried. Late Dr.Vidyasagar introduced

Historical Perspectives

In order to get an insight in understanding of the origin of the current burden of mental illness & of trends in care and treatment it would be necessary to review some historical aspects. This would be discussed in five phases. Phase- I The early medical approach did not encourage compassion or tolerance towards the mentally ill but implied punishment. Mental illness was shrouded with many myths like-incurable infectious disease & activity of evil spirits, black magic etc. From the latter part of the eighteenth century, several "lunatic asylum" were built in different parts of the country.

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a humane treatment to patients and allowed involvement of care givers in taking care of them. However, overcrowding, chronic long stay of patients, poor funding, inadequate facilities for rehabilitation and lack of adequately trained and motivated staff have continued to plague many hospitals which resulted in poor quality of care and services. Phase-III Psychiatric units were started in general hospitals in the mid 1960s. Shorter period of hospitalization, the constant involvement of family members and active treatment strategies, encouraged opening of more such units in different parts of the country each year both in the Government and Private Sectors. Surveys carried out during this period showed that mental illness of all types was widely prevalent in the country. Phase-IV It was felt that there is a need for the extension of care from mental hospital to primary health centers and community. Some of the centres in India, especially Bangalore and Chandigarh, initiated pilot programmes to develop and evaluate an extension of mental health services for the rural under-privileged population. These programmes demonstrated that basic mental health care can be offered by health workers and doctors in primary health care centers, if they are adequately trained. India adopted "National Mental Health Programme" in 1982, which involves integration of mental health services into general health services as the primary approach for delivering mental health care throughout the country. Phase-V The recent trends include contribution of major changes in mental health services. The impact of media, which revealed the poor and scandalous situation in many mental hospitals, was instrumental in addressing mental hospital reforms. Media also focused on rights of the mentally ill and those individuals who were in Jails. The supreme Court of India's pronouncement helped in substantial increasing the funding & improvements in the

conditions of many hospitals. It also decreed against housing mentally ill in Jails. A new Indian Lunacy Act (of 1987) came into practice. Mental hospitals started assuring newer roles & functions. Many of them established out-patient services for ambulatory care of new patients, follow-up and after-care of discharged patients. Rehabilitation services of various types which never existed before such as occupation therapy, relaxation therapy, gardening, bibliotherapy, music, dance, yoga etc. are being added. The average period of hospitalization is being reduced by several and dedicated efforts. Some hospitals have opened 'short stay' wards, 'open wards' and 'family wards'. In recent years, voluntary and non-governmental organization are taking active interest in various aspects of mental health which includes rehabilitation of patients with chronic mental illness, like establishing day care facilities, half way homes, crisis intervention centers, suicide prevention counseling, the treatment and rehabilitation of substance abusers and mental health education. There is a need for a larger number of such organizations as they have tremendous potential for initiating innovative programmes. The Indian Nursing Council integrated mental health nursing into nursing curriculum during the early 1960s. The Indian Society of Psychiatric Nurses (ISPN) was founded in 1990s. ISPN is organizing annual meeting to discuss various issues at different places in India and to disseminate information to help nurses update their knowledge. It has brought out two Journals in mental health nursing. At present the District mental health programme is being carried out in 25 districts across 20 states & Union Territories. In recent years there have been significant changes in our understanding of mental disorders. There are effective treatments for many mental disorders. The world health report 2001 presents the evidence of

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

various treatments for such disorders. them are briefly mentioned here:

Some of

In medical colleges & major hospitals where psychiatric facilities are available only on an out patient basis, the role of psychiatric nurses assumes great significance. In such situations, the psychiatric nurse could help in case history taking, so that the psychiatrist would be available for consultation of a larger number of patients with the time saved in case history taking. These psychiatric nurses could also assist psychiatrists during counseling, especially while emphasizing the need for compliance of medication as prescribed.

i. Depression can successfully be treated with antidepressants and psychological interventions. ii. Modified ECT is significantly useful in early interventions in severe depression, catatonia & suicidal cases. iii. Psychosocial rehabilitation and family therapy in combination with medication can reduce very significantly (50% to 10%) the relapse rates for schizophrenia. iv. Brief interventions directed at people who are hazardous drinkers have been shown to reduce alcohol consumption by 30%. v. Treatment of drug dependence is cost effective in reducing drug use by 40-60%. vi. The uses of complementary and alternative medicine are being tried. The utility of yoga therapy is also being tried. Introduction of various novel methods of treating mentally ill offers a welcome move in protecting human rights of people with mental disorders, who comprise a vulnerable section of any society. Mental Health advocacy is a relatively new concept, developed with a view to reduce stigma and discrimination and promoting human rights of people with mental disorders. It is a welcome trend that during 1950s All India Institute of Mental health introduced certain courses for nurses viz., Diploma in Psychiatric Nursing. Subsequently post graduate course was also introduced here and at other places.

Conclusion

Mental disorders account for significant burden of disease in all societies. Effective interventions are now available but are not accessible to the majority of those who need them. To overcome this facilities, intervention are being made accessible through changes in policy & legislation, service development, adequate financing & the training of appropriate personnel. Advocacy on human rights is making impact in the care of the mentally ill.

References

1. Mohan Isaac (1996). Trends in the development of psychiatric services in India. The psychiatrist (formerly the psychiatric bulletin) 20:43-45. 2. Murthy S.R. (1998). Rural psychiatry in developing countries. Psychiatric services,49:967-9 3. World health organization (2003). The mental health context, (mental health policy and service guidance package) page 39.

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Research Papers...

