Download It refers to the mothers of the pre-school children with chronic illness.

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
Ms. HAOBAM. YAIMABI
M.Sc. Nursing 1ST year
Child Health Nursing
Year 2011-2013
PADMASHREE INSTITUTE OF NURSING
BANGALORE 560 060
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR RESGISTRATION OF SUBJECTS FOR
DISSERTATION
1.
NAME OF THECANDIDATE Ms. HAOBAM YAIMABI,
I Year M.Sc Nursing,
AND ADDRESS
1.A
Padmashree Institute of Nursing,
Kommagatta,
Bangalore – 560 060.
2.
NAME OF THE INSTITUTION
Padmashree Institute of Nursing,
Bangalore.
2.
3.
COURSE OF THE STUDY AND 1st year M.Sc. Nursing
SUBJECT
3.
4.
DATE OF ADMISSION
5.
TITLE OF THE STUDY
Child Health Nursing
16th July 2011
4.
Assessment of effectiveness of structured
teaching programme on knowledge and
5.
attitude regarding management of emotional
and behavioural problems among mothers of
pre-school children with chronic illness in
selected hospital, Bangalore
2
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Feelings of sadness, depression or being overwhelmed may come and go for
child. This is normal and healthy. As busy as these times can be, most youngsters and their
families emerge with few if any long-term behavioural problems or lasting psychological
scars. In fact, the majority of children really do manage their situation well, despite riding an
emotional roller coaster on occasion. Researchers believe that the likelihood of emotional and
behavioural problems associated with chronic illness has been decreasing recently because
parents, school staffs, and health-care providers are learning more effective ways to help
children and their parents meet their psychological needs. Nevertheless, children who have a
chronic illness often feel "different," socially isolated and restricted in their activities. They
may have school problems and feel overprotected. They may experience recurrent fear and
pain. When these emotional difficulties are not dealt properly, they can lead to anxiety,
sadness, withdrawal, rebelliousness, or a decreased interest in school.1
A chronic childhood illness can be defined as a medical condition that is long
term or permanent, and is rarely able to be completely cured. A child with a chronic illness
may be ill or well at any given time, but he is always living with the condition. Examples
include asthma, epilepsy, diabetes, Cohn’s disease and cystic fibrosis. Such chronic illnesses
affect the child's lifestyle, and parents will be required to deal with the child's health needs on
a daily basis. Chronic illness usually requires regular medical treatment, and sometimes long
hospital stays. Once the illness is routinely managed, most children can function well and live
relatively normal lives.
The effect that chronic illness will have on the child will depend on a number of
things, including the type of illness, what support they have, child's age, their level of
maturity, and their individual temperament. How the family cope with the situation, as well
as the attitude toward the illness, can also make a big difference in helping the child to
manage the emotional impact.2
Hospitals can be a frightening and lonely experience for a child. How a child
copes with these separations will depend a lot on her age. For a infant, toddler or pre-school,
who does not understand much about time, it can be very distressing to be separated from
3
parents. Studies have shown that the stress can even effect recovery times. Most hospitals
understand the stress that separations place on children, particularly for children under the
age of five years, and make provisions for a parent to stay with their child.
The child may need to attend a lot of medical appointments or spend a lot of time
in bed resting. This can result in missing school, which affects opportunities for learning,
playing, and making friends with other children. The child may also be less able to participate
in activities that are enjoyed by most other children. For example, Playing sport and attending
parties. This may lead him to feel "different" from other children. If the illness stops him
from doing some things that other children do, and he is prevented from enjoying the same
independence as other children, he could become frustrated and angry. The child may
experience stress around the symptoms of the illness itself, such as pain and discomfort
associated with the symptoms of the illness. She may also experience stress from the
treatment, such as injections and operations.3
Most of the early research on living with chronic conditions from the child’s
perspective has dealt with emotional and cognitive responses. Children with and without
chronic conditions have been compared based on various psychosocial measures of
adjustment, such as measures of self- esteem, anxiety and depression. While there is some
indication that children with chronic conditions, as a group, are at risk for maladjustment.
