Download rajiv gandhi university of health sciences, bangalore, karnataka

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MS.K.SABARI.
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NAME OF THE CANDIDATE
AND ADDRESS
GAYATHRI COLLEGE OF NURSING,
KOTTIGEPALYA, BANGALORE
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NAME OF THE INSTITUTION
GAYATHRI COLLEGE OF NURSING,
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COURSE OF STUDY AND
SUBJECT
FIRST YEAR MSC NURSING,
DATE OF ADMISSION TO
COURSE
12-06-2008
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PSYCHIATRIC NURSING
A STUDY TO ASSESS THE CHANGES IN
SELF ESTEEM AMONG NEUROTIC
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TITLE OF THE TOPIC
PATIENTS ATTENDING OUTPATIENT
DEPARTMENT IN A SELECTED
HOSPITAL, BANGALORE.
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6. BRIEF RESUME OF THE INTENDED WORK:
INTRODUCTION
“Love yourself first and everything else falls into line. You really have to love yourself to
get anything done in this world”.
Lucille Ball
The term “self-esteem” one of the oldest concepts in psychology first appeared as a coinage
of American psychologist and philosopher William James in 1890.
Self esteem is the way individuals think and feel about, themselves and how they do things
that are important to them. Self esteem is shaped by what they feel about themselves.
Schools can influence children self-esteem through the attitudes they foster toward
competition and diversity and their recognition of achievements in academics, sports and art. By
middle childhood friendships have assumed a pivotal side in a child’s life.
Teenager’s self esteem is often affected by the physical and hormonal changes, they
experience, especially during puberty. Body image is a major component in teenagers self esteem,
and they are very concerned about how their peers see them. Parents can enhance teenager’s self
esteem by asking for their help or advice and listening to their opinions.
Lack of self esteem is expressed in negative behaviours, such as criminal activities, gang
affiliation, smoking and alcohol and other drug dependency. A person inner conviction of his or her
own competency and worth as a human being.
Positive self esteem is viewing oneself as a
competent and worthy person. However that is defined feeling good about that aspect of oneself.
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Psychological literature and popular culture both concentrate on the presence or absence of
high self-esteem, however some evidence suggests that the over emphasis on the self esteem mantra
can lead to rapid falls when the self becomes invalidated in the domains that one considers
important.
Self esteem is the experience of one’s personal self worth. It is a mental indicator, as body
temperature and blood pressure are physical indicators. But when their self esteem is very low some
people are depressed and apathetic, sometimes even suicidal, but so do narcissistic disorders in
which people appear to have very high levels of self esteem, while behaving with arrogance and
disregard for others.
Unhealthy self esteem may also be associated with grandiose and delusional thinking among
people suffering from psychosis and neurosis. This kind of self esteem can be described as the
pathological result of a failed attempt to develop a stable, cohesive self or identify.
Neurosis is a functional mental disorder. Patient with neurosis may have other distressing
emotional symptoms such as morbid fears, obsessive thoughts. These symptoms do not involve
gross personality disorganization, total lack of insight or total loss of contact with reality.
A neurotic, very simply is one who suffers from acute anxiety, stress and indecision to an
extent where it impedes his social behaviour and makes him a maladjusted individual. What is very
important is that there is no considerable change or dysfunction in his nerve structure or in the
functioning of his organs.
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This instigated the investigator to undertake a study to assess the self esteem of neurotic clients.
6.1 NEED FOR THE STUDY:
Self esteem is a basic human need i.e. “it makes an essential contribution to the life
process”….. is indispensable to normal and healthy self development and has a value for survival.
Maslow described two kinds of esteem needs. The need for respect from others and the need
for self respect. Maslowian self esteem entails competence, confidence, mastery, achievement,
independence and freedom.
Respects from others entails recognition, acceptance status and
appreciation. Without the fulfillment of these needs, Maslow suggests that an individual feels
discouraged, weak and inferior.
Neurosis is a functional disorder in which feelings of anxiety, obsessional thoughts,
compulsive acts, and physical complaints without objective evidence of disease, in varying degrees
and patterns, dominate the personality.
Neurosis is a less severe form of psychological disorder where patients show either excessive
or prolonged emotional reaction to any given stress.
The basic and predominant features of neurosis are tension, fear or worry. All people
get tense or worried from time to time especially when faced with difficult problems. However, they
are all able to cope with the situations and overcome these tensions.
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In traditional usage, neurosis is a psychological disturbance in which there are one or more
symptoms, such as phobia, obsession or compulsion that are ineffective attempts to deal with
anxiety.
There are no clear cut organic problems, no violation of basic social norms, no loss of
orientation to reality, but the individual still shows a lifelong pattern of self defeating and inadequate
coping strategies aimed at reducing anxiety.
Burns, Tom, Paykel, ES Ezekiel, A Leman’s conducted a study to analyze the self esteem
among neurotic disorders; a study was carried out between 1977 and 1982. Which evaluated the
effects of psychiatric nursing care and psychiatric outpatient care among discharged chronic
neurotics. Results demonstrated that outpatient and psychiatric nursing care groups had almost
identical levels of depression, anxiety and distress to those found in their original intakes. It is
suggested that benefit treatment effects probably work by improving patients self esteem and sense
of personal efficacy.
During the clinical experience, the investigator had an opportunity to observe that most of the
neurotic clients have some changes in self esteem.
Hence the investigator felt that it is essential to undertake a study to assess the changes in self
esteem among neurotic clients. It will help to identify the factors and concentrate to improve the
quality of life among neurotic clients.
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6.3 REVIEW OF LITERATURE:
“I have often wondered how it is everyone loves himself more than the rest of men, but yet
sets less value on his own opinions of himself than the opinions of others”. –Marcus Aurelius
The review of literature for the present study in organized under following.
Robert KL, Reasoner, Conducted a study to assess self esteem. They discovered that as
neurotic disorder arises, self esteem declines. However low and high self esteem correlates closely
with neurotic symptoms. Often it is the lack of communications skills or close relationships that are
necessary for developing and maintaining self esteem that ate the underlying cause.
The difference between a person with high self esteem and one with low self esteem is not
how often they get low or even how they go low but what, they do with their low moods.
Geoffery R Hooke conducted a study predicting outcomes of group cognitive behaviour
therapy for patients with affective and neurotic disorder. Observed the group by using depression,
anxiety, and stress scale (DASS) before and after treatment. Prior to treatment, date from the locus
of control of behaviour a global assessment of function (GAF) and the Rosenberg self esteem scale
(RSE) were also collected. Results indicated, that post treatment stress scores of all patients were
predicted by pretreatment stress and self esteem.
Among patients with neurotic disorders, post treatment anxiety was predicted by initial
anxiety and self esteem where as among patients with affective disorders, post treatment anxiety
scores were predicted by initial anxiety for patient with neurotic disorders. Self esteem did not
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predict variance in post treatment depression in addition to that explained by pretreatment
depression.
Trenkl A conducted a study on correlation between the experience of pleasure and self
esteem of neurotic patient based on practical knowledge in therapeutic area. The embittering of
essential parts of later self and identify feeling by cultural discrimination of primary pleasure of
oneself during the early child hood is shown by a clinical case.
Primary self esteem or self feeling is degraded into guilt and fear and cannot be replaced by
secondary satisfactions.
Biovats C, Eide GE, Hanestad Br, Havik OE, conducted a study to investigate changes in
anxiety and depression overtime in subjects attending counseling. The results support the buffer
theory which proposes that social support acts as a buffer protection people from the potentially
pathogenic influence of stressful life events. Self efficacy seems to be more vulnerable to anxiety
and depression.
Goldstein LH, Atkins L, Landar S, Brown RG, Leigh PN, concluded a research to identify
predictors of psychological distress (measured by anxiety and neurotic depression) and low self
esteem and to determine the changes of neurotic disorders. Results at the first interview, negative
social support and bulbar impairment were most predictive of psychological distress, pre illness;
marital intimacy retained an ability to predict patient’s affective state and self estem.
Knapen J, Vande Vliel P, Van coppenolle H, David A, Peuslcent , etal, compared the
changes in physical self concept, global self esteem, depression and anxiety. The results suggested
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that both psychomotor therapy programs were usually effective in enhancing physical self-concept.
The relationship between improvements in physical, self concept and enhancement in depression and
anxiety supports the potential role of the physical self concept in the recovery process of depressed
and anxious.
Powell R, Dolan R, Wessely.s. Researched a attribution and self esteem in neurotic
depression and chronic fatigue syndromes. This study showed differences in the severity of mood
disorder between samples and neurotic disturbances, but suggested that an outward style of
attribution protects the depressed (neurotic depression) from cognitive changes associated with low
mood but at the expense of greater vulnerability towards somatic symptoms such as fatigue.
Dr. Klayne Katon, conducted a study on high neurotic personalities and that they were found
likely to respond to treatment with behavioural therapy. Because people with “Neuroticism” tend to
have more anxiety, lower self esteem and lower tolerance for stress than other individuals and they
may feel alienated victimized and resentful. Researcher resulted that their findings on neurotic
personalities, the researchers note that anxiety, low self-esteem, low tolerance for stress and other
problems. According to the researchers these findings call attention to certain neurotic depression.
Jorgensen CR conducted a study on disturbed sense of identity or self esteem in borderline
personality disorder. Traditionally, personal identity is considered to be important for psychological
health and adaptive functioning.
It was argued that the development of personal identity is
intimately related to and indeed dependent on, elements of modern culture, with significant cultural
changes having affected the conditions under which human identity develops. Therefore the identity
diffusion seen in patients with borderline disorders must be understood in relation to mot only the
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individual patient’s personal history and inner structures but also contemporary rate modern culture
and social organization.
Bach S conducted a study on perspectives on self and objects. The normal adult is able both
to experience himself and to know himself as an objective in the world he is capable of both
subjective and objective self-awareness. Psychological theories are very along these dimensions
and although psychoanalysis is distinctive in attempting to integrate both viewpoints the language of
the theory and certain technical parameters change as the emphasis changes from defects in objective
self awareness to defects in subjective awareness.
6.4 STATEMENT OF THE PROBLEM:
A STUDY TO ASSESS THE CHANGES IN SELF-ESTEEM AMONG NEUROTIC
PATIENTS ATTENDING THE PSYCHIATRIC OUTPATIENT DEPARTMENT IN A
SELECTED HOSPITAL BANGALORE.
6.5 OBJECTIVES OF THE STUDY:

To assess the changes in self esteem among neurotic patients.

To associate the relationship between self esteem and with selected demographic variables.
6.6 ASSUMPTIONS:
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The neurotic patients who are attending Out Patient Department are liable to have negative
self esteem which can deteriorate the personality further.
6.7 DELIMITATION:
The study is limited to selected hospitals in Bangalore.
6.8 OPERATIONAL DEFINITIONS:

Self esteem: Good opinion of oneself or self esteem encompasses both self confidence and
self acceptance.

Neurosis:
A relatively mild mental illness involving symptoms of stress without loss of
contact with reality.
7. MATERNAL AND METHODS:
7.1 Source of Data: Data will be collected from neurotic clients who are coming to the OPD in
selected hospitals of Bangalore.
7.2 Method of Data Collection: Structural interview schedule.
7.2.1. Research approach: Descriptive analytic method.
7.2.2. Research Design: Non experimental design.
7.2.3. Setting of the study: Study will be conducted in selected psychiatric outpatient department,
Bangalore.
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7.2.4. Sample Size: The sample size consists of 50 patients in selected psychiatric outpatient
department, Bangalore.
7.2.5. Sample Techniques: Convenient sampling technique.
7.2.6 Sampling Criteria:
Inclusion Criteria: Who are all coming to psychiatric outpatient department.
Data collection tool: Self structured question and Rosenberg self esteem scale.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION TO BE CONDUCTED ON
PATIENTS OR OTHER HUMAN OR ANIMALS?
NO
7.4 HAS THE ETHICAL CLERANCE BEEN OBTAINED FROM YOUR INSTITUITON?
1. Permission will be obtained from the research committee of the Gayathri College of
Nursing.
2. Permission will be obtained from authorities of selected hospitals at Bangalore.
3. Informed consent will be obtained from subjects who are willing to participate in the
study.
8. LIST OF REFERENCES
1. Psychiatric Neuro Med Psychol (leipz) 1985 Aug 37, Page No 472-479.
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2. Looman’s, Diana, and Julia Loomans, 100 ways to build selfesteem and teach values.
Tiburin Ca, HJ.Kramer, 2003.
3. Baumeister R Smart, L and Boden J (1996) “relation of threatened egotism to violence and
aggression, the dark side of esteem” Psychological review Page No 103, 5-33.
4. Crocker J and Parle L E (2004) “The costly pursuit of self esteem” Psychological Bulletin
130(3) Page No 392-414.
5. Lernex, Barbara (1985) “Self esteem and excellence” The choice and the paradox American
educator winter (1985).
6. Rodewalt, F and Tragakis M W (2003) self esteem and self regulation. Toward optimal
studies of self esteem “Psychological Inquiry 14(1) Page No 66-70.
7. James W (1983) “The principle of psychology” Cambridge MA Harward University press.
8. Mruk C (2006) “Self esteem research, theory and practice, toward a positive psychology of
self esteem Newyork Springer.
ELECTRONIC MEDIA
1. www.pubmed.com
2. www.cinabl.com
3. www.medline.com
4. www.americanpsy.urg.com
5. www.google.com.
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9.
NAME OF THE CANDIDATE : SABARI K
10.
REMARKS OF GUIDE : GOOD
11.
11.1 NAME AND DESIGNATION OF THE GUIDE : Mrs. Hilda Elizebath Mony, Prof
11.2SIGNATURE
11.3 HEAD OF THE DEPARTMENT : Mrs. Hilda Elizebath Mony, Prof
11.4 SIGNATURE
12.
12.1 NAME OF THE PRINCIPAL : Mrs. Shenbagalakshmi V
12.2 REMARKS OF THE PRINCIPAL : GOOD
12.3 SIGNATURE
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