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RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
PERFORMA SYNOPSIS FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED BY:
Mr.SUBIN KOCHUPARAMBIL
1ST YEAR.MSC. NURSING
PSYCHIATRIC NURSING
SNEHA COLLEGE OF NURSING
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RAJIV GANDHI UNIVERSITY OF HEALTH AND SCIENCES
BANGALORE – KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
NAME OF THE CANDIDATE
1
AND ADDRESS
2
NAME OF THE INSTITUTION
COURSE OF STUDY AND
SUBJECT.
DATE OF ADMISSION TO THE
COURSE
3
4
Mr. SUBIN KOCHUPARAMBIL
1st YEAR MSC NURSING,
SNEHA COLLEGE OF NURSING,
BANGLORE.
SNEHA COLLEGE OF NURSING
1ST YEAR M.Sc. NURSING
PSYCHIATRIC NURSING
01/07/2011
“A STUDY TO ASSESS THE
EFFECTIVENESS OF GUIDED IMAGERY IN
THE REDUCTION OF STRESS AND PAIN
AMONG ONCOLOGY PATIENTS FROM
SELECTED HOSPITALS IN BANGLORE.”
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TITLE OF THE TOPIC
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Brief resume on intended work
6.1: Need for the study
6.2: Review of Literature
6.3: Objectives of the study
6.4: Hypothesis
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Materials and Methods:
7.1: Sources of Data: Data will be collected from the HIV/AIDS patients admitted in
selected rehabilitation center in Bangalore.
7.2: Method of Data Collection: Self administered questionnaire method
7.3: Does the study require any investigation or intervention to be carried out on
the patients or human or animals?
NO
7.4: Has ethical clearance been obtained?
YES
ENCLOSED
ENCLOSED
ENCLOSED
ENCLOSED
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6: BRIEF RESUME OF THE INTENTED WORK
INTRODUCTION,
“To look behind or to look up front is not as important as to look inside”- Randolf waldo
The ability and power of the mind to help influence the body in healing is quite
extraordinary, and at times, it seems unbelievable what can transpire with this powerful
influence. The connection between the mind and physical health has been well documented and
extensively studied. One among the application of those studies is mentioned as the therapeutic
Guided Imagery, which will help us to tap into its powerful influence for cancer treatment and
recovery.1
Imagery is said to be a relaxation technique, similar to meditation and self-hypnosis, that has
physical and psychological effects. Promoters claim it can relax the mind and body by
decreasing heart rate, lowering blood pressure, and altering brain waves. Some supporters also
say that imagery can relieve pain and emotional anxiety, make drugs more effective, and provide
emotional insights. Practitioners use imagery to treat people with phobias and depression, reduce
stress and pain, increase motivation, promote relaxation, increase control over one’s life,
improve communication, and even to help people stop smoking. Imagery is also used in
biofeedback, hypnosis, and neuro-linguistic programming. For oncology patients, some
supporters of imagery report that it can relieve nausea and vomiting from chemotherapy, relieve
stress associated with having cancer, enhance the immune system, help with weight gain, combat
depression, and lessen pain.2
Guided imagery is believed to have been used as a medical therapy for centuries. There is
recorded evidence that Tibetan monks in the 13th and 14th centuries began meditating and
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imagining that Buddha would cure diseases. Some say the techniques even go back to the ancient
Babylonians, Greeks, and Romans. The Simonton’s popularized imagery therapies in a bestselling 1978 book titled Getting Well Again. The book described their experiences in treating
oncology patients with imagery and other therapies.3
Guided imagery is also known as mind-body medicine, essentially because we are using our
mind to affect the status of our body, this form of alternative therapy has two main objectives:
Emotional conflicts due to negative life experiences can be shed from the conscious mind by
teaching the individual to re-train their thoughts and feelings to a peaceful co-existence with the
former bad experiences.4
Some commonly used types of guided imagery include; Relaxation imagery, which involves
conjuring up pleasant, relaxing images that rest the mind and body. These may be experiences
that have already happened, or new situations. In healing imagery, patients coping with diseases
and injuries can imagine cancer cells dying, wound healing, and the body mending itself. Or,
patients may picture themselves healthy, happy, and symptom-free. In Pain imagery, individuals
can control pain through several imagery techniques.4
The simplest explanation of guided imagery as one of the types of alternative medicine is the
principle of using your own positive reinforcement from the mind to improve your health and
well-being. Guided Imagery has been called the language of the mind. It is a language that the
mind can use to talk to the body, a language the body can understand immediately without
question. It has also been described as the interface, or connection between the body and the
mind because of the positive chemical and biological changes it can produce in the body. These
changes are extremely useful in the successful treatment of and recovery from cancer.5
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6.1:NEED FOR THE STUDY
Over half of the patients diagnosed with cancer suffer from stress and pain. Often,
analgesic medications do not completely relieve the pain and alternative measures are sought out
for relief. Mind—body techniques such as guided imagery have been thought to be helpful and
used as an adjuvant to pain relief. The studies performed from 2001 to 2008, which investigated
the use of guided imagery for relief of cancer pain. Electronic databases were searched with the
keywords cancer pain, visualization, and guided imagery, for any studies utilizing guided
imagery with an outcome measure of pain. Five studies included pain as either a primary or a
secondary outcome measure. In three of those, pain intensity and pain-related distress decreased
in the guided imagery intervention versus control.6
While guided imagery cannot fight cancer itself, the technique may help to treat certain
cancer-related complications. Although there are many different approaches to guided imagery,
the technique often involves visualizing in a peaceful place. When used as an adjunct treatment
for oncology patients (and other health conditions), guided imagery may also involve visualizing
specific images associated with healing. Guided imagery appears to increase comfort and support
psychological well-being in oncology patients, according to a research review of six clinical
trials.7
Other studies on guided imagery and oncology patient care are:1) Guided Imagery and
Cancer Pain 2)Guided Imagery and Mood and 3) Guided Imagery and Immune Response.
1) Guided Imagery and Cancer Pain
In a pilot study of 62 hospitalized oncology patients currently experiencing pain,
researchers found that using guided imagery audiotapes helped to reduce pain intensity. Study
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results suggest that patients with greater visualization abilities may be more likely to experience
pain reduction when using guided imagery.8
A study conducted in the University of Sydney in Australia observed that progressive
muscle relaxation combined with guided imagery has the potential to promote relief of cancer
pain. The techniques appear to produce a relaxation response that may break the pain-muscletension-stress and anxiety cycle and facilitate pain relief through a calming effect. This technique
seems to provide a self-care strategy that, to a limited extent, shifts the locus of control from
clinician to patient.9
2) Guided Imagery and Mood
Guided imagery may help to boost mood and improve quality of life for oncology people
, according to a study of eight people with a history of cancer. For 10 weeks, half the participants
took part in weekly sessions that combined guided imagery and music. Compared to study
subjects assigned to a waitlist, the treatment group experienced greater improvements in mood
and quality of life.10
A study conducted to measure the effectiveness of customized guided imagery for
increasing comfort in early stage cancer. They found that listening to a guided imagery audiotape
once a day for the duration of the study indicated a significant overall increase in comfort over
time, and was especially salient in the first three weeks of therapy.10
3) Guided Imagery and Immune Response
Preliminary research indicates that guided imagery may improve immune response in
oncology people. In a pilot study of 28 breast cancer patients, for instance, those who took part in
a guided imagery and relaxation program prior to undergoing surgery experienced increased
activity in natural killer cells which means it is known to play a key role in immune defense.11
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Although there's no evidence that guided imagery can directly combat cancer, using
guided imagery may be of some benefit to cancer patients, especially in terms of emotional
health. This alternative therapy may also help to cope with cancer-related complications as well
as the adverse effects of oncology treatments like radiation and chemotherapy.12
The researcher felt from his clinical experience that most of the cancer patients are vulnerable to
severe stress and pain, which cannot be relieved by analgesics or other sedative drugs. Hence
based upon the above information, the researcher felt that there is a need to create awareness
among oncology patients about various aspects of imagery treatment in the reduction of stress
and pain and to find out, up to what extend it is successive is reducing stress and pain among
those patients, by conducting an experimental study among selected oncology institutes in
Banglore.
6.2:REVIEW OF LITERATURE.
Review of literature refers to the activities involved in identifying and searching for the
information on a topic and developing and understanding it. It is a written summary to the state
of an art on a research problem.
Review of literature is an important step in research process. The review of literature on a
topic of interest often prepared to put a research problem in context or as the basic for the
implementation project. It helps to relate the findings from one study with a view to establish a
comprehensive body of scientific knowledge in a professional discipline, from which valid and
pertinent theories may be developed.
A study conducted in a Cancer Hospital and Research Institute at Ohio State University
in Columbus found that those patients using a chemotherapy-specific guided-imagery audiotape
expressed a significantly more positive experience with chemotherapy, finding guided imagery
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to be an effective intervention to promote patient involvement in self-care practices and to
increase patient coping abilities during symptom occurrence.11
A study conducted in Walther Cancer Institute found that individuals who participated in
guided imagery sessions scored better on both mood scores and quality of life scores than those
who did not. Interestingly, these scores continued to improve in the experimental group, even
after sessions were complete, indicating that guided imagery is effective in improving mood and
quality of life in oncology patients.12
A study conducted in Ohio State University tried a self-hypnotic, cue-controlled
relaxation, and guided imagery intervention that showed a marked and clinically significant
reduction in nausea and vomiting as well as a concurrent increase in sleep duration in oncology
patients.13
A study conducted by researchers at Ohio State University in Columbus, Ohio found that
oncology patients who used imagery while receiving chemotherapy felt more relaxed, better
prepared for their treatment and more positive about care than those who didn't use the
technique. They also found it can help chemotherapy patients cope with one of the most severe
side effects of their treatment.14
A study conducted in University School of Nursing in Baltimore, Maryland showed
significant benefits from the use of information, cognitive restructuring, and relaxation with
guided imagery in those patients with breast cancer who underwent autologous bone
marrow/peripheral blood stem cell transplantation. This strategy was found to be effective in
significantly reducing anxiety, nausea, and nausea combined with fatigue 7 days after surgery
when the side effects of treatment are usually the most severe.15
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A study conducted in the Center for Stress Management examined the effects of mental
imagery on the immune system response, and specifically, on depressed white blood cell (WBC)
counts. Results indicated significant increases in WBC count for all patients over a 90-day
period, even when possessing disease and illnesses that would have predicted a decrease in WBC
count.16
A study conducted by Danish researchers found increased natural killer cell activity
among ten college students who imagined that their immune systems were becoming very
effective. Natural killer cells are an important part of the immune system because they can
recognize and destroy virus-infected cells, tumor cells and other invaders. A group of metastatic
oncology patients using daily imagery for a year achieved significant improvements in natural
killer cell activity and several other measures of immune functioning.17
A study conducted in the University of Miami found that 13 weeks of guided imagery
and music showed significant decreases in cortisol level, the stress hormone which strongly
correlated with mood disturbances, as well as demonstrating a significant reduction in
depression, fatigue, and total mood disturbance.17
A study conducted in the Anderson cancer Center in Houston, TX observed a desire for
and a benefit from patients being able to attach meaning to the disease and its treatment. They
felt that this is why many are drawn to guided imagery as a tool in the management of oncologyrelated stress and pain by using it to reconnect to the self, to make sense of their experiences with
breast cancer, and for managing oncology pain in a manner that increases ones sense of control,
thereby alleviating the suffering of the survivor.18
Relaxation and guided imagery are useful strategies for cancer pain; however, their
effects vary from patient to patient. Patients' perceptions of these treatments and factors that
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contribute to their effectiveness have not previously been described. Data from interviews
conducted after a trial of guided imagery and progressive muscle relaxation (PMR) interventions
were analyzed to compare patients' perceptions of treatment effects with observed changes in
pain scores, and to explore patients' ideas about factors that contributed to the effectiveness of
each intervention. Post-study interviews were conducted with 26 hospitalized patients with
cancer pain who had completed trials of guided imagery and progressive muscle relaxation. In
most cases, participants' perceptions of treatment effects shown observed changes in pain scores.
Participants described treatment and patient characteristics that influenced effectiveness of the
interventions such as active involvement in the intervention, guided instructions, providing a
source of distraction, stimulating relaxation, individual abilities and preferences, and pain
qualities.19
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF GUIDED IMAGERY IN
THE REDUCTION OF STRESS AND PAIN AMONG ONCOLOGY PATIENTS IN
SELECTED HOSPITALS IN BANGALORE.”
6.3:OBJECTIVES

To identify the severity of stress and pain in oncology patients before and after the
application of guided imagery

To evaluate the effectiveness of guided imagery in the of patients by comparing the pre
application and post application results.

To identify the association between selected demographic variable and stress and pain.
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6.4:HYPOTHESIS
H0. - There will not be a significant association between selected socio demographic variables ,
stress and pain level among oncology patients.
H1. There will be a significant association between selected socio demographic variables and
level of stress and pain level among oncology patients.
H2. There will be a significant difference between pre and post application of guided imagery in
the reduction of stress and pain among oncology patients.
6.5:OPERATIONAL DEFINITION.
Assess:- In this study it refers to an activity to measure the outcome by using structured
interview schedule.
Effectiveness:- In this study it refers to the outcome of imagery therapy upon stress and pain
among selected oncology patients.
Guided imagery:- Here it refers to the use of relaxation and mental visualization to improve
mood and physical wellbeing.
Oncology Patients:- In this study it refers to all the patients who are admitted for the treatment
of cancer, in selected oncology institutes in Banglore.
6.6:ASSUMPTION
The study is based on following assumptions :
1. Most of the oncology patients will have stress and pain.
2. After the application of guided imagery some changes may occur in their stress and pain
level.
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6.7:DELIMITATIONS OF THE STUDY.
 Data collection period will be limited to 4-6 weeks.
 Sample size will be limited to 50 patients.
 The study is limited to only selected hospitals in Bangalore.