Children with chronic conditions use less-adaptive coping strategies such as withdrawal,
blaming themselves or others for their condition, negativity and irritability. There have been
associated with poorer medical outcomes.4
The way children react to diagnosis with a chronic illness depends on several factors,
including the child’s personality, the specific illness, and their family. One big factor is the
child’s developmental stage. Kids’ understandings of illness and their coping strategies
change as they grow older. Preschool Children are beginning to develop a sense of
independence. They may understand what it means to get sick, but they may not understand
the cause and effect nature of illness. For example, they may believe that throwing up causes
them to get sick, rather than the other way around. Being in the hospital or adjusting to
medication schedules can challenge the child’s developing independence. The child may try
to counter lack of control over their world by challenging limits set by parents. Parents can
help by being firm with things the child does not have a choice over .Parents can help their
4
preschool child be resilient in times of stress. Here are some tips for helping young children
learn to cope with stress.
Following are the some information for the family to cope better in order to help the
child cope better with the chronic illness:
 Stay involved and give information
Family should discuss with the child (at their age level) what their illness is all about, and
what will
happen to them in the hospital. When the child doesn’t do this, they may
imagine the worst.

Give them choices
Some tasks for children with chronic illness must be done no matter what it is. Others
are more flexible. Parents should know what tasks are mandatory (scheduled medications,
specific diets) and which are open for discussion (“as-needed” medicines, choice of foods
within a given diet). Conflict may arise when a child tries to assert independence. As
preschoolers, and even older children’s test adults' limits, there is natural conflict with
adults' demands. Children with chronic illness, more than other children’s, need chances to
make choices to have control over any part of their lives they can control.

Support their friendships and activities with peers
Illness often interferes with routines and activities. For children, particularly
devastating consequence can be the weakening or loss of friendships. Friends can grow
apart as a result of these changes. Keeping preschool children involved with their peers
and making extra efforts to maintain those connections can go a long way in helping a
preschool children cope with an illness. Parents should help the child to find new ways to
make and maintain new relationships is critical during this time. Parents may also need to
help their child find ways to cope with teasing from peers.
Children need to feel like they belong. Their peer relationships are an important arena
for them to do this. Parents should try to help the child find interests and activities that
provide opportunities to connect with other preschool children’s with similar illnesses.
Give them opportunities to spend time with friends. Most major hospitals and clinics will
help to find support groups for parents, families, and for children affected by the illness.
5

Be hopeful
Coping with a chronic illness can be discouraging and scary. It is incredibly important
to stay hopeful. Parents should not ignore the worries or negative feelings—they need to
be recognized and addressed. If the parents try to find the positive side of things and keep
their eye on the potential positive outcomes, they will be teaching their child a valuable
lesson, and maintaining their ability to cope as well.

Listen
Parents should be available so child can talk about the problems they are facing and
help them find solutions to their problems. Parents should be able to recognize the warning
signs of depression. If child talks about some emotional or abnormality in nature, take it
seriously. Allow child to express their fears; validate child’s feelings. There's nothing
worse than feeling scared and confused and not being able to talk about it. Parents should
find out more about depression in children with chronic illnesses.

Have fun together as a family
Parents can expect the whole family to be under increased stress. Maintaining
commitment to their family and getting support from each other may be harder during
times of stress, but it is also even more important! Spend time together that is not focused
on the illness. To carve out time for family activities they may need to schedule family
time, including one-on-one time for parents and parent-child “dates,” as well as whole
family activities.
 Involve the whole family and even an extended support network
Allow each family member to help in any way that they are willing and able. Seek
support and help from people outside immediate family, such as through extended family,
school, religious community, neighbourhood, or children's hospital.

Teach coping skills
Parents need to help children learn new ways to cope with the special challenges of an
illness. They can do a lot to help their child cope with the stress that comes with a chronic
illness.5
6
6.2 NEED FOR THE STUDY
World health organization (2000) has represented that one of the greatest
challenges that will face health systems globally in the twenty-first century will be the
increasing burden of chronic diseases. Greater longevity, “modernization” of lifestyles, with
increasing exposure to many chronic disease risk factors and the growing ability to intervene
to keep people alive who previously would have died has combined to change the burden of
diseases confronting health systems.
Chronic conditions are defined by the World Health Organization (WHO) as
requiring “ongoing management over a period of years or decades” and cover a wide range of
health problems that go beyond the conventional definition of chronic illness, such as heart
disease, diabetes and asthma. They include some communicable diseases, such as the human
immunodeficiency virus and the acquired immunodeficiency syndrome (HIV/AIDS) that
have been transformed by advances in medical science from rapidly progressive fatal
conditions into controllable health problems, allowing those affected to live with them for
many years. They also extend to certain mental disorders such as depression and
schizophrenia, to defined disabilities and impairments not defined as diseases, such as
blindness and musculoskeletal disorders (WHO 2002) and cancer. While others have offered
different definitions for chronic illness (Conrad and Shortell 1996; Unwin et al. 2004), the
common theme is that these conditions require a complex response over an extended time
period that involves coordinated inputs from a wide range of health professionals and access
to essential medicines and monitoring systems, all of which need to be optimally embedded
within a system that promotes patient empowerment.6
Patterns of chronic illness in childhood are both complex and dynamic. National
survey data suggested that 30% of all the children have some form of chronic health
condition. If allergies, eczema, minor visual impairments, and other conditions not likely to
generate serious consequences are excluded, between 15 and 20% of all the children have a
chronic physical, learning or developmental disorder. Boys have higher rates of chronic
illness than girls. The most common serious chronic illness is asthma, with >12% of children.
Approximately 6% of children are reported to have a diagnosis of ADHD. The severity and
impact of the chronic illnesses can vary significantly. Approximately 8% of all children have
activity limitations due to one or more chronic illnesses. Of these children 40% have
7
developmental or learning disorders, 35% have chronic physical conditions, 25% reported
chronic mental health disorders.
Chronic illness accounts for a growing portion of serious illness, hospitalizations
and deaths among children. Children with chronic illness are hospitalized approximately four
times more often and spend more than seven times as many days in the hospital as children
without a chronic illness. Multiple admissions in any given year have risen substantially.7
Mental health and physical health impact one another. Increased physical symptoms
can cause a rough time on the child’s emotional health. Chronic illnesses can interfere with
children’s happiness and how they feel about themselves. When children are distressed and
unhappy, their illness may be harder to control. Many things having to do with a chronic
illness can affect the child emotional health. Some examples include:
 A child may need to complete medical tests. These can be invasive and scary.
 A child may be sad and grieving because of a doctor’s suggestion to remove a pet from
the home, or to limit his or her activities
 A child may feel “different” than peers
 Medicine side effects can affect children’s mood and they feel about themselves and
their bodies
 Children, when sick, can be clingy, lethargic, sad, fussy, mad, tearful and withdrawn.
Children often feel unhappy when sick. These mood changes often improve quickly
as child begins to feel better physically. However, when a child with a chronic illness has
mood changes that continue or return, this may signal a problem that needs parents and
professional attention. The good news is that it can be helped.8
Over the past several years, a number of studies have shown a rise in behaviour
problems among preschoolers with chronic illnesses. Investigators say that these problems
include "prolonged tantrums, physical and verbal aggression, disruptive vocal and motor
behavior, property destruction, self-injury, noncompliance, and withdrawal." At the same
time, the Yale Child Study Center has found that U.S. preschoolers are three times more
likely to be expelled from their classrooms than students in grades K-12. These findings are
alarming, especially in light of the fact that challenging behaviours are one of the strongest
predictors of more serious problems as children’s grow older, including delinquency,
aggression, anti-social behaviour, and substance abuse.9
8
A study was conducted to assess the influence of parent-child relationship quality
and its possible mediating role on the association between illness-related functional status and
depressive symptoms in children with asthma. Questionnaire data were collected from the
child, caregiver and physician. Regression analyses suggested that patterns of mother-child
relatedness (secure vs. insecure) mediate the relationship between functional status and
depressive symptoms. The parent-child relationship may be an important pathway by which
illness influences symptoms of depression in children with asthma. This study suggests that
impaired functional status does not directly contribute to symptoms of depression, but rather
influences the parent-child relationship in ways that may promote the development of
depressive symptoms in the child.10
A study was conducted to evaluate behaviour problems and mood disorders in
children with congenital heart disease (CHD). The study group included the mothers of 96
children randomly selected (ages ranging from 3to 6 years) who were being monitored at the
Institute of Cardiology. A 21-item questionnaire was administered to obtain information
about the mother and the child. Internal subsets of the Child Behavior Check List (CBCL)/418 were performed, including withdrawn aggressive behaviours, somatic complaints, and
anxiety/depression tests. The results showed that factors influencing withdrawn aggressive
behaviour were low parent education (p=.000), poor economic status of the family (p =.02),
and aggravation of the hemodynamic status of the disease (p =.003) and somatic complaints
were low parent education (p =.000) and severity of the haemodynamic status of the disease
(p =.02). An increase in the number of children in the family seemed to have an effect on
anxiety/depression levels (p =.009).11
Epidemiology surveys suggested that 6-12% of children are afflicted with serious
chronic physical illness, while some may adapt to this quite successfully, a significant
number may not, resulting in social, psychological and academic handicaps that may
sometimes be more serious than the physical limitations of the underlying disease. Studies
addressing this issue have confirmed that behaviour problems such as anxiety, depression,
misconduct, hyperactivity, frustration, anger and adjustment problem are twice as common in
children with chronic illness as in healthy children of same age.12
One of the study showed the amount of maternal involvement in disease management
which related to treatment adherence and quality of life. The amount of maternal involvement
9
may be a more important determinant of disease specific psychological outcomes such as
preschool children treatment adherences and quality of life. In this study the researcher
reported regarding the parental involvement in chronic illnesses management is vary valuable
with treatment adherence and quality of life.13
Another important finding that emerged in the study was the association between
presence of behavioural problems and inability to attend school .50% of the pre-school
children with nephrotic syndrome were out of school at the given point of time. Similar
study in India involving with nephrotic syndrome also mentions lower school performance of
these children compared to healthy children.14
In 2000-2001 there were 4,390 children under the age of 10 years admitted in
hospital with asthma. Around 12,000 children attended the emergency department. Children
with asthma not only have a chronic disease that imparts in their live, but they are also more
likely to have emotional and behavioural problems compared to children without asthma. The
reason for increased behaviour problem in children with asthma is still unknown. Specific
behaviour like acting out , disruptive and under controlled behaviour and destructiveness,
deceitful behaviour, truancy, temper tantrum, argumentativeness, defiance, harassment of
others, frequent frustration, negative effect, anger etc.
The adaptive tasks that have been identified for caregivers(mothers) include accepting
the condition, managing the condition, meeting the child’s developmental needs, meeting the
developmental needs of other family members, coping with stress and crisis, assisting family
members to manage feelings, educating others about the condition and establishing support
system.15
The investigator had personally witnessed the problems which the children with chronic
illness has face and how the care has been provided by the caregivers. From this study, the
investigator is interested to assess the knowledge and attitude regarding the emotional and
behavioural problems of preschool children with chronic illness and provide structured
teaching programme regarding emotional and behavioural problems among mothers of
preschool children with chronic illness as they are the only one who provides care for their
children.
10
6.3 STATEMENT OF PROBLEM
“A study to assess the effectiveness of structured teaching programme on knowledge
and attitude regarding management of emotional and behavioural problems among mothers
of pre-school children with chronic illness in selected hospital, Bangalore.”
6.4 OBJECTIVES OF STUDY
1. To assess the existing knowledge and attitude regarding management of emotional and
behavioural problems among mothers of pre- school children with chronic illness.
2. To assess the post- test knowledge and attitude regarding management of emotional and
behavioural problems among mothers of pre- school children with chronic illness.
3. To compare the pre- test and post- test knowledge and attitude regarding management
of emotional and behavioural problems among mothers of pre- school children with
chronic illness.
4. To correlate the knowledge and attitude regarding management of emotional and
behavioural problems among mothers of pre- school children with chronic illness.
5. To associate the pre- test knowledge and attitude regarding management of emotional
and behavioural problems among mothers of pre- school children with chronic illness
with their selected demographic variables.
6.5 OPERATIONAL DEFINATIONS
1. Effectiveness
It refers to significant increase in the level of knowledge and attitude among mothers
after receiving structured teaching programme regarding management of emotional and
behavioural problems of pre- school children with chronic illness.
2. Structured teaching programme
It refers to the systematically developed teaching strategy for duration of 45 minutes
to 1 hour, design to focus on discussion prepared to educate regarding management of
emotional and behavioural problems among mothers of pre-school children with chronic
illness by means of instructional aids.
11
3. Knowledge
It refers to the awareness and understanding of the mothers regarding management of
emotional and behavioural problems of pre- school children with chronic illness.
4. Attitude
It refers to the opinion and belief regarding management of emotional and behavioural
problems of pre- school children with chronic illness among their mothers.
5. Management of children
It refers to the care given for the emotional and behavioural problems of pre school
children with chronic illness by their mothers.
6. Emotional problems
It refers to the problems concerning with emotions and feelings of pre-school children
with chronic illness such as anxiety, guilt, sorrow, anger.
7. Behavioural problems
It refers to the problems concerning to the changes in behaviour of the pre-school
children with chronic illness such as temper tantrums, truancy, argumentativeness,
defiance, frequent frustration.
8. Chronic illness
It refers to the illness suffered by the pre-school children for a long duration which
includes nephrotic syndrome, bronchial asthma, pneumonia, rheumatic fever, type I
diabetes mellitus.
9. Mothers
It refers to the mothers of the pre-school children with chronic illness.
12
6.6 ASSUMPTIONS
1. Mothers of pre- school children may have some knowledge regarding management of
emotional and behavioural problems of pre- school children with chronic illness.
2. Mothers of pre- school children may have unfavourable attitude regarding management
of emotional and behavioural problems of pre- school children with chronic illness.
3. Structured teaching programme may enhance the knowledge and attitude regarding
management of emotional and behavioural problems of pre- school children with
chronic illness among their mothers.
4. Mothers knowledge and attitude regarding management of emotional and behavioural
problems of pre- school children with chronic illness may vary with the selected
demographic variables.
6.7 RESEARCH HYPOTHESIS
H1: There will be a significant difference between the mean pre-test and post- test
knowledge and attitude regarding management of emotional and behavioural problems of
pre- school children with chronic illness among their mothers.
H2: There will be a significant correlation between the knowledge and attitude regarding
management of emotional and behavioural problems of pre- school children with chronic
illness among their mothers.
H3: There will be a significant association between the pre-test knowledge and attitude
regarding management of emotional and behavioural problems of pre- school children
with chronic illness among their mothers with their selected demographic variables.
13
6.8 REVIEW OF LITERATURE
A study was conducted among children with persistent asthma who attended the
asthma clinic attached to the Department of pediatrics at medical college, Calicut. Children
were interviewed along with the mothers and evaluated using the childhood psychopathology
measurement schedules(CPMS). Controls were selected from children attending the general
pediatric outpatient department for minor illnesses. On the CPMS 35 (69%) children in the
study group scored more than 10 while only 8 (13%) children in the control group scored
above 10 (p<0.01). On the CPMS subscales, children in the study group showed significantly
more behaviour problems, conduct symptoms, anxiety, depression and emotional problems
(p<0.05).16
A comparative study was conducted to assess the prevalence of behaviour
abnormalities in children with nephrotic syndrome attending the renal clinic of a state
medical college in eastern India, Kolkata and with the prevalence in a control group of pre
school children without any detectable physical illness. The total of 50 consecutive children
with nephrotic syndrome attending the renal clinic of a state medical college and 51pre
school children as controls using the Developmental Psychopathology Checklist (DPCL) and
also assessed the statistical association between disease and treatment related variables and
behavior profile in the nephrotic children group. It was found that the prevalence of behavior
disturbance in children with nephrotic syndrome was 68%, significantly higher than that in
the control group (21.6%).17
A study was conducted to assess the behavioural problems of children with asthma.
Behavioral problems of 116 children with asthma were studied at the Linn Medical Center in
Haifa, Israel, where they were under treatment. Parents were administered a medical
questionnaire and the Achenbach Child Behavior Checklist. The study examined the
relationship between asthmatic children of various levels of severity of the illness and
behavioral problems. A comparison was made among the Achenbach scale, level of
compliance with treatment procedures, and level of severity of the illness. Another
comparison was made between age groups and level of behavioral problems. Significant
differences were found between all three illness severity groups and two variables-somatic
complaints and social problems. 18
14
A cross sectional study was conducted to assess psychological problems and
quality of life(QOL) in children with thalassemia in the Department of psychiatry
NIMHANS, Bangalore, were assessed for psychological problem using childhood
psychopathology measurement schedule and QOL was assessed using the EQ-5D. 44% of
children had psychological problem and 74% had a poor QOL. Anxiety related symptom
67%, emotional problem, particularly depression 62% and conduct problem 49% were the
main findings. The children were most likely to report impaired QOL due to severe
difficulties in pain/ discomfort 64% dimension followed by depression. The recognition and
management of the psychological problem that accompany chronic physical illnesses
including thalassemia would optimize treatment outcome and quality of life.19
A study was conducted to assess prevalence and nature of mental health problems in
preschool children with chronic illness and the feasibility and effectiveness of a screening
tool in identifying these problems. It was conducted in Colombo Municipal Council Child
Welfare Centre – preschool clinics. Method of Assessment tool was a semi-structured
interview, which included a checklist of common symptoms of developmental, emotional and
behaviour problems.120 children were available for analysis. Mild symptoms were present in
45.5% and severe symptoms in 9.9%. A reliable positive correlation was found only between
aggressive behaviour, disobedience and destructive behaviour (r= +0.66). There was low
correlation between behaviour problems and eating problems and emotional symptoms (r=
+0.11). Rapid and effective screening was possible using the assessment tool, which can be
used to improve recognition of mental health problem in preschool with chronic illness.20
A study was conducted to assess the risk of emotional and behavioral problems among
pre-school children with a chronic physical illness. Random-effects meta-analysis was
computed to integrate the results of 569 studies that used the Child Behavior Checklist,
Youth Self Report, and the Teacher Report Form. Pre-school children with a chronic physical
illness have higher levels of internalizing (g=0.47 standard mean difference), externalizing
(g=0.22) and total behavior problems (g=0.42) than healthy peers. Strongest elevations of
internalizing problems were found for chronic fatigue syndrome and strongest elevations of
externalizing problems were observed for epilepsy and migraine/tension-type headache. The
results call for regular screens for psychological distress and referrals for mental health
services, when needed.21
15
A study was conducted to examine the self esteem of preschooler with diabetes
mellitus and leukaemia. Participants of this descriptive study were 22 preschool children’s
with diabetes mellitus and 33 with leukaemia. After the initial diagnosis, over time a decrease
in self esteem in the leukaemia group and an increase in self esteem in the diabetes mellitus
group were observed. In both groups, the mean scores of self esteem were compared to
depressive affect, daydreaming, psychosomatic symptoms, intensity of discussion and
parental interest (subscales in the Rosenberg self esteem scale). No significant difference was
found between the two disease groups. There was a strong and significant correlation
between self esteem and depressive affect in both groups.22
A study was conducted to describe the psychosocial adaptation problems of preschool
children with asthma, compared with a matched group of healthy children, and to examine
the relationship between demographic and illness related variables and psychosocial
adaptation. Seventy preschool children with asthma and 68 healthy children participated.
Children were interviewed along with the mothers and evaluated using the childhood
psychopathology measurement schedules(CPMS). Children with asthma were found to have
significantly higher psychopathology scores. It was concluded that preschool children with
asthma are more at risk for emotional and behavioural problems than healthy controls. The
CPMS seems to be a useful screening instrument in identifying psychosocial problems.23
A study was conducted to assess the relationship between childhood asthma and
behavioural adjustment. Of 78 studies initially reviewed 26 studies (encompassing 28 data
sets), reflecting data on nearly 5,000 children with asthma, and met criteria for inclusion.
Effect size estimates were calculated across studies using standard methods. Separate effect
sizes were calculated for internalising and externalising behavioural problems, degrees of
asthma severity, and differences in control group used (i.e., sample controls or normative
data). Results indicate that children with asthma have more behavioural difficulties than do
healthy children, with the effect for internalising behaviours being greater than that for
externalising behaviours (d(mn) = .73 vS .40). The findings suggested that patients with
asthma, particularly children with severe asthma, should be considered at higher risk for
behavioural difficulties that may necessitate psychosocial intervention.24
A study was conducted to assess the quality of life of children with chronic intestinal
pseudo-obstruction. A structured telephone interview was held with parents that included the
16
Child Health Questionnaire to gather information about the current status and quality of life
for each patient and family. Preschool children with chronic intestinal pseudo-obstruction had
less freedom from pain, depression, and anxiety than healthy children. Parents of children
with chronic intestinal pseudo-obstruction had poorer emotional status than parents of healthy
children. In conclusion, the quality of life for children with chronic intestinal pseudoobstruction lags behind that of healthy children.25
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Data will be collected from the mothers of pre-school children with chronic illness in
selected hospital, Bangalore.
7.2 METHODS OF DATA COLLECTION
i.
Research design
Pre - experimental- one group pre- test post test design.26
ii.
Variables
Dependent variable - Level of knowledge and attitude regarding management of
emotional and behavioural problems of pre- school children with chronic illness
among their mothers.