"COGNITIVE BEHAVIOUR THERAPY FOR PATIENTS WITH DEPRESSION"

*Asha Chacko, M.Sc.(N), ** Blessy Antony M.Sc.(N), *** Mr. M.K. Acharya Clinical Psychologist Abstract

Depression occurs in persons of all genders, ages, and backgrounds. Age is a crucial factor, and higher rates of depression in females are detected at mid puberty through adult life as opposed to male preponderance in early adolescence. Therefore, an experimental study was conducted to assess the effectiveness of cognitive behaviour therapy on change in the levels of depression among patients suffering from depression in selected hospital of Indore. A pre test- posttest control group design was used in the study. A sample of 12 clients was selected using nonprobability purposive sampling technique. Assessment was done prior to, post and at one month follow up session of completion of therapy using Beck's Depression Inventory. Statistical analysis revealed that there was no association between level of depression and selected demographic variables. The Mann Whitney 'U' value between post assessment scores of experimental and control group was significant i.e. 'U' is 0 at the level of p < 0.05 (U crit = 2) which revealed the effectiveness of cognitive behavioral therapy. Friedman test for "analysis of variance" of pre, post and one month follow up BDI Scores of experimental group also revealed that CBT was effective in reducing the level of depression. Key words: Depression, CBT (cognitive behaviour therapy), BDI (Beck's Depression Inventory)

Background

Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. World Bank Report publication on the global burden of disease demonstrated that, depression accounted for 10% of all DALY's (disability adjusted life year). Furthermore, this figure is projected to rise to 15% by the year 2020, making depression second only to ischemic heart disease in terms of worldwide disease burden. (Dickey et al, 2003)4 .Cognitive therapy for depression has its roots in the cognitive theory of depression. It is an active, structured, problem-focused, and time-limited approach to treatment which is based on the premise that depression is maintained by negatively biased information processing and dysfunctional beliefs. Most salient feature of cognitive therapy is to make patients aware of their distorted and negative views and emotional

* Asha Chacko, Lecturer, MASS College of Nursing, Udaipur email: [email protected] ** Blessy Antony. Associate Professor, Choithram College of Nursing, Indore *** M. K. Acharya, Clinical psychologist, Choithram Hospital & Research Centre, Indore

consequences of such irrational beliefs. A recent larger study of chronically depressed individuals treated with either drugs or cognitive behaviour therapy showed that a combination of the two was significantly more effective than either alone (Keller. et.al, 1992).7

Need Of The Study

Depression is one of the most prevalent psychiatric disorders. According to the World Health Organization (WHO), major depressive disorder has been identified as the fourth leading cause of worldwide disease in 1990, causing more disability than either ischemic heart disease or cerebral vascular disease (Murray & Lopez, 1996).11 Lifetime risk for major depression is 5-12% for men & 1025% for women. (Jiloha et al, 2010)6. In the National Health Services the cost of treating depression exceeds the cost of treating both hypertension and diabetes (Department of Health, 1996)3. Cognitive behaviour therapy is based on the personal cognitive appraisal by an individual of an event and the behaviour that results from the appraisal and aim at modifying the distorted thinking. Peden et al conducted a randomized controlled

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"EFFECT OF PSYCHO EDUCATION ON DRUG COMPLIANCE"

* Bharti S. Batra, M.Sc. (N) **Blessy Antony, M.Sc. (N) ***M.K. Acharya, Clinical Psychologist Abstract

Schizophrenia is the heartland of psychiatry and the core of its clinical practice. It represents a major burden for caregivers, health services and society as a whole. Psycho education of patients and relatives appear to be one of the successful intervention strategies for improving compliance. Therefore, a pre-experimental approach with one group pre-test and post-test design was adopted to identify the non-compliant patients with Schizophrenia and to assess the effectiveness of psycho education on the knowledge regarding compliance to psychotropic medications among their caregivers. The Psycho education was completed in 8 sessions with sample size of 10 non-compliant patients with schizophrenia and their 10 caregivers. Results indicated that the mean Pre-test score was 13.1 and at post test level, it raised to 21.90. Median at pre test score was 13.50, and at post test score it came to 22.00 and the standard deviation at pre test was 2.80, which came to 1.10 at post test. The Z value, which is 2.809 and the level of significance (2tailed), was significant at p< .05 confidence level, which revealed the effectiveness of psycho education on the knowledge level of the caregivers of patients with schizophrenia. Z value which was-.359 level of significance (2 tailed) was non-significant at P> 0.05 confidence level, revealed the non-effectiveness of psycho education in changing the Drug Attitude Inventory (DAI-10) score of the schizophrenic patients regarding their psychotropic medication compliance. Key words: Psycho education, Non-Compliance, compliance, Knowledge, Attitude, Care Giver, Patients with Schizophrenia, Psychotropic Medications, Drug Attitude Inventory (DAI-10)

Background

Schizophrenia is a common condition, which often cripples people in adolescence or early adult life, without greatly reducing their life expectancy; it has been described as the worst affliction of mankind. It probably causes more suffering, distress and blights more lives than any cancer. It certainly represents a major burden for caregivers, health services and society as a whole. Jhonstone Eve, Cunningham Owens. (2004).1 A study conducted in All India Institute of Medical Science reported that total annual cost of care of schizophrenia was 274 US dollars; INR (13687.38) which was not significantly different from Diabetes Mellitus. The main brunt of financial burden was borne by family. Grover S, Avasthi A, (2005). 2 Mental disorders are truly universal. An analysis done by WHO global burden of disease, 2000 showed about 450 million people were estimated to be suffering from neuropsychiatric illnesses, Schizophrenia being the major killer. Park K, (2009).3 It suggested a

* Bharti Batra, Sr. Tutor, Training College of Nursing, Indira Gandhi Govt. Medical College & Hospital, Nagpur email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** M.K. Acharya, Clinical psychologist, Choithram Hospital & Research Centre, Indore

morbidity rate of not less than 18-20 per thousand per year, same as in other parts of the world. The lack of compliance was associated with an increased risk of relapse & hospitalization. There is high prevalence of psychiatric disorder among general population approximating about 20 per1000, with lack of resources. There are only 47 hospitals with total number of 10329 beds only in a country of more than 1 billion. The number of outdoor mental disorder cases were 896425 in 2004, and number of cases treated in child guidance clinics were 22361. Park K.( 2009).3 In India because of a limited number of mental health professionals and lack of scientific information about the nature and causes of mental illness, a large number of patients do not receive mental health services.

Need of the Study

Non-compliance is more extensive in Psychiatry as psychiatric illnesses have a significant effect on judgments, insight, stability and chronicity. Park K. (2009).3 Providing care for a member of the family with mental illness is an exhaustive task for care givers and their role

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

'EFFECT OF MEMORY RETRAINING AMONG ELDERLY DIAGNOSED WITH MILD DEMENTIA'

*Sweta Bhoskar, M.Sc.(N), ** Blessy Antony M.Sc.(N), *** M.K. Acharya, Clinical Psychologist Abstract

Ageing is a major challenge in the century. As longevity increases, the concern for conditions like dementia and Alzheimer's become prominent in the lives of some of the elderly. These diseases are growing fast in India. Therefore, a pre experimental study on effect of memory retraining among elderly diagnosed with mild dementia in selected urban areas of Indore was undertaken. A pre experimental approach using with pre, mid and post therapy assessment was used in this study. Sample size of 7 patients was selected using non probability purposive sampling technique. The independent variable was memory retraining whereas gain in memory score among elderly with mild dementia was dependent variable in the study. The investigator used the standardized (HMSE) Hindi Mental state Examination for the screening and PGI memory scale to assess the memory impairment. PGI scale consisted of 10 subtests covering areas of memory impairment. Assessment was done prior to, in the middle and after the completion of therapy ranging from 12 sessions spread over approximately one month. The data were analyzed using Wilcoxon singed- rank test to assess effectiveness of memory retraining on mild dementia. A significant difference in pre, mid, and post therapy scores indicated the efficacy of the therapy. The computed Wilcoxon signed rank test z value for pre test and mid test (z= 2.36), and pre test and post test (z= 2.371) was significant at P< 0.05 confidence level which revealed the effectiveness of memory retraining in improving memory in elderly diagnosed with mild dementia. Hence, research hypothesis was accepted. It concluded that memory retraining was effective in improving the memory in early stage dementia. Key words: Dementia, Memory Retraining, Elderly, (HMSE) Hindi Mental state Examination, PGI (Memory scale developed by Post Graduate Institute of Medical health and Sciences, Chandigarh).

Background

Dementia is a brain disorder that affects the ability to remember, think clearly, communicate, and perform daily activities and may cause changes in mood and personality (Cleusa P. Ferri, Prince M, Brayne C, Brodaty H, & Fratiglioni L, 2005)13. Cognitive disturbance is the clinical hallmark of dementia. The most dramatic and consistent cognitive impairment is in memory (Boyd Ann Mary, 2008)2. Memory impairment is the prominent early sign of dementia. Clients have difficulty learning new material and forget previously learned material. Initially recent memory is impaired (Videbeck L. Sheila, 2008) . Memory retraining is a training programme in which new skills are established or the efficacy of the existing cognitive function (memory) is enhanced by the process of gradual learning.

* Shweta Bhoskar, M.Sc.(N) Choithram College of Nursing, Indore Email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** M.K. Acharya, Clinical psychologist, Choithram Hospital & Research Centre, Indore

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Brain becomes denser if we memorize more, learn more, think more, solve problem more, etc. Nerve growth factor stimulates and supports growth of myelin sheath and formation of new synapses. Thus helps in memory processing (Prince M. et.al,2004)9. Recent research has shown that people with Alzheimer's disease can benefit from instruction to improve their memory (James E. Birren, 1996)3. The effects of memory training in elderly people are positive. Memory training can be effective in mildly demented elderly persons as well. Interestingly, memory training which combines memory strategies with reattribution training, in order exaggerated achievement levels and change attribution pattern for success and failure, might help elderly most (Alan S. Bellack and Michel Hersen, 1998)1.

Need of the Study

Recent estimates show that dementia is a major cause of burden of disease amongst the elderly in developing countries. As many parts of the developing world witness a demographic transition, dementia is likely to account for

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"PARENT EFFECTIVENESS TRAINING' FOR PARENTS HAVING CHILDREN WITH BEHAVIORAL PROBLEMS."

* Deepika Pathak, M.Sc (N) **Vinu Nair, M.Sc (N) ***M.K. Acharya, Clinical psychologist. Abstract

Parenting skills' training is worthwhile for every parent, because it can help the parents to do the best possible job in raising their children and it can improve confidence in their parenting ability. Wrong parenting leads to multiple behavior problems in children. Therefore a pre experimental study was conducted to assess the effect of Parent Effectiveness Training (PET) among parents of children with behavioral problems in selected hospital of Indore. One group pre test post test research design was adopted. 30 parents having children with behavioral problem were selected using purposive sampling techniques from pediatric and psychiatric OPD. Pre test was conducted by using Modified Eyberg Child Behavior Inventory to assess behavioral problem of children and Gottman Parenting Style Questionnaire was used to assess parenting style of parents followed by structured six sessions of PET. Fifteen days after last session posttest was conducted by using the same tools. Statistical analysis revealed that there was a high positive correlation between behavioral problems and parenting style (rho=.990) and the correlation is significant at the level p=0.01. The finding of the study also revealed that mean pretest score of behavior problem was 107.33, which was decreased up to 73.57 in posttest. A significant difference among pre and post test score of parenting style (Z= 0) at p=0.01 confidence level, indicated the effect of PET. A significant difference among pre and post test score of behavioral problems was (Z= 5.295) at p=0.001 confidence level indicated the effect of PET. The findings suggested that Parent Effectiveness Training Program when added as an adjunct to the management of behavior problem leads to greater response. Key words: Parent Effectiveness Training (PET), behavior problems, parenting style, Eyberg Child Behavior Inventory,

