ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
By
ELIZABETH JEBAKANI. C
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University,
Chennai in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING
APRIL – 2011
A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY
ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
By
ELIZABETH JEBAKANI .C
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai
in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING
APRIL – 2011
INTERNAL EXAMINER EXTERNAL EXAMINER
CERTIFICATE
Certified that this is the bonafide work of Mrs. Elizabeth Jebakani.C of K.G. College of Nursing, Coimbatore, submitted in partial fulfillment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M.G.R Medical University under the Registration No: 30096442.
MRS.VAIJAYANTHI MOHANDAS, PROF.(MRS.) SONIA DAS,
Director of Education, Principal,
K.G.College of Health Sciences, K.G College of Nursing,
Coimbatore. Coimbatore.
A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY
ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
Approved by the Dissertation Committee on: 09-04-2010
___________________________
Prof. (Mrs.) TAMILSELVI. ,
Head of the department,
Psychiatry Nursing,
K.G.College of Nursing,
K.G.Hospital,
Coimbatore- 641018.
___________________________
Dr.(Mrs.) V. PONNI MURALIDHARAN. ,
Psychiatrist,
K.G.Hospital,
Coimbatore- 641018.
___________________________
Prof. (Mr.) K.SUBRAMANIAN. ,
Biostatistics and Research,
K.G.College of Nursing,
K.G.Hospital,
Coimbatore- 641018.
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University,
Chennai, in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING
APRIL – 2011
ACKNOWLEDGEMENT
“I can do all things through him who strengthens me”
(Philippians 4:13)
I praise and thank the Almighty for the opportunity he gave me and the blessings bestowed on me throughout the course of my study.
The essence of all beautiful art, all great art, is gratitude. Gratitude can never be expressed in words but this is only deep perception, which makes the words to flow from ones inner heart
My heartfelt thanks to Padmashri. Dr. G. BAKTHAVATHSALAM,
Chairman, K.G. Hospital, Coimbatore, for giving me an opportunity to carry out this study successful.
“Changes are not made in this world until somebody brings them out”. I express my sincere, respectful and whole hearted gratitude to Mrs.VAIJAYANTHI MOHANDAS, Director of Education, K.G.College of Health Sciences, for her constant support, encouragement and guidance in all my endeavours.It is my great honor and privilege to have completed this study under her guidance.
“Greater achievements come from experiences and they stand as key to successes”. It is my privilege to express my sincere gratitude and heartfelt thanks to Prof. (Mrs.) SONIA DAS, Principal, K.G .College of Nursing for her encouragement, support and constant guidance to pursue this study.
My heartfelt thanks to Prof. (Ms.) RAJI. K, Vice-Principal, K.G College of Nursing for her support during this study.
“The dream begins with a teacher who believes in you, who tugs and pushes and leads you to the next plateau, called “truth.” I solicit my esteem gratitude to my research guide Prof.(Mrs.)TAMILSELVI , Head of the Department of Psychiatry Nursing, K.G.College of Nursing for her positive outlook,direction,valuable guidance and unwavering support which contributed towards the successful completion of this work.
I express my sincere gratitude towards Dr. V.PONNIMURALIDARAN, Psychiatrist, K.G.Hospital, for her constant support and guidance.
“There cannot be an excellent piece of architecture without an architect”. I am obliged to Prof. (Mr.) K.SUBRAMANIAN, Department of Biostatistics and Research for his critical statistical advice, his tremendous efforts to make figures meaningful.
I convey my sincere thanks to Prof. (Mrs.) SOFIA CHRISTOPHER, class coordinator and head of the Department of Community Health Nursing, for her patience, affectionate, moral support and guidance throughout my study.
I extend my heartfelt thanks to Prof. (Mrs.) VIJAYALAKSHMI.N, Head of the Department of Child Health Nursing and Prof. (Mrs.) SHEEBA. R, Head of the Department of Obstetrics and Gynecological Nursing, for their constant inspiration throughout the study.
I sincerely thank Mrs. NUZIBA BEGUM, Ms.SANTHAKUMARI, Lecturers, Department of Psychiatry Nursing, and K. G. College of Nursing for their essential motivation and inspiration throughout my study.
My sincere gratitude to all the experts Dr.(Mr.)MARIKANNAN, Dr.(Mrs.)PONNI MURALIDHARAN.V, Prof.(Mrs.)VIJAYALAKSHMI, Prof.(Mrs.)LALITHA VIJAY, Prof.(Mrs.)VANITHA, Prof.(Mrs.)MEERA SARAVANAN and Prof.(Mrs.)UTTRAMANI, who have given the content validity and given suggestions in the modification of the tool.