Independent variable- Structured teaching programme regarding management of
emotional and behavioural problems of pre- school children with chronic illness.
Demographic variable- It includes mother’s age, occupation, education, family
income, number of children, age of child, duration of hospitalization, duration of
illness and source of information.
iii.
Setting
This study will be conducted in paediatric wards of Rajarajeshwari medical
college and hospital, Bangalore.
iv.
Population
The population of the study will comprise of all the mothers of pre- school
children in paediatric wards in Rajarajeshwari medical college and hospital,
Bangalore.
17
v.
Sample
Mothers who fulfil the inclusion criteria will be considered as the sample and
the sample size is 60.
vi.
Criteria for sample selection
Inclusion criteria: The study includes:
1. The mothers of pre- school children diagnosed with one of the chronic medical
illnesses such as nephrotic syndrome, bronchial asthma, pneumonia, rheumatic
fever, type I diabetes mellitus.
2. The mothers who are willing to participate in the study.
3. The mothers of the pre-school children who can understand kannada and English
Exclusion criteria: The study includes:
1. The mothers who are not available at the time of study.
2. The mothers of the pre-school children with cerebral palsy, mental retardation.
vii.
Sampling techniques
Non probability convenient sampling techniques
viii.
Tool for data collection
The tool consists of the following sections;
Section A
Demographic performa consists of mother’s age, education, occupation,
family income, number of children, age of child, duration of hospitalization, duration
of illness and source of information.
Section B
Structured teaching programme regarding management of emotional and
behavioural problems of pre-school children with chronic illness
Section C
Structured interview schedule to assess the knowledge regarding management
of emotional and behavioural problems of pre-school children with chronic illness
among their mothers.
18
Section D
Likert scale will be used to assess the attitude regarding management of emotional
and behavioural problems of pre-school children with chronic illness among mothers.
ix. Procedure for data collection
After obtaining the formal permission from the authorities and informed consent from
the samples, the investigator personally will collect the demographic data. After which the
data will be collected in the following three phases:
Phase I: Assess the existing knowledge regarding management of emotional and behavioural
problems of pre-school children with chronic illness among mothers with the help of
structured interviewed schedule.
Phase II: Assess the existing attitude regarding management of emotional and behavioural
problems of pre-school children with chronic illness among mothers with the help of likert
scale.
Phase III: Structured teaching programme regarding management of emotional and
behavioural problems of pre-school children with chronic illness will be given for about 45
minutes-1hour on the same day with the help of A.V aids.
Phase IV: After a period of one week, post test knowledge and attitude regarding
management of emotional and behavioural problems of pre-school children with chronic
illness will be assessed by using same tool.
Duration of the data collection is 4- 6 weeks.
x. Plan for data analysis
The data will be analyzed by using descriptive and inferential statistics.
Descriptive statistics
1. Frequency and percentage distribution will be used to analyze the demographic variables.
2. Mean and standard deviation will be used to analyze the level of knowledge and attitude
regarding management of emotional and behavioural problems of pre-school children with
chronic illness among their mothers.
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Inferential statistics
1. Paired t’ test will be used to compare the pre-test and post-test knowledge and attitude
regarding management of emotional and behavioural problems of pre-school children with
chronic illness among their mothers.
2. Co-relation co- efficient will be used to correlate between the knowledge and attitude
regarding management of emotional and behavioural problems of pre-school children with
chronic illness among their mothers.
3. Chi- square test will be used to associate the pre-test knowledge and attitude regarding
management of emotional and behavioural problems of pre-school children with chronic
illness among their mothers with their selected demographic variables.27
xi. Projected out come
The study will improve the knowledge and attitude regarding management of
emotional and behavioural problems of pre-school children with chronic illness among
mothers and help them to improve child’s rearing and enabling them to lead normal life.
7.3 Does the study require any investigations or interventions or other humans or
animals?
Yes, structured teaching programme will be administered regarding management of
emotional and behavioural problems of pre-school children with chronic illness among
mothers in selected hospital, Bangalore.
7.4 Has ethical clearance been obtained from your institution?
Yes, permission will be obtained from the concerned authorities of the institution and
formal consent will be taken from the samples. Confidentiality and privacy of data will be
maintained.
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8. LIST OF REFERENCES
1. Children with chronic illness: dealing with emotional problems and depression
available from http :// www. Biomedcentral. com
2. Managing the emotional impact available from http :// www.cyh.com
3. The international newsletter on child health and disease prevention, child health
dialogue: 1999 July/September. Issue 16
4. Nicki L potts, Barbara L. Mandluo. Pediatric nursing. Caring for children and their
families; 2nd edition ; Haryana; Sanat printers. 2001
5. Kyla. Boyse. Children with chronic illness available from http:// www. nlm.nih .com
6. Ellen Nolte , Martin Mckee. Caring for children with chronic illnesses available from
http:// www. Nih.com
7. Kleigman, Jenson- Stanton. Nelson textbook of pediatric volume-I. eighteen edition .
New Delhi. Elsevier, health sciences marketing. 2008.
8. Understanding children and chronic illness available from http:// www.rwjf. Org
9. Nancy. Preschool and bad behaviour available from http:// school.family edu.com
10. Bleil ME. Ramesh S. The influence of parent- child relatedness on depression
symptoms in children with asthma: test of moderator and mediator models. Journal of
pediatric psychology.2000 .volume 25(7), 481-491
11. Yildir S. Savaser S. Evaluation of internal behaviour of children with congenital heart
disease. Journal of pediatric. 2001. Volume 16(6), 449-452
12. Bernard W.K.Lau, Wilson N.C. Psychological effect of physical illness and
hospitalization on child and family available from http:// www. Prenhall.com
13. Tim Wysocki(PHD), Leslie Gavin( PHD). Paternal Involvement in the Management
of Pediatric Chronic Diseases: Associations with Adherence, Quality of Life and
Health Status available from http:// www. Ces.ncsu.edu
14. Tong A, Lowe A, Sainsbury P, Craig JC.caring for a child with chronic kidney
disease: an in-depth interview study. Available from http://www.indianpediatric.net
15. Stephanie J. Beynon. Behaviour Problems in Children with Asthma and their Siblings
available form http://www. Ncbi.nlm.nih.gov/pmc.
16. TV Rajesh, P. Krishnakumar and Lulu Mathews. Temperamental traits and
psychological problems of children with Bronchial Asthma. Available from
http://www. indian paediatrics.net
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17. Prathama Guha, Arun De and Malay Ghosal. Behavior profile of children with
nephrotic syndrome. Indian Journal of Psychiatry.2009 Apr-Jun; volume 51(2): 122–
126.
18. Liana Duvdevany, Yael Harel. Behavioural problems of Asthmatic children.
University of Haifa, Israel. Available from http://baywood.metapress.com
19. D Shaligram, S.C.Girimaji and S.K.Chaturvedi. psychological problems and quality
of life with in preschool children with thalassemia. Indian journal of pediatric, 2007;
volume 74(8):727-730.
20. Ellis N, Upton D, Thompson P. prevalence and nature of mental health problem
among preschool children with chronic illness: a review of current literature. Pediatric
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and impact. American Journal of Public Health, 1999, Volume. 82, Issue 3; 364-371.
22. Cavusoglu H. Self-esteem in adolescence: a comparison of adolescents with diabetes
mellitus and leukaemia. Pediatric Nursing, 2001;volume 27(4):355-361
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adolescents with asthma. Indian Pediatrics, 2001;volume 38(5):524-530.
24. McQuaid EL, Kopel SJ, Nassau JH. Behavioral adjustment in children with asthma: a
meta-analysis. Developmental and Behavioral Pediatrics, 2001; volume 22(6): 430439.
25. Schwankovsky L, Mousa H, Rowhani A, Di Lorenzo C, Hyman PE. Quality of life
outcomes in congenital chronic intestinal pseudoobstruction. Digestive Diseases and
Sciences, 2002;volume 47(9):1965-1968.
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27. P.S.S.Sundar Rao, J. Richard. Introduction to Biostatistics and Research Methods. 4th
edition. New Delhi; Prentice-Hall of India Private Limited: 2008.
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9. Signature of the candidate
:
10. Remarks of the guide
:
11.1 Name and designation of the Guide
: Mrs. Bhima Uma Maheswari,
HOD, Pediatric Nursing
11.2 Signature
:
11.3 Co-guide [if any]
:
11.4 Signature
:
11.5 Head of the department
: Mrs. Bhima Uma Maheswari
11.6 Signature
:
12.1 Remarks of the principal
:
12.2 Signature
:
23