Background

Parents are the first and most enduring teachers for their children. It has been said that parenting is the most difficult job, and the most important responsibility, a person ever has in his or her life. Unfortunately, one receives little or no formal training in parenting, and yet one is constantly criticized for every mistake committed. Usually, either we do what our parents did, or we do the exact opposite, depending on our opinion of the parenting we received. The parent-child relationship consists of a combination of behaviors, feelings, and expectations that are unique to a particular parent and a particular child. The relationship involves the full extent of a child's development. (Dr. Thomas Gordon, 1975) . Parents need to understand that their children's behavior is often a reflection of their own behavior. Raising wellbehaved children is not easy. Many parents fail not because they are inadequate but because they are

* Deepika Pathak,, Lecturer Holy Spirit Institution of Nursing Education, Mumbai email: [email protected] ** Vinu Nair. Lecturer, Choithram College of Nursing, Indore *** M.K. Acharya, Clinical psychologist, Choithram Hospital & Research Centre, Indore

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inconsistent. Successful parents know that the discipline is a teaching process, not just punishment and understand that their behavior and emotions affect their children's behavior and emotion. (Severe Sal , 2000)13. Waltham Forest study showed 7% prevalence for moderate to severe behavior problem and another 15% with mild behavior problems in a population study in outer part of London. Temper tantrums were found to be most common at 3-5 years (75.3%), less common at 6-8 years (20.8%), and least common at 9-12 years (3.9%).

Need of the Study

Behavioural problems of children need to be considered by parents as well as health care personnel as an important issue requiring professional interventions. 45.6% of the children were estimated to have behavioural problems, of which 36.5% had significant problems. Indira Gupta and Manorama Verma (2001)7. The better the relationship parents have with their child the greater the impact they can have in their lives. Large number of children suffers; from behavioral problems during their development years. Many of these problems are transient and may not even be noticed. At times,

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"EFFECTIVENESS OF RATIONAL EMOTIVE BEHAVIOR THERAPY AMONG ANXIETY PATIENTS."

* Sini Punnoose, M.Sc (N) **Blessy Antony, M.Sc (N) ***Anila Gangarde, M.S.W, M.Phil. Abstract

Anxiety disorders are the most common of all neuro-psychiatric illnesses and result in considerable functional impairment and distress. Therefore, a quasi experimental research approach with non-equivalent control group design was used to assess the effectiveness of REBT among the patients with anxiety disorder. 30 patients who attended the OPD of Choithram Hospital & Research Center and diagnosed having anxiety disorder by the psychiatrist were purposively selected for the study. 15 patients were assigned to experimental and 15 to the control group respectively. Level of anxiety and rational belief scores were assessed using Burns Anxiety Inventory and Rational Belief Inventory. Seven sessions of REBT were conducted for the experimental group. Post therapy and 1 month follow up assessment was done respectively. Statistical analysis revealed that there was a high negative correlation of anxiety with rational belief (rho= -.79). A significant difference among pre, post and follow up BAI scores of both the experimental and control group at p=0.01 confidence level, indicated the effectiveness of Rational Emotive Behaviour Therapy on reduction of level of anxiety. The Mann Whitney U value (U= 20) at post test and at follow up (U= 1) was significant at the level p=0.01 which revealed the effectiveness of Rational Emotive Behaviour Therapy. The total reduction in the level of anxiety from pretest to follow up in experimental group was 64.93 to 11.13. There was also some reduction in the level of anxiety among patients of control group because of pharmacotherapy. Friedman test for analysis of variance of pre, post test and follow up BAI scores of experimental group was significant at the level p=0.01, which also revealed that REBT is effective in reducing the anxiety. Keywords: Anxiety Disorder, Rational Emotive Behaviour Therapy (REBT), Rational belief, Burn's Anxiety Inventory (BAI).

Background

Anxiety disorders are among the most prevalent mental disorders in the general population. Anxiety disorders are associated with significant morbidity and often are chronic and resistant to treatment. It is characterized most commonly as a diffuse, unpleasant, vague sense of apprehension, often accompanied by autonomic symptoms such as headache, perspiration, palpitation, tightness in the chest, mild stomach discomfort, and restlessness, indicated by an inability to sit or stand still for long (Sadock, 2007)17. Therapy for anxiety disorders often involves medication or specific forms of psychotherapy. Medications, although do not cure completely, can be very effective at relieving anxiety symptoms. Research has also shown that behavioural therapy and cognitive-behavioural therapy can be effective for treatment of the anxiety disorders. An

* Sini Punnoose, Lecturer, BIMTS College of Nursing, Burhanpur email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** Anila Gangrade, Lecturer, Choithram College of Nursing, Indore

experimental test of a core REBT hypothesis showed that those holding a rational belief reported the greatest increase in concern whereas those holding an irrational belief reported the greatest increase in anxiety. (Dryden, Windy, 2006)6.

Need of the Study

A global survey conducted by WHO, indicated that of all the disorders assessed, anxiety disorders are the most common with a prevalence rate of 12-month period of 2.4% to 18.2%. (WHO Survey report, 2010)21 Ganguli (2010)9 analyzed 15 epidemiological studies on psychiatric morbidity in India. In this meta-analysis prevalence rate (in per thousands) of anxiety neurosis was reported to be 16.5% with a rural- urban ratio of 100:106. Moreover, the consequences of the anxiety disorder are higher work absenteeism, loss of productivity, increased use of health care, higher rates of seeking professional help, higher costs related to medication and laboratory testing and higher medication use. (Kessler et al. 2000)12. Russell and Jarvis (2003)16 also have produced a summary of the main research on

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE AND ATTITUDE REGARDING ECT AMONG THE RELATIVES OF THE MENTALLY ILL PATIENTS"

*Siva Subramanian, M.Sc.(N), ** Muthukumari M.Sc.(N), Abstract

Electro convulsive therapy is regarded as a controversial treatment by many people and it has been portrayed as negative experience rather than safe and effective procedure that treats a recognizable illness. The study was conducted in Govt. Rajaji Hospital, Madurai & 40 relatives of mentally ill patients undergoing Electro Convulsive Therapy (ECT) were selected by purposive sampling technique. A one group pre test post test design was adopted for this study. The pre test was conducted, later Self Instructional Module (SIM) was administered. After 7 days post test was conducted to assess the effectiveness of SIM. The study result showed that knowledge and attitude of relatives related to ECT was improved in post test than in pre test and there was a significant positive correlation between the knowledge and attitude of relatives (r=+0.3). Keywords: Effectiveness, Self Instructional Module(SIM), Electro Convulsive Therapy(ECT), Relatives.

Background

ECT is safe, cost effective and useful treatment of mental illness, and there is also a lack of knowledge, misconception and ignorance regarding ECT not only among public, even among the population of mentally ill patient and their relatives. Though ECT is commonly used for the mentally ill patient. The term "ECT" has not become very popular among patients and public. Instead of the term ECT common terms which are popular among public is shock therapy. so the word "Shock" itself is shocking to patient and family members (Bhatia MS, 2000)2. They also think that it is punitive to the patient as a result it causes different level of attitude and fear among family members and patients. Even today, majority of patient are taken to Temples, wizards and faith healers and very few of them realize that, it is a type of illness and considered the treatment for mental illness by psychiatrist. Szuba MP, et al (1998)9 conducted a study in California among 25 patients who were apprehensive to undergo electro convulsive therapy and one relative of each patients for their attitude, knowledge, and opinion about ECT. They found that the patient and family members had highly positive attitude and good knowledge towards ECT

* Shiva Subramanian N., Associate professor, Sumandeep College of Nursing, Vadodara,Gujarat, Email:[email protected], Mobile 07567659912 ** Muthukumari. M. Associate professor, Matha College of Nursing, Manamadurai, Tamilnadu

both before and after treatment, and after the course felt strongly that the ECT was beneficial.

Need of the Study

A prospective cross sectional survey was done involving 96 patients and their relatives. The study showed that the majority of patients and relatives received limited knowledge on ECT (Ugeskar Lager, 2001)8. Walter G, et al (1999) 7 conducted a study on knowledge and attitude of the family members regarding ECT. The findings were consistent and complement evidences showed ECT to be an effective and safe treatment. They reported that knowledge, attitude related to ECT was adequate and most favorable. Bird J.M. (2001)8 conducted a study on the effects of the media on patient's attitude towards ECT in Britain. He interviewed 30 patients on the day before the first treatment, based on the publicity about ECT. 11 patients were aware of the publicity. But only one felt that her attitude towards ECT had altered as a result. The patients who were aware of the publicity were more knowledgeable than the others. Only six patients were not fearful of ECT. Taieb, O et al. (2001)10 conducted a study in Paris on adolescence with mood disorder and their parent's knowledge and attitude about ECT. The aim of the study was to assess the knowledge and attitude towards the use of ECT in adolescence. Study result showed that the patients had adequate knowledge and positive attitude towards ECT. ECT was considered as helpful treatment. Bijtebier and Fowler (2001)3 in their

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

'EFFECTIVENESS OF TEACHING-LEARNING MODULE FOR SCHOOL TEACHERS ON KNOWLEDGE REGARDING BEHAVIORAL THERAPY FOR CHILDREN WITH ADHD'

* Annapoorna S.H., M.Sc. (N) **Prof. K. Jeyabarathi, M.Sc. (N) Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is the most frequently encountered and most extensively studied neurobehavioral disorder of childhood, yet mental and psychiatric services for children lag behind those for adults in developing countries. Therefore, a pre experimental one group pre-test, post-test design was used to find out the Effectiveness of Teaching Learning Module for School Teachers on Knowledge, regarding Behavioral Therapy for Children with Attention Deficit Hyperactivity Disorder (ADHD) in Selected Schools of Hassan, Karnataka. The sample consisted of 100 schoolteachers, selected by convenient sampling method. Data were collected by structured knowledge questionnaire prepared by the investigator. After collecting base line data, teaching learning modules were given to schoolteachers and after 7 days post-test was conducted using the same questionnaire. The results showed that the module was effective in increasing the knowledge of teachers (t99 =28.99). In Post-test significant association was found between knowledge scores and demographic variables like age (?2 = 7.21), gender (?2 = 5.90), religion (?2 = 3.89) and earlier information (?2 = 4.40). Thus H2 was accepted. Key words: Attention Deficit Hyperactivity Disorder (ADHD), Behavioral therapy.

Background

Children are supremely important asset of a nation. Their healthy upbringing is our prime responsibility. Children's programs should find a prominent part in our national plans for the development of human resources in each sector, so that our children grow up to become responsible citizens. Equal opportunities for development to all children during the period of growth should be our aim (Shastri PC, 2009)1. There is no health without mental health. The future of the country, therefore, depends on the mental health and strength of young people (Anant mane 2008) . In India, though children constitute nearly 40% of the population, child mental health care has received scant attention in service, research and training. Child and adolescent psychopathology is a major concern among health professionals and educators in the developed countries. A few surveys conducted in India have revealed that 7-30% of children under the age of 12 years need either evaluation or continuing psychiatric care (Col

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S Chaudhury et al)3. School age is a formative period, physically as well as mentally, transforming the school child into a promising adult. Health habits formed at this stage will be carried to the adult age, old age and even to the next generation (Mahajan B.K..Gupta, 1995) 4. The teachers have an immense impact on young children's mental health. Teacher's services have been utilized for school health programs in health status assessment and health education. Since there is considerable shortage of mental health professionals, school teachers can make important contributions in the promotion of mental health of the children. The opportunity that the teachers have for interpersonal relationship with children and their parents, greatly contribute to the mental health of the children (Dr. Prasad mata 1996) 5. It is estimated that about 50% of students with ADHD do not qualify for special education services and are accommodated full-time in the general education classroom. It is also estimated that of the other 50% of students with ADHD who qualify for special education services, approximately 85% of these students receive at least part of their instruction in the general education setting .Thus, it is crucial to examine what general education teachers know about ADHD. There are many interventions which can be implemented by teachers that

* Annapoorna S.H., Lecturer, P.D. Bharatesh College of Nursing, Halaga, Belgaum Karnataka Mob:07760948479, Email: [email protected] ** Prof. K. Jeyabarathi. Professor, N.D.R.K. College of Nursing, Hassan, Karnataka

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

'PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING ILL-EFFECTS OF TOBACCO CONSUMPTION AMONG THE FOURTH CLASS WORKERS'

* Jyoti Shrivastava, M.Sc. (N) **Blessy Antony, M.Sc. (N) ***Anila Gangrade, M.Phil Abstract

Nicotine is a psychoactive stimulating, habit forming substance found in tobacco. WHO stated that more than 500 million people who are alive today will be killed by tobacco by 2030 and tobacco consumption will become the single leading cause of death. Therefore, an evaluative study was conducted to find out the effectiveness of planned teaching programme through booklet on knowledge regarding ill-effects of tobacco consumption among the fourth class workers. This study was carried out among the fourth class workers in Choithram Hospital and Research Centre, Indore. The objectives were to find out the level of knowledge regarding ill-effects of tobacco consumption, practice of tobacco consumption and to evaluate the effectiveness of planned teaching program on creating awareness about the ill effects of tobacco consumption. A sample of 100 fourth class workers was selected using convenient sampling technique. One group pretest and posttest research design was used in the study. The finding of mean post-test knowledge score (23.42) was higher than the mean pre-test knowledge score (15.89). The findings also revealed that 42 (60.86 %) participants, 33 (47.81%) male and 9 (13.04%) females wished to stop tobacco consumption, whereas 27 (39.13%) participants, 24 (34.78%) male and 3(4.34%) female, were not serious to stop tobacco consumption. Key words: Effectiveness, Planned teaching program, Knowledge, Ill-effect of Tobacco consumption, fourth-class workers.

Background

The Spanish word "tobacco" is thought to have its origin in Arawakan Language, particularly in the Teino language of the Caribbean and it refers to a roll of these leaves (Burtolome de las casas, 1552) or to the "Tobago", a kind of 'Y' shaped pipe for sniffing tobacco smoke (Oviedo, 1567). The International Classification of Diseases (ICD10) has recognized that "tobacco dependence" is a disease. (W.H.O., 1997).15 The leaves of mature tobacco plants are dried and used to produce cigarettes, cigars, and pipe and chewing tobacco (Bhatia,MS.2006). 1 Smoking is one of the biggest causes of premature death in the Western world. Not only does it cause over one third of cancers, but it also causes heart disease and major forms of lung disease, such as chronic bronchitis and emphysema. Smoking had already killed 60 million people worldwide since 1950 and more likely to kill half a billion of those alive today unless current habits are changed.

* Jyoti Shrivastava, Tutor, College of Nursing, Institute of Medical Sciences, Banaras Hindu University, Varansi email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** Anila Gangrade, Lecturer, Choithram College of Nursing, Indore

In the United Kingdom over 102,000 people die every year from smoking. Fifty thousand of these deaths are from cancer, mostly of the lung; almost 35,000 people died of lung cancer in the United Kingdom in 1998. Out of 1,000 young adults (if they all smoke), on an average 1 will be murdered; 6 will be killed on the roads; and 250 will be killed by smoking in middle age alone. In the European Union, disease attributable to smoking accounts for approximately 15 per cent of all deaths. Tobacco smoking has consistently been referred to "as the single most important preventable cause of premature death". (Bulletin of World Health Organisation. 2004)2

Need of the Study

Today of the 1.1 billion who smoke world-wide, 182 million (16.6%) live in India. Tobacco consumption continues to grow in India at 2 to 3% per annum and by 2020 it is predicted that it will account for 13% of all deaths in India. Tobacco used in India is more varied than in most countries. It was estimated that among the 400 million individuals aged 15 years and over in India, 47% used tobacco in one form or other. 72% of tobacco users smoke beedi, 12% smoke cigarette and 16% use tobacco in the smokeless form. Of the 250 million-kg tobacco cleared for domestic consumption in India, 85% is used for smoking,

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

'IDENTIFICATION OF PERCEIVED STRESSORS AMONG HOSPITALIZED PATIENTS'

*Shailendra Ghosh, M.Sc.(N), ** Blessy Antony, M.Sc.(N), *** Dr. Pankaj Jain, MD Psychiatrist Abstract

There are several stimuli in the hospital environment which patients perceived as stressors. The process of recovery of patients is considered to be affected in the hospitals by the experience of stress, therefore an exploratory study was conducted to identify the perceived stressors of hospitalized patients admitted in medical unit at selected hospitals of Indore. The sample comprised of 100 patients (male & female). The researcher adopted purposive sampling technique. Modified Volicer's Hospital Stressors Rating Scale was used to identify the stressors. 69 (69%) of the samples were male and rest 31(31%) were female. The major findings of the study revealed that 25(25%) patients perceived hospitalization as severe stress, 61(61%) perceived moderate stress and 14(14%) perceived mild stress. The highly rated events were change in personal routine, worrying about family members being far away and had to stay in same bed or same room all the day. The least stressful events were hesitation in approaching nurses & doctors and weakened faith in God. There was significant association between marital status and perception of stressors (X2=18.67, p <0.05), however there were no association found with other demographic variables. The finding of the study revealed that hospitalization was a stressful experience for the patients; psychological stressors were highly rated by the hospitalized patients. Key Words: Perceived Stressors, Hospitalized patients, Volicer's Hospital Stressors Rating Scale.

Background

Admission to hospital removes individuals from a familiar, well-ordered world and places them in an environment, which is different in every respect. In hospital, they are likely to be very dependent on others for most basic functions such as maintaining hygiene and feeding. Usually they will be restricted to one place, surrounded by totally new people, whose skills are now of vital importance to them, and it is significant that developing good relations with hospital staff is not only an important factor in adaptation to hospital life but can also be a potential source of stress for patients (Kerlnger, Fred.N. 2000)8. Period of admission into hospital following illness is a stressful time requiring considerable attention. During hospitalization, apart from the strange surroundings, the smell and colors are not the same as at home. Previously the patient belonged to himself and took care of his own bodily needs and functions, he is now a "property" to be cared for, fed, washed and cleaned by others. There are several stimuli in the new hospital environment which

* Shailendra Ghosh, Principal Herbertpur Christian Hospital, P.O.Herbertpur, Dist: Dehradun,Uttrakhand Email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** Dr. Pankaj Jain, MD, Psyciatrist, Choithram Hospital & Research Centre, Indore

patient perceive as stressors, that provokes his/her limited threshold and individual becomes stressful. Every individual has unique responses to stressors. (Stuart G.2005)9

Need of the Study

Today, the majority of community members are frightened when they are ill and have to go to hospitals. Some express the wish to die in peace at home rather than to go to one of these health care institutions to suffer humiliation or be treated as a second-class citizen. This means that the process of recovery from illness was considered to be affected in the hospitals by the experience of stress. A person's response to stress was influenced by several variables such as mental attitude, life style, perception and heredity (Franck, S Linda, Cox, Allen, Winter 2005)5. With the curiosity to know the various stressors patients experience during hospital stay and to develop information booklet for them to prevent the occurrence of stress due to hospitalization, this study was taken up by the researcher.

Problem Statement

"An exploratory study to identify the perceived stressors of hospitalized patients admitted in medical unit at selected hospital of Indore."

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"PLANNED TEACHING PROGRAMME ON KNOWLEDGE OF PARENTS REGARDING SELECTED EMOTIONAL AND BEHAVIOURAL PROBLEM IN CHILDREN."

* Vinu Nair, M.Sc. (N) **Blessy Antony, M.Sc. (N) ***Anila Gangrade, M.S.W., M. Phil. Abstract

Children are in fact the real wealth of a nation. The Report on the Mental health (WHO,2001) estimates a global Burden of Serious Emotional disturbances in children and adolescents up to 15%. Further, one in ten young people suffers from mental illnesses, but one in five receives the needed treatment. The situation in large parts of the developing world is likely to be more alarming. Therefore, a pre-experimental approach, one group pretest post test design was adopted to find the effectiveness of planned teaching program through PowerPoint followed by the booklet on knowledge regarding selected emotional and behavioral problems of children was taken up. 30 parents were selected using purposive sampling. The investigator developed a structured questionnaire for data collection. Further, the booklet was restricted to hyperactivity disorders, anxiety disorders and conduct disorders only. The finding of the pre-test score revealed that most of 21(70%) parents had average (9-16) knowledge and 9(30%) parents had poor knowledge (0-8) regarding emotional and behavioral problem in the children. After providing the planned teaching program through booklet, 19 (63.33%) parents were found to have average knowledge score and 11(36.6%) parents found to have good knowledge. The mean post-test knowledge score was 16.14, which was higher than that of mean pre-test knowledge score of 9.46. The computed 't' value for knowledge score ( t29=18.8,p<0.05) showed statistically significant value and suggested that the planned teaching programme was effective in increasing the knowledge of parents regarding emotional and behavioral problem of children. Key Words: Planned teaching program, emotional and behavioral problems, hyperactivity disorder, anxiety disorder, conduct disorder.

Background

Emotional or Behavioral Disorder (EBD) refers to a condition in which behavioral or emotional responses of an individual in school are so different from his/her generally accepted, age appropriate cultural norms that they adversely affect performance in such areas as self care, social relationships, personal adjustment, academic progress, classroom behavior, or work adjustment .Forness & Knitzer( 1992)4. The emotional or behavioral responses adversely affect educational or developmental performance, including intrapersonal, academic, vocational, or social skills. Leena, M et al.(2002)5 conducted a study on the teacher's evaluation in 1998, it revealed that behavioral and emotional problem in schools has increased to about 74.7% and has become more severe over the past few years. Anita & Gaur (2003)1 conducted a cross section study to

* Vinu Nair. Lecturer, Choithram College of Nursing, Indore ** Blessy Antony, Professor, Choithram College of Nursing, Indore *** Anila Gangrade, Lecturer, Choithram College of Nursing, Indore

assess the prevalence of psychiatric morbidity among 6 to 14 years old children of both urban and rural area. The study revealed the prevalence of psychiatric disorder 4.5% in these children. It also revealed that prevalence was more in male children18.37 % than in female children14.44 %.

Need of the Study

Shoba Srinath et al.(2004 )9, in their study found 12.0 % prevalence rate of behavioral disorders in 4-16 yr old children. Enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder were the most frequent diagnoses. When impairment associated with the disorder was assessed, significant disability was found in 5.3 % of the 4-16 yr group. Ehsan Ullah Syed et al.(2007)3 Conducted study to know the prevalence of child mental health problems in Pakistan which seemed to be higher than that reported in studies from other countries. The Prevalence was higher amongst children attending community schools. Consistent with most studies, male children were at a higher risk than females. There was a need for developing

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

"EFFECTIVENESS OF RELAXATION TECHNIQUES ON LEVEL OF CARE BURDEN AMONG PARENTS OF THALASSEMIA CHILDREN"

* Archana Masih, M.Sc. (N) **Blessy Antony, M.Sc. (N) ***M.K. Acharya, Clinical Psychologist Abstract

Over 250 million people in the world and around 20 million in India carry the gene for beta-thalassemia. One lakh children are born world over with the homozygous state for thalassemia, of which, 8,000 to 10,000 children are born in India. IAP, Textbook of Paediatrics (2006)4. Caregivers often experience physical, psychological, and financial stress, and social isolation. Therefore, to identify care givers burden and help them to cope with it, a pre-experimental study was conducted to assess the effectiveness of Relaxation Techniques on level of care burden among parents of thalassemia children at selected hospitals, Indore. One group pre-test post-test design with purposive sampling technique was used to select 20 parents of thalassemia children based on certain predetermined criteria. Pre test was conducted using a Semi structured interview schedule (Rating Scale) to assess the level of care burden and then relaxation technique was introduced to them. Herbert Benson relaxation response was practiced for 15 minutes twice a day for 24 sessions. After 24 sessions, post test was taken with the same tool. The findings revealed that mean post test score 72.85 was lower than mean pre test score i.e. 86.55, mean difference was 13.7, calculated SD was 14.61 and computed 't' value (t19 = 4.19) which was significant at P < 0.01 level, thus indicated that relaxation techniques was effective in decreasing the level of care burden among parents of thalassemia children. However, no significant association was found between pre-test score and selected demographic variables. Key words: Thalassemia, Relaxation Techniques, Caregivers, Care Burden, Herbert Benson relaxation response.

Background

Thalassemia is most common single gene disorder in the world and represents a major health burden worldwide. It is a heterogeneous disorder recessively inherited resulting from various mutations of the genes which code for globin chains of Hb (haemoglobin), leading to reduced or absent synthesis of globin chains and when beta chain synthesis is affected it is called as beta thalassemia. First described by Cooley and Ice in 1925 and the first case of beta-thalassemia in India was reported by Dr. Mukherjee from Calcutta in 1938. Recent estimate revealed that more than 52 million caregivers are providing long-term care in the home settings. Many caregivers have chronic health problems as a direct result of the burden itself. Working caregivers reduce their work hours, take frequent leaves or absence, arrive late or leave early from their work setting and miss career opportunities. The caregiver must be recognized and supported by communities and the healthcare

* Archana Masih, Lecutrer, Anushree College of Nursing, Jabalpur email: [email protected] ** Blessy Antony. Professor, Choithram College of Nursing, Indore *** M.K. Acharya, Clinical psychologist, Choithram Hospital & Research Centre, Indore

delivery system. Financial, emotional and hands-on help is needed to prevent caregiver's burden and burnout. Laura Brumm (2008)2

Need of the Study

Among Indians, prevalence of thalassemia is very high among certain communities, such as Punjabis, Gujaratis, Bengalies, Parsis and Sindhies. (Pathlabs,lal,2009)11. Family caregivers are often described as the backbone of the long term care system: they provide nearly 80% of the country homecare. Today, patients are released from the hospital "quicker and sicker" families with no medical experience are often providing hospital level care at home. (Aldridge, susan,2008)1. Care presents many challenges for family members, including emotional stress, strenuous physical activity leading to depression. "Yet there are no 'sick days" for a family care giver, who is solely responsible for administering medicines and other treatments, providing nursing and personal care, doing the shopping, preparing the meals, taking care of the house holds, paying bills, keeping track of appointments and arranging transportation for medical visits. (Brody E. Jane, 2008)3

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

Case Vignette MULTIDISCIPLINARY BEHAVIOUR INTERVENTION CENTRE

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

Beyond Nursing Reflections on Healing and Regeneration

Gravity may hold us to the earth, but there is not much to hold us up and keep us moving, other than our bodies. And many doctors will tell you that if there is nothing else to learn in a life time, there is at least to learn how to respect and nurture your own body. Finally, we meet a man who matches his respect for state of the art medical technology with his respect for the human body's ability to heal and regenerate itself. An excellent essay for teaching, the famous autobiographical case history is often cited as the story of how a patient laughed himself out of an illness. After a stressful trip to cold-war Russia in 1964, Saturday Review editor Norman Cousins tells how he developed a debilitating illness which confine him to bed. He is admitted to hospital for tests and treatments, and is diagnosed with ankylosing spondylitis, but his condition deteriorates and he is given a gloomy prognosis. He notices that the depressing routine of hospital life tends to produce side effects that aggravate his condition. With the assistance of one of his doctors, he checks out of hospital and into a comfortable (yet less expensive) hotel where the food is better and he can watch funny movies while he medicates himself with high doses of Vitamin C. He is convinced that the slow improvement in his condition is owing to his individualized methods of therapy and his having taken charge of his own situation. Keeping up his spirits with humour was indeed an important part of the treatment, but Cousins did not rely on laughter alone. He also relied on physiological rationalization for the efficacy of high-dose Vitamin C and on the restoration of control over his own condition. Treatment must be in line with the perceived cause. Attitude and emotions have a great deal to do with health or the lack of it. Since we are apt to think of illness as being caused by germs, it is difficult for us to recognize that many serious illnesses can be controlled, reduced or even cured through positive ideas, emotions and attitudes. You see, every person who is ill comes to the doctor with two diseases, not one. One is the disease that is diagnosed. The other is the powerful disease that goes by the name of panic. Panic is a disease! Because panic produces specific biochemical changes in the body. Panic can release catecholamine abnormally, in profusion, which can destabilize the heart. The catecholamine flooding can even rupture the muscle fibers of the heart and produce a heart attack! You have heard of people being scared to death. That has happened. Cases have been recorded. This is how it happens. Another thing is that panic actually constricts the blood vessels, and this puts a burden on the heart. And one reason that so many patients, or people who have heart attacks, never reach the hospital alive is not just because of the severity of the heart attack, but because of the overlay and the overload produced by the panic. Here you have a heart, which is in precarious condition, and now suddenly it is confronted by panic and it has to work extra hard to get the blood through the narrowed openings! And it becomes an additional intolerable burden and it stops functioning. Therefore, what is more important than helping to treat them is to liberate them from their panic.

Source : Anatomy of an illness as perceived by the patient: reflections on healing and regeneration Author: Norman Cousins

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Indian Journal of Nursing Studies Vol. 2, No.2, July.- Dec. 2011

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