I acknowledge the timely help of all the FACULTY MEMBERS of K.G.College of Nursing for their kind support during the course of the study.
My whole hearted thanks to the DIRECTOR of Sheela Senior Citizen Home, Coimbatore for her valuable permission and constant support throughout my study.
A word of appreciation to Mrs. JOSEPHINE PRINCEY, English Lecturer, K.G. College of Nursing, for her valuable editorial support.
I have immense pleasure in thanking Prof.(Mr.)A.SUBRAMANIAN, Tamil Lecturer, J.J.Teacher Institute, Trichy, for his valuable editorial support.
I acknowledge my sincere thanks to Mr.KADTHIRVADIVELU.M, Librarian, K.G.College of Health Sciences for rendering his help and support in procuring the literature related to the study.
I express my sincere thanks to all the PARTICIPANTS for their kind co-operation throughout the study, without them it would have been impossible to conduct the study.
I dedicate this work to my PARENTS and HUSBAND for their unconditional love, care, supporting prayers and encouragement to complete this task.
It gives me great pleasure to thank with deep sense of gratitude to Mr.ABRAHAM MESHAK, for his painstaking efforts in preparing the reminiscence therapy album for my study.
I am extremely thankful to Mr.RANGARAJ, Xerox, Saravanampatty, who spent hours to prepare the script of this thesis.
I would also like to render a word of appreciation to all my FRIENDS and CLASSMATES for their timely help and support throughout the study.
I thank one and all who directly and indirectly helped in the successful completion of this dissertation.
INDEX
CHAPTER
CONTENT
PAGE NO
I
II
III
IV
V
VI
INTRODUCTION
Need for the study
Statement of the problem
Objectives
Operational definitions
Assumptions
Hypothesis
Limitations
Projected outcomes
Conceptual framework
REVIEW OF LITEATURE
Literature studies related to stress.
Literature studies related to reminiscence therapy.
Literature studies related to coping.
METHODOLOGY
Introduction
Research approach
Research design
Setting of the study
Variables
Population
Sample size
Sampling technique
Criteria for sample selection
Description of the tool
Content validity
Pilot study
Reliability
Method of data collection
Plan for data analysis
DATA ANALYSIS AND INTERPRETATION
RESULTS AND DISCUSSION
SUMMARY,RECOMMENDATIONS AND
NURSING IMPLICATIONS OF THE STUDY
BIBLIOGRAPHY
APPENDICES
1-3
4-6
7
7
7-8
8
8
8
9
9-12
13-21
13-16
17-20
20-21
22-32
22
22
22-24
24
25-26
27
27
28
28
28-30
30
30-31
31
31
32
33-57
58-62
63-67
LIST OF TABLES
Fig No
TABLES
1.
Distribution of demographic variables among elderly in experimental group and control group.
2.
Distribution of pre test stress and coping score among elderly in experimental group and control group.
3.
Distribution of post test stress and coping score among elderly in experimental group and control group.
4.
Comparisons of scores on pre test and post test stress among elderly in experimental group.
5.
Comparisons of scores on pre test and post test coping among elderly in experimental group.
6.
Comparisons of scores on stress among elderly in experimental and control group.
7.
Comparisons of scores on coping among elderly in experimental and control group.
8.
Correlation coefficient between stress and coping among elderly in experimental group.
9.
Correlation coefficient between stress and coping among elderly in control group.
10.
Association on stress score with selected demographic variables in experimental group.
11.
Association on coping score with selected demographic variables in experimental group.
LIST OF FIGURES
Fig No
FIGURES
1.
Conceptual Framework.
2.
Schematic Representation of Study Design.
3.
Relationship of Variables.
4.
Diagram showing the demographic variables with regard to age of the elderly in the experimental and control group.
5.
Diagram showing the demographic variables with regard to stay of the elderly in the experimental and control group.
6.
Diagram showing the demographic variables with regard to marital status in the experimental and control group.
7.
Diagram showing the comparisons of scores on pre test and post test stress among elderly in the experimental group.
8.
Diagram showing the comparisons of scores on pre test and post test coping among elderly in the experimental group.
9.
Diagram showing the comparisons of scores on stress among elderly in the experimental and control group.
10.
Diagram showing the comparisons of scores on coping among elderly in the experimental and control group.
LIST OF APPENDICES
APPENDIX
TITLE
A
B
C
D
E
F
G
H
I
Letter seeking permission for conducting the study.
Letter granting permission for conducting the study.
Letter seeking experts opinion for content validity of the tool.
Format for content validity.
List of experts for content validity.
Certificate of English editing.
Certificate of Tamil editing.
Tool I: Demographic Variables
Tool II: Modified Sheldon Cohen’s Perceived Stress Scale.
Tool III: Modified Lazarus Coping Scale.
Procedure of reminiscence therapy.
APPENDIX – A
LETTER SEEKING PERMISSION FOR CONDUCTING THE STUDY
To,
The Director,
Sheela Senior Citizen Home,
26, Annai Amirthanandha Nagar,
Thadagam Road,
Velandipalayam,
Coimbatore.
Respected Madam,
This is to bring your kind notice that Mrs. Elizabeth jebakani.C, student of K. G. College of Nursing is conducting a research on “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE, COIMBATORE.” For the purpose of submission to the TamilNadu Dr.M.G.R Medical University, Chennai, as a partial fulfillment of the requirement for the award of M. Sc (N) Degree.
I kindly request you to grant her permission to conduct this study in your old age home. Further details of the proposed project, if required will be furnished by the student personally. Kindly do the needful.
Thanking you
Yours truly,
Prof. Sonia Das
PRINCIPAL
APPENDIX – C
LETTER SEEKING EXPERTS OPINION FOR CONTENT VALIDITY
From,
Mrs. Elizabeth jebakani.C
II year M. Sc Nursing,
K. G. College of Nursing,
Coimbatore.
To,
Through Principal of K. G. College of Nursing,
Respected Madam / Sir,
Sub: Requisition for expert opinion and suggestions for content validity of the tool.
I am a student of M.Sc Nursing II year, of K. G. College of Nursing, Coimbatore affiliated to the Dr. M.G. R. Medical University, Chennai. As a partial fulfillment of M.Sc, Nursing Programme, I am conducting a study on “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE, COIMBATORE.”
Here with I am sending the developed tool for content validity and for your expert opinion and possible suggestion. It will be very kind of you to return the same to the undersigned at the earliest possible.
Thanking you
Date
Place: Coimbatore
Yours faithfully,
(Mrs. Elizabeth jebakani.C)
APPENDIX – D
FORMAT FOR CONTENT VALIDITY
Name of the expert :
Address :
Total content for the tool : Adequate / Not Adequate
Kindly validate each tool and (ƒ-) if it is applicable.
S. No
No. of Tool / Section
Strongly Agree
Agree
Need Modification
Remarks
Signature of the expert with date
APPENDIX-E
LIST OF EXPERTS FOR CONTENT VALIDITY
1. Dr. (Mr.) MARIKANNAN,
Psychiatrist,
Government Hospital,
Coimbatore – 641018.
2. Dr. (Mrs.) PONNI MURALIDHARAN. V,
Psychiatrist,
K.G.College of Nursing,
Coimbatore – 641018.
3. Prof. (Mrs.) VIJAYALAKSHMI. R,
Head of Psychiatry Nursing Department,
Chettinad College of Nursing,
Chennai – 600044.
4. Prof. (Mrs.) LALITHA VIJAY,
Head of Psychiatry Nursing Department,
Sri Gokulam College of Nursing,
Salem – 636412.
5. Prof. (Mrs.) VANITHA,
Head of Psychiatry Nursing Department,
Ramakrishna College of Nursing,
Coimbatore – 641044.
6. Prof. (Mrs.) MEERA SARAVANAN,
Head of Psychiatry Nursing Department,
P.S.G College of Nursing,
Coimbatore – 641004.
7. Prof. (Mrs.) UTTRAMANI,
Head of Psychiatry Nursing Department,
Rabindharanath Tagore College of Nursing,
Salem – 637303.
APPENDIX – F
CERTIFICATE For ENGLISH EDITING
TO WHOMSOEVER IT MAY CONCERN
This is to certify that the tool developed by Mrs. Elizabeth Jebakani.C II year M.Sc Nursing Student of K.G. College of Nursing for dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE HOME ,COIMBATORE.” edited for English language appropriateness by Mrs. JOSEPHINE PRINCY M.A, M. Phil.
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Signature
APPENDIX – G
CERTIFICATE For TAMIL EDITING
TO WHOMSOEVER IT MAY CONCERN
This is to certify that the tool developed by Mrs. Elizabeth Jebakani.C II year M.Sc Nursing Student of K.G. College of Nursing for dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE HOME , COIMBATORE.” is edited for Tamil language appropriateness by Mr. A. SUBRAMANIAN, M.A, M.Ed.
APPENDIX-H
TOOL-I
SECTION:A
SECTION:A
DEMOGRAPHIC VARIABLES:
1. AGE years
2. GENDER
a. Male
b. Female
3. EDUCATIONAL QUALIFICATION
a. Illiterate
b. Primary
c. High school
d. Higher secondary
e. College level
4. MARITAL STATUS
a. Unmarried
b. Married
c. Widow/Widower
d. Separated
5. PAST OCCUPATION
a. Unemployed
b. Coolie
c. Professional
d. Others
6. MONTHLY INCOME
a. < Rs.1000
b. Rs.1001-2000
c. >Rs.2000
7. SOURCE OF INCOME
a. Pension
b. Deposit
c. Family members
d. Institution
8. DURATION OF STAY
a. c. 2-5years
d. more than 5 years
a. Once in a week
b. Twice in a week
c. Thrice in a week
d. Never
a. One
b. Two
c. Three
d. None.
a. Staying together with spouse
b. Staying alone.
a. Diabetes Mellitus
b. Hypertension
c. Respiratory problems
d. Others
Friends
Family members
Relatives
None.
The Perceived stress scale [PSS] is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one’s life are appraised as stressful.
The questions in this scale ask about your feelings and thoughts during the lifetime. In each case, you will be asked to indicate by tick mark how often you felt or thought in a certain way. Perceived stress scale scores are obtained by reversing responses (eg:0=4,1=3,2=2,3=1 &4=0)to the four positively stated items(4,5,7,&8)and summing across all scale items.
[0=Never; 1=Almost never; 2=Sometimes; 3=Fairly often; 4=Very often]
1
How often have you been upset because of something that happened unexpectedly?
2
How often have you felt That you were unable to control the important things in your life?
3
How often have you felt nervous and stressed?
4
How often have you felt confident about your ability to handle your personal problems?
5
How often have you felt that things were going your way?
6
How often have you found that you could not cope with all the things that you had to do?
7
How often have you been able to control irritations in your life?
8
How often have you felt that you were on top of things?
9
How often have you been angered because of things that were outside of your control?
10
How often have you felt difficulties were piling up so high that you could not overcome them?
0-10: No Stress,
11-20: Mild Stress,
21-30: Moderate Stress,
31-40: Severe Stress.
The coping strategy instrument which is made by Lazarus in 1991 to assess the coping methods used by the family members. The instrument is classified into problem oriented method and affective oriented method.
This method consists of 15 items and the responses as always, sometimes, never and undecided. The questions in this scale ask about your feelings and thoughts regarding coping strategies. In each case, you will be asked to indicate by tick mark in the following.
KEY: Never=1; Sometimes=2; Always=3; Undecided=0.
SCORE:<50= Inadequate coping ; 51-70= Moderate coping ;
>70= Adequate coping.
Try to maintain some control over the situation.
Look at the problem objectively.
Accept the situation as it is.
Think through different ways to handle the situation.
Try out different ways of solving the problem.
Try to find meaning in the situation.
Find out more about the situation so that you can handle in better.
Break the problem down in to “Smaller Pieces”.
Set specific goals to help solve the problem.
Settle for the next best thing.
Talk the Problem over with someone who has been in the same type of situation.
Draw on past experience to help you handle the situation.
Actively try to change the situation.
Do anything just to do something.
Let someone else solve the problem.
1
Hope that things will get better.
2
Pray.
3
Worry.
4
Try to put the problem out of your mind.
5
Laugh out off, figuring that things could be worse.
6
Get nervous.
7
Seek comfort or help from family or friends.
8
Over eat.
9
Smoke.
10
Drink.
11
Go to sleep, figuring that things will look better in the morning.
12
Work off tension with physical activity.
13
Get prepared to expect the worst.
14
Don’t worry about it; everything will probably work out fine.
15
Get mad, curse, swear.
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ftiyg;gly;
c’;fs; kdjpypUe;J gpur;rpidia kwe;J tpl KaYjy;
gpur;rpidiag; ghh;j;J eifj;jy;. mjidg; bghpjhf;Fjy;
eLf;fKWjy;
ez;gh;fsplnkh, FLk;gj;jpdhplnkh mutizg;g[j; njLjy;
mjpfkhf rhg;gpLjy;
g[ifg;gpoj;jy;
kJ mUe;Jjy;
gpur;rpidfs; rhpahfptpLbkd cw’;Fjy;
clYf;F gapw;rpaspg;gjd; yk; ntiyapd; kd mGj;jj;ij ePf;Fjy;;
nkhrkhd epiyia vjph; bfhs;s jahuhf ntz;Lk;.
mijf; Fwpj;J ftiy ntz;lhk;. vy;yh fhhpa’;fspYk; rpwg;ghf Koa[k;
igj;jpak;, rgpj;jy;, rj;jpak; bra;jy;
Measures to stimulate long term elderly patients with memorabilia, films and songs meaningful to their generation used in conjunction with or as a prelude to reality orientation therapy. Reminiscing is a universal activity in old person. In the past two decades there has been a change in our understanding of the psychological role played by reminiscing theoreticians and clinicians to-day view it as an adaptive mechanism for the aging person. [LEWIS, 19752]
So it as come up as a therapeutic measure to enhance psychological well being in elderly.
To learn about and appreciate life of individual.
To gather valuable information concerning psychological factors underlying health beliefs, coping skills and cultural perspective.
To help in bette
9. FREQUENCY OF VISIT BY FAMILY MEMBERS
10. NUMBER OF CHILDREN
11. STAY OF THE ELDERLY
12. PHYSICAL ILLNESS
13. SOCIAL SUPPORT
TOOL-II
SECTION:B
MODIFIED SHELDON COHENS PERCIEVED STRESS SCALE
KEY:
S.NO
CONTENTS
0
1
2
3
4
SCORE:
TOOL-III
SECTION:C
MODIFIED LAZARUS COPING SCALE:
S.no
Coping methods
Never
Sometimes
Always
Undecided
Problem Oriented Methods
No
%
No
%
No
%
No
%
S. no
Coping Methods
Never
Sometimes
Always
Undecided
Affective- Oriented Methods
No
%
No
%
No
%
No
%
gphpt[ m
Kjpnahh;fspd; milahs ml;;il bgw;wpUf;Fk; mk;r’;fs;
milahs ml;ltid
2. ghypdk;
3. fy;tpj;jFjp
4. jpUkz epiy
5. fle;j fhy ntiy
6. khj tUkhdk;
7. tUkhdj;jpw;fhd tHpfs;
8. j’;fpapUf;Fk; fhyk;
9. FLk;g egh;fs; te;J ghh;f;Fk; Kiw
10. FHe;ijfspd; vz;zpf;if
11. Kjpnahh; trpf;Fk; epiy
12. cly; Mnuhf;fpakpd;ik
13. rf Mjut[
gphpt[ M
t.
vz;
bghUslf;fk;
0
1
2
3
4
vjph;ghuhky; ele;j epfH;r;rpahy; eP’;fs; vj;jid Kiw ghjpf;fg;gl;Ls;sPh;fs; ?
c’;fs; thH;f;ifapy; Kf;fpakhd fhhpa’;fs; fl;LgLj;j Koatpy;iy vd vj;jid Kiw czh;e;Js;sPh;fs; ?
vj;jid Kiw eLf;fj;jpYk; kd mGj;jj;jpYk; tplg;gl;Ls;sPh;fs; ?
c’;fs; jdpg;gl;l gpur;rpiifis eP’;fns ifahs Koa[k; vd;w ek;gpf;ifia vj;jid Kiw czh;e;Js;sPh;fs; ?
eP’;fs; epidj;j gona fhhpa’;fs; elf;fpd;wd vd;W vj;jid Kiw czh;e;Js;sPh;fs; ?
eP’;fs; bra;a ntz;oa fhhpa’;fspy; c’;fshy; rkhspf;f Koatpy;iy vd vj;jid Kiw fz;lwpe;jPh;fs; ?
thH;f;ifapy; vj;jid Kiw vhpr;riy c’;fshy; flLg;gLj;j Koe;jJ ?
vy;yh fhhpa’;fspy; eP’;fns Kjd;ikahdth; vd vj;jid Kiw czh;e;Js;sPh;fs; ?
fhhpa’;fs; c’;fs; fl;Lg;ghl;Lf;Fs; ,y;iy vd vj;jid Kiw nfhgg;gl;Ls;sPh;fs; ?
c’;fshy; nkw;bfhs;s Koahjgo f#;l’;fs; kiynghy; Ftpe;J tpl;ljhf vj;jid Kiw czh;e;Js;sPh;fs; ?
gphpt[ ,
gpur;rpid jGtpa Kiwfs;
czh;t[fisj; jGtpa Kiwfs;
APPENDIX-I
PROCEDURE OF REMINISCENCE THERAPY
REMINISCENCE THERAPY:
PURPOSE:
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Therapy is the attempted remediation of a health problem, usually following a medical diagnosis. There are many different types of therapy. Not all therapies are effective. Many therapies can produce unwanted adverse effects.
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