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Rajiv Gandhi University of Health Sciences, Karnataka
SYNOPSIS
FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. Name of the candidate
Ms K. Subapandi
Diana College of Nursing,
2.Name of the Institution
No.68, Chokkanahalli, Jakkur Post,
Bangalore-64.
Masters of Science in Nursing
3.Course of Study& Subject
Psychiatric Nursing.
4. Date of admission to course
28.06.2008
Effectiveness of structured teaching
5. Title of the Topic
program on occupational
rehabilitation among drug abuse
patients at selected rehabilitation
centers, Bangalore.
Introduction
Social context influences people’s judgments about what behavior is abnormal
or disordered .This seems especially true when it comes to the problem of
Substance abuse. Most societies frown on some form of substance dependence, but
different societies do not agree on which dependencies are normal and which are
problem. Few people consider caffeine or tobacco dependence a serious
psychological disturbance, despite the fact that Drug abuse and Statistical Manual II
liots caffeine intoxication, tobacco dependence, and tobacco withdrawal as
disorders .On the other hand, alcohol Dependence is widely considered to be
serious disorders in our culture (Morgan T. King 1993).
Ray (1976) stated that even for substance like alcohol, which produces real
physiological dependence; Psychological factors play a major role .The dreamy,
euphoric state produced by many people as a way to reduce their anxiety and
tension. Cultural norms also play a large role in alcohol addiction. Alcohol use may
be accepted and even expected in certain substances as the norm “The think to do”.
Infact, drug addicts who leave their subcultures and the habits are very likely to
start using heroin again if they return to their cultural groups.
Drug abuse is a chronic or habitual use of any chemical substance which alters
states of body or mind. Drug addiction is due to biological factors, psychological
factors, and social factors. Substance abuse disorders are more common in
Depression, Anxiety disorders, and Personality disorders (Sreevani (2007).
American Society of Addiction Medicine 2006 divided many levels of
substance abuse and many kinds of drugs, some of them readily accepted by
society.
Legal substances, approved by law for sale over the counter or by doctor's
prescription, include caffeine, alcoholic beverages, nicotine and inhalants (nail
polish, glue, inhalers, gasoline).Prescription drugs are considered illegal when
diverted from proper use. Some people shop until they find a doctor who freely
writes prescriptions; supplies are sometimes stolen from laboratories, clinics, or
hospitals. After diagnosing the substance abuse, the management consists of
Supportive and Symptomatic treatment. The psychiatric symptoms may require
proper Psychotropic medications and sometimes Hospitalization. Occupational
rehabilitation plays a major role in treating substance abuse.
6. Brief resume of the intended work
Need for the study
Psychoactive drug abuse commonly results from a combination of low selfesteem, peer pressure, inadequate coping skills, and curiosity. Most people who are
predisposed to drug abuse have few mental or emotional resources against stress, an
overdependence on others, and a low tolerance for frustration. Taking the drug
gives them pleasure by relieving tension, abolishing loneliness, allowing them to
achieve a temporarily peaceful or euphoric state, or simply relieving boredom.
Risk factors for Drug abuse are factors that do not seem to be a direct cause
of the disease, but seem to be associated in some way. Having a risk factor for Drug
abuse makes the chances of getting a condition higher but does not always lead to
Drug abuse. Also, the absence of any risk factors or having a protective factor does
not necessarily guard you against getting Drug abuse.
Professional Guide to Diseases Eighth Edition (2005) reported that 19.5
million people over the age of 12 years were using illegal drugs in worldwide and
among them19, 000 deaths occurring due to the drug addiction.
James C. Anthony (1995) stated that The United States has the highest
substance abuse rate of any industrialized nation. Government statistics (1997)
show that 36% of the United States population has tried marijuana, cocaine, or
other illicit drugs. By comparison, 71% of the population has smoked cigarettes and
82% has tried alcoholic beverages. Marijuana is the most commonly used illicit
drug.
Epidemiological descriptions of drug abuse in the US in the last three
decades have generally not included data on the patterns and trends in the incidence
of illicit drug use (i.e. new users). In this paper, estimates of illicit drug use
incidence are presented, based on retrospective data from the National Household
Survey on Drug Abuse. Incidence of marijuana use began increasing in the 1960s
and reached a peak in 1973, after which a continuing decline was seen. Cocaine use
incidence began to increase in the late 1960s and reached a peak in 1982, then
declined.
Megge Miller at 2000 concluded that approximately 23 percent of
Australians reported using any illicit drug in the 12 months preceding the 1998
survey. Marijuana was the most common illicit drug used. Amphetamines had been
recently used by approximately 4 percent of those aged 14 years and over, and 2
percent had used ecstasy/designer drugs; approximately 1 percent had used heroin,
cocaine, or injected an illegal drug during the previous 12 months. Rates of
marijuana use, as for most illicit drugs, increased over the past decade, although
rates for other drugs were much lower than for marijuana. Of the top 10
prescription medicines prescribed in 1998, three affect the central.
