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DESSERTATION PROTOCAL 1 2 NAME OF THE CANDIDATE AND ADDRESS Ms. JOTHI. M NAME OF THE INSTITUITION HINA COLLEGE OF NURSING M. Sc NURSING STUDENT HINA COLLEGE OF NURSING, YELAHANKA NEW TOWN, BANGALORE-64 YELAHANKA NEW TOWN, BANGALORE 3 COURSE OF STUDY SUBJECT 4 5 DATE OF ADMISSION TO COURSE M. Sc NURSING PSYCHIATRIC NURSING 27/06/2008 TITLE OF THE TOPIC: Assess the anxiety level and effectiveness of psychotherapy of the mother of hospitalized neonatal ICU child in selected hospital at Bangalore. 6. BRIEF RESUME OF INTENDED WORK 6.1 NEED FOR THE STUDY The children who received psychotherapy were compared with controls or children receiving another form of treatment. Only those studies using Ss younger than a mean age of 13 yrs at the time of treatment were included. Exceptions to the age limitation were made only if separate analyses for younger children were reported or if individual data from older could be eliminated. Results show that therapy with children was similar in effectiveness to therapy with adults; treated children achieved outcomes about two-thirds of a standard deviation better than untreated children. Although behavioral treatments appeared to be more effective than non behavioral treatments, this apparent superiority was due largely to the types of outcome and target problems included in behavioral studies. (Casey et al., 2001) Anxiety disorders are among the most prevalent psychiatric conditions in the US and in most other population’s studies. Further, studies have persistently shown that they produce in order morbidity, use of health are services, and functional impairment. Recent studies also suggest that chronic anxiety disorder may increase the rate of cardiovascular related mortality. reported that modern psychotherapies have often demonstrated a significant degree of effectiveness, in that they help clients overcome their presenting symptoms, their degree of 'efficiency' may not measure up to their 'effectiveness.' Efficiency in psychotherapy includes several issues that are often neglected in research on 'effectiveness.' These criteria include such ingredients as thoroughgoingness, depth-centeredness, maintenance of pervasiveness, therapeutic extensiveness, progress, preventive psychotherapy, minimization of therapeutic harm, and encouragement of scientific flexibility. It is contended that these aspects of psychotherapy are of profound importance to therapists and clients and that such aspects should be consciously included as values in psychotherapy (Ellis & Albert .,1999). The investigator observed that the mother of hospitalized child will have a lot of tension and anxious. This may affect their health status of the mother. In many of the hospital there is no consideration about psychological state of the mother. So the investigator felt that assess the anxiety level and effectiveness of psychotherapy is needed. 6.2 REVIEW OF LITERATURE: Tritt. K, (2004) et al., stated that the influence of co-admission of their children in the treatment of 29 female patients diagnosed with generalized anxiety disorder, 15 of whom were admitted with accompanying children and 14 without, were compared (response rate 95.3%). The results indicate that mothers with generalized anxiety disorder who were accompanied by their children during in-patient psychotherapeutic treatment achieved treatment results that were just as good as mothers with the same diagnosis who were admitted without children. M. L. Smith et al., (1998) reported that the benefits of psychotherapy in 475 controlled studies, using only studies of patients seeking treatment for neuroses, true phobias, and emotional-somatic complaints. The results of 81 controlled trials were integrated statistically using the meta-analytic technique. The condition of the typical patient after treatment was better than that of 77% of untreated controls measured at the same time, and the rate of relapse in the 1st 2 yrs was small. Behavior and psychodynamic verbal therapies appeared to be superior to other therapies. The relationship between severity of illness and choice of therapy is unknown, and could account for some of the differential effects, but does not vitiate this further evidence of the efficacy of psychotherapy. Smith (2004) et al., coated that 375 controlled evaluations of psychotherapy and counseling were coded and integrated statistically. The findings provide convincing evidence of the efficacy of psychotherapy. On the average, the typical therapy client is better off than 75% of untreated individuals. Few important differences in effectiveness could be established among many quite different types of psychotherapy. More generally, virtually no difference in effectiveness was observed between the class of all behavioral therapies (e.g., systematic desensitization and behavior modification) and the non behavioral therapies (e.g., Regression, psychodynamic, rational-emotive, and transactional analysis). Casey (2001) et al., revealed that children who received psychotherapy were compared with controls or children receiving another form of treatment. Results show that therapy with children was similar in effectiveness to therapy with adults; treated children achieved outcomes about two-thirds of a standard deviation better than untreated children. Although behavioral treatments appeared to be more effective than non behavioral treatments. Manos (1994) et al., stated that motioned the outcome of psychoanalytically oriented psychotherapy administered to 15-54 yr olds who presented with a variety of syndromes, including personality disorders, anxiety/somatoform disorders, psychotic disorders, psychosexual disorders, and bulimia. Ss and 16 non treatment controls (aged 16-38 yrs) were evaluated post intake. MMPI scores, target symptoms, global evaluation, and other clinical evaluations were used as outcome measures. Findings show that Ss who underwent therapy improved significantly more than controls on subjective and objective parameters. Paplau (1963) identified four levels of anxiety and described their effects mild anxiety is associated with tension of day to day living. Moderate anxiety, in which persons focuses only on immediate concerns, involves the narrowing of the perceptual filed. Severe anxiety is marked by a significant reduction in the perceptual filed. Panic is associated with awe, dread, and terror and the person feeling it is unable to do things even with direction. Melnyk (2007) conducted the study to test COPE program for mothers of critically ill children: an integrative model of young children's post-hospital adjustment behaviors. COPE effects on children's post-hospital externalizing behaviors were indirect, via associations with parental beliefs and maternal negative mood state. Furthermore, COPE participation was associated with more maternal support of their children, which was also associated with less internalizing and externalizing behaviors 3 months post discharge. Parloff, (1996) et al., stated that the treatment of adults by a range of individual psychosocial therapies. The contradiction between increased conceptual and methodological sophistication and increased skepticism regarding the scientific merit of positive research findings in the field of psychotherapy is examined. Efficacy research findings are discussed through a critique of global outcome surveys via meta-analysis and studies of particular therapies for specific problems/disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and behavioral medicine categories (e.g., depression, schizophrenia, anxiety, alcoholism). Issues and trends with regard to therapy manuals, brief therapies, clinical trials, placebos and specificity of effects, theory development and integration, are also discussed. STATEMENT OF THE PROBLEM: Assess the anxiety level and effectiveness of psychotherapy of the mother of hospitalized neonatal ICU child in selected hospital at Bangalore. 6.3OBJECTIVES: To assess the anxiety level of the mother of hospitalized neonatal ICU child. To evaluate the effectiveness of psychotherapy on mother of hospitalized neonatal ICU child. To determine the association between the anxiety level of the mother of hospitalized neonatal ICU child with their demographic variables. 6.4. RESEARCH HYPOTHESIS: The anxiety level of the mother will become low after giving psychotherapy. 6.5. OPERATIONAL DEFINITIONS OF THE TERMS: ASSESSMENT: Refers to the process used to identify evaluate and analyse the anxiety level and effect of psychotherapy of mothers in relation to the hospitalized neonatal child. ANXIETY: The state of feeling nervous or worried that something bad is going to happen. PSYCHOTHERAPY: Helping person attempts to relieve an individual distress of facilitating changes in his feelings, attitudes and behaviors by means of verbal and emotional communications. NEONATES: It is said to be baby’s age between 0 - 28 days. NICU: An intensive care unit designed with special equipment to care of premature or seriously ill new born. 6.6ASSUMPTIONS OF THE STUDY: It is assumed that, The anxiety level of the mother will be reduced with effect of psychotherapy. 7.0 MATERIALS METHOD: 7.1 SOURCE OF DATA: Mothers of hospitalized neonatal child are considered as source of data. 7.2 METHOD OF COLLECTION OF DATA: Purposive sample collection method will used to collect data from mothers. 7.2.1. RESEARCH DESIGN: The selection of research design is an important and essential state in research as it is concerned with the overall framework of conducting the study by giving a plan, structure and strategy of investigation (Abdelah & Levine, 1965) The research design selected for present study is pre test and post test design under quasi experimental design to assess the anxiety level and effectiveness of psychotherapy on a randomly selected sample of 50 subjects 7.2.2SETTING OF THE STUDY: The study will be conducted in the hospitals of Bangalore District (Urban). There are about 20 hospitals in this district and total of 100 mothers of neonatal. The settings of the study is among the mothers of hospitalized child. 7.2.3POPULATION: The mothers whose child is admitted in the NICU in the selected hospitals of Bangalore constituted the population. 7.2.4, SAMPLE SIZE: There will be about 50 mothers are considered as sample. 7.2.5. SAMPLING PROCEDURE: Based on availability of the mother on the time of study, the sample was collected. Purposive sampling procedure will be used in this study. 7.2.6. SAMPLING CRITERIA: INCLUSION CRITERIA: Mothers, Those children admitted in NICU. Who are willing to participate. Those who are able to read and write. EXCLUSION CRITERIA: Mothers, Will not present at the time. Not able to read and write. Child admitted other than NICU. 7.2.7. DATA COLLECTION TOOL: A structural scale is used to assess the anxiety level and effectiveness of psychotherapy. 7.2.8. DATA COLLECTION METHOD: Formal permission will be obtained from incharge of the hospital. Pre test will be carried out before giving psychotherapy then after therapy again anxiety level will be assessed by using rating scale. 7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS AND ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY. -No7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUITION IN CASE OF 7.3? Formal ethical clearance will be obtained from the concerned authority and consent from hospitalized mother before data collection. REFERENCES: Andrews, Archives of General Psychiatry; 1981 Nov Vol 38 (11) 12031208. Ellis, Albert. Psychotherapy Theory, Research and practice; 1980 Win Vol 17 (4) 414-419 Fam Process. 2003 Fal; 42 (3) : 391 – 402. J. Pediatr Psychol. 2007 May; 32 (4) : 463 – 74. Smith, Meta analysis of psychotherapy outcome studies; 1977 Sep Vol 32 (9) 752-760. Wien Klin Wochenschr. 2004 Nov 30; 116 (21-22): 750-4 9. SIGNATURE OF THE CANDIDATE : (JOTHI. M) 10. REMARKS OF THE GUIDE: The study is useful to reduce the anxiety level of mothers of hospitalized NICU children. The need for study explained is appropriate and methodology is as per the statement of the problem. Hence, can be approved for undertaking this study. 11. NAME AND DESIGNATION : 11.1 GUIDE: Mrs. PARIMALA KRIPANIDHI ASSOCIATE PROFESSOR AND HOD Dept. of PSYCHIATRIC NURSING Hina College of Nursing, Bangalore. SIGNATURE : 11.3 HEAD OF THE DEPARTMENT : Mrs. PARIMALA KRIPANIDHI ASSOCIATE PROFESSOR AND HOD Dept. of PSYCHIATRIC NURSING Hina College of Nursing, Bangalore. 11.2 SIGNATURE : 12.1 REMARKS OF THE CHAIRMAN AND PRINCIPAL : This study is recommended by research committee and it is useful to assess the level of motivation among drug addiction patients. Hence, can be approved for the study. 12.2 SIGNATURE :