7: MATERIALS AND METHODS OF STUDY.
7.1: SOURCE OF DATA COLLECTION:Oncology patients from selected hospitals in Banglore, Karnataka.
7.2: METHOD OF DATA COLLECTION
Research design
-
Pre experimental, one group pre test post test study
is planned for research study.
Sample technique
-
Non probability convenient sampling.
Population
-
Oncology patients from selected hospitals in
Bangalore.
Sample
-
Oncology patients from selected hospitals in
Bangalore who have fulfilled the inclusion
criteria.
Sample size
-
50 oncology patients from selected hospitals
in Bangalore.
Setting of the study
-
The study is planning to conduct in selected
Oncology institutes in Bangalore.
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Research variable
Dependent variable
-
In this study the dependent variable is Stress and
pain among oncology patients.
Independent Variable
-
In this study independent variable is guided imagery
in reduction of stress and pain among oncology
patients.
PROJECTED OUTCOME.
This study will help the oncology patients to decrease their sufferings and cope up with
the disease condition by the use of guided imagery.
7.2.1:CRITERIA FOR SELECTION OF SAMPLE.
1. Inclusive criteria:a) Male and female oncology patients from selected hospitals in Banglore.
b) Oncology patients who are willing to participate.
c) Oncology patients who understands either kannada or english.
2. Exclusive criteria:a) Male and female oncology patients those who are not willing to participate.
b) Patients those who are not available at the time of study.
7.2.2: TOOLS OF RESEARCH
Type of tool selected
Section A:1. Socio demographic data sheet
Section B:1. Cohen’s perceived stress scale
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2. Numerical pain rating scale.
7.2.3: DATA COLLECTION
Collection of data will be done by using a self administered questionnaire/structured interview
schedule.
7.2.4: METHOD OF DATA ANALYSIS AND PRESENTATION
Descriptive statistics - It includes percentage, frequency, mean and standard deviation.
Inferential statistics - It include paired‘t’ test and chi-square test.
7.3: ETHICAL CONSIDERATION
Does the Study Require Any Investigation OR Intervention to be Carried Out on Patients OR
Other Humans OR Animals?
No
Has the ethical clearance being obtained from the institution?
Yes
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8 REFERENCES
1. Elizabeth scott.Use guided imagery for relaxation 2006:153-157.
2. Relaxation techniques: Learn ways to calm your stress May 2007:267-274.Available from
www.mayoclinic.
3. Burt goldman. A short history of guided imagery 2007: 37-44.
4.
Weil A, Martin Rossman.Self-Healing with Guided Imagery 2006;36:163-171.
5. Kwekkeboom KL, Wanta B, Bumpus M. Individual difference variables and the effects of
progressive muscle relaxation and analgesic imagery interventions on cancer pain. J Pain
Symptom Manage 2007: 386-391.
6. Rof Spencer JW, Jacobs JJ. Complementary/Alternative Medicine: An Evidence-Based
Approach. 2005;22:368-381.
7. www.guidedimageryinc.com
8. Kwekkeboom KL, Kneip J, Pearson L. "A pilot study to predict success with guided
imagery for cancer pain." Pain Manag Nurs. 2006:26-31.
9. Carulla Torrent J, et al. Oncologists’ perceptions of cancer pain management : the real and
the idea. Eur J Pain. 2007;11:352–359.
10. Newell SA, Sanson-Fisher RW, Savolainen NJ. Systematic review of psychological
therapies for oncology patients: overview and recommendations for future research.2009:
631-647.
11. University of South Florida College of Nursing, Tampa, FL 33612-4766, USA.
[email protected]: Biol Res Nurs.Jan 2008;9(3):205-14
12. Rossman M .Imagery and cancer recovery 2008:47-52.
13. www.quantumjumping.com
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14. Goudas LC, Bloch R, Gialeli-Goudas M, Lau J, Carr DB. The epidemiology of cancer
pain. Cancer Invest. 2005:463-477.
15. Sarkar TK, Segar A, Walker LG. "Immuno-modulatory effects of relaxation training and
guided imagery in women with locally advanced breast cancer undergoing multimodality
therapy: a randomised controlled trial." Breast. 2009;5:87-91
16. Olness, K Imagery as adjunct therapy cancer:journal of Pediatric Hematology/Cancer;2007:
364-372
17. Walker LG, et al. Psychological, clinical and pathological effects of relaxation training and
guided imagery. Br J Cancer.2005:876-883
18. Vainio A, Auvinen A. Prevalence of symptoms among patients with advanced cancer: An
international
collaborative
study:
Symptom
prevalence
group. J
Manage. 2008;127:276–286.
19. Kwekkeboom KL Complement Ther Clin Pract.2008Aug;14(3):185-94
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Pain
Symptom