Anna Zagari found that nearly 49 percent of full-time college students -- about
3.8 million people - binge drink and/or abuse drugs, according to a recent study.
SAMHSA reported at (2000), the rate for illicit drug dependence or abuse was
lowest in completely rural counties (1.1 percent) and highest in large metropolitan
counties (2.1 percent)
Out of 4 million registered drug addicts in South Asia, 1.25 Lakh abusers are
present in India. Among them 42% alcohol users, 20% Opium users, 13% heroin
users, 6.2% cannabis users, 1.8% illicit drug users were found. Also reported that
majority of drug abusers are aged between 16-30 years and they are mostly
unmarried
as
well
as
they
belongs
to
lower
socio-economic
status
(Indian express 1999).
Survey reported that approximately 1 in 5 people aged between 16 and 59 said
that they had taken at least one of the drugs. People aged 18 to 21 were most likely
to admit to having taken drugs, with almost half (46%) claiming to have taken them
(Drug-statistics Bangalore2007).
Rehabilitation is a treatment designed to facilitate the process of recovery
from drug abuse as early as possible.Rehabilitation includes physical therapy which
uses exercises and physical activities to help condition muscles and restore strength
and movement, Occupational Therapy uses activities of daily living and exercise to
promote the highest level of independent functioning and Speech Pathology works
with individuals to help them improve language, thinking, and swallowing, speech
and voice skills.
Occupational therapy as a profession concerned with promoting health and
well being through occupation. The primary goal of occupational therapy is to
enable people to participate in the activities of everyday life. Occupational
therapists achieve this outcome by enabling people to do things that will enhance
their ability to participate or by modifying the environment, or the activity to better
support participation.
well
being
and
Occupational Therapy enables people to achieve health,
life
satisfaction
through
participation
in
occupation
(Bimla Kapoor 2004).
Occupational Therapy has been described as an active method of treatment
with a profound psychological justification in case of substance abuse.
Occupational Therapy is the application of goal-oriented, purposeful activity in the
assessment
and
treatment
of
individuals
with
substance
abuse
(Clark, 1963).
There is more prevalence of drug addiction through out the world.
Because of the constant stress in the day-to-day life many people are changing to
drug addiction. So in these cases compared to providing medical treatment,
rehabilitation plays a major role. To fulfill those purpose this study becomes need.
Occupational rehabilitation is the only way to give exercise to both mind and body.
6.2 Review of literature
The review of literature is made under following heading:
A. Literature related to drug abuse
B. Literature related to Occupational Rehabilitation
C. Literature related to structured teaching program on occupational
rehabilitation among patients with drug abuse
A. Literature related to drug abuse
Sean esteban mccabe (2008) concluded that
Non medical users of prescription
drugs are at heightened risk for drug abuse, whereas medical users without history
of non medical use are generally not at increased risk. Drug abuse screening should
be routine for college students, especially among individuals with any history of
non medical use of prescription drugs.
N.al-nahedh (1998) contributed Substance abuse started as a result of peer
pressure, social problems, or the pressure of family problems.
Li-Tzy Wu et. Al., (2003) concluded the study by Compared with the
privately insured, uninsured persons had increased odds of having alcohol/drug
dependence and appeared to face substantial barriers to health services for substance
use problems
The incidence of alcohol and substance dependence is 2%, in India 20-40% of
subjects above 15 years are event users of alcohol and nearly 10% of them are
regular or excessive users. Nearly 15-30% of patients are developing alcohol
related problems and seeking admission in rehabilitation centers.
Sreevani (2007)
A bogner j.a ,corrigan j.d (2001) Substance abuse was found to contribute to the
prediction of life satisfaction and productivity ,while violent etiology was not a
significant contributor to predictive models
Selkirk (1995) concluded two quantitative evaluations that reduction or abstinence
From substance abuse compared to initial entry to the program( daily use, weekly
use, Monthly use) and found that 75% of persons had either eliminated use or
reduced their use at six months compare to their levels at admission.
B. Literature related to Occupational Rehabilitation
Sullivan, Michael j. et. al., (2003) The findings suggest that a psychologically
based activity mobilization program can be an effective means of yielding
reductions in psychological risk factors for occupational disability. Challenges to
program implementation, fidelity to protocol, and issues related to cost efficacy are
discussed.
Van der Weide et. al., (1999) suggested that Quality of the process of care was
related to outcome. Interventions of occupational physicians need improvement in
the areas of continuity of care and communication with treating physicians. The
effectiveness of an improved intervention should be studied in a subsequent
randomized clinical trial.
Chan, Elaine Y L (EY); et al; (2007) concluded that Without reviewing and
revamping the current ECO, the goal to provide timely and effective occupational
rehabilitation services for workers with injury could not be fully achieved.
Sager, Lorraine; et.al., (2005). Quoted that highlight the opportunity for
occupational therapists to increase their role within occupational rehabilitation;
however, they need to adopt a more holistic approach to their practice.
Anthony J. Kerrigan, (2000) findings support the conclusions of the Treatment
Research Report (6) that occupational services improve the employment rates of
clients leaving treatment and that job counseling, placement, and development
services are positively correlated with the differences in employment rates between
admission and discharge. Clients who complete a drug treatment program, obtain
supportive housing in a drug-free environment, and participate in a work therapy
program are more likely to return to work and become fully rehabilitated.
C. Literature related to structured teaching program on occupational
rehabilitation among patients with drug abuse:
Richard f.catalano (1991) stated that some treatment is better than no treatment,
that few comparisons of treatment method have consistently demonstrated the
superiority of one method over another ,that post treatment relapse rates are high
,and that more controlled studies of adolescents treatment which allow evaluation
of the elements of treatment are needed.
Evaluation program judged the treatment program successful however the
reviewers cautioned that success was dependent on proper referral and admission
procedures so that the candidate had a supportive family and environment in which
to returns (Okunongegayin 1993).
Cardoza E (1991) concluded that clients at high risk for relapse can participate in
the Transitional Living Component for a period of 30-90 days. While in the TLC
program a client must be working on education or employment goals.
Henley,t (1989) described as reversing the process of residential schools. Through
the wilderness experience, people are brought back in touch with the land, their
cultural roots and themselves.
National and state organizations need to develop policies that focus on prevention,
treatment, and rehabilitation of alcohol and other drug using health care
professionals. The results of this study may help to delineate the characteristics of
health personnel’s abusing drugs, leading to the development of more effective
policies designed to protect the public and move toward more tailored and effective
intervention strategies for health care professionals.
George a kenna &david c
lewis (2008)
Jenny keen,philip oliver (2001) study shows overall low levels of programme
completion and high levels of unplanned departure and eviction from the
programme amongst these long term drug users.
Platt, Jerome J (1995) concluded that a number of programs have been
demonstrated to have had some success in the occupational rehabilitation of drug
abusers. Specific recommendations are made concerning both the direction of
further research in this area and the application of existing knowledge in current
practice.
Niraula sr (2006) stated that there should be a strong coordination and network
with each other to increase the effectiveness of the treatment program for drug
abuse. The treatment centers should be increased in number as well as in quality.
Drug Rehabilitation Program, (2004) explained the several types of drug
rehabilitation program aimed at different people in different circumstances,
impacted by different types of drugs. There are treatment programs for all kinds of
different drug addictions, including opiates, marijuana, and narcotic addictions.
These programs are designed to meet the particular needs of the patients, including
withdrawal pain, the drug addiction itself, as well as the eventual reintroduction to
society. Additionally, the programs try to not only prevent the patient from
reverting back to drugs, but also from reverting back to crime, and a life that
promotes drugs abuse."
Statement of problem
Effectiveness of structured teaching program on occupational rehabilitation among
drug abuse patients at selected rehabilitation centers, Bangalore.
6.3 Objectives of the study
*
To assess the knowledge of patients with drug abuse regarding
occupational rehabilitation before intervention.
*
To assess the effectiveness of structured teaching program on occupational
rehabilitation among patients with drug abuse.
*
To associate the post test knowledge score of drug abuse patients and their
demographic variables.
Operational definitions
Effectiveness: Refers to significant gain in their knowledge as determined by
statistical difference in the pre-test and post-test knowledge score on occupational
rehabilitation among drug abuse patients.
Structured
teaching program: It refers to systematically organized series of
content on occupational rehabilitation for drug abuse patients. It includes meaning,
aims, process, services, centers, classification, approaches and techniques of
occupational rehabilitation.
Drug abuse patients: Males between 21-60 years of age admitted in the selected
rehabilitation centers for the rehabilitation services.
Occupational rehabilitation: Occupational Rehabilitation refers to the technique in
which physical work given to change the physiological behavior of the drug abuse
patients.
Hypothesis
H 1: There will be a significant association between post test knowledge score of
drug abuse patients and their demographic variables.
Assumptions

Drug abuse patients may have some knowledge about occupational
rehabilitation.

Structured teaching program may enhance the knowledge of drug abuse
patients.
7. Materials and methods:
7.1
Source of data
Drug abuse patients admitted in
selected
rehabilitation
centers
at
Bangalore.
7.2 Method of data collection:
Research design
Quasi Experimental Design will be
used to assess the effectiveness of
structured teaching programme on
occupational rehabilitation.
Setting
The setting of the study will be selected
rehabilitation centers at Bangalore.
Population
Sample
Drug abusers
Drug abuse patients between 21-60
years of age admitted in selected
rehabilitation centers.
The sample size will be 60 drug abuse
Sample size
patients
admitted
in
selected
rehabilitation centers at Bangalore.
Convenience sampling technique will
Sampling technique
be used to select the drug abuse
patients
admitted
in
selected
rehabilitation centers at Bangalore.
The drug abuse patients:
Inclusion criteria
1. between 21-60 years of age
2. who understand kannada
3. who
will
give
consent
to
participate in the study.
who will be available at the time of data
collection
Structural Interview Questionnaire will
Tools
be used to assess the effectiveness of
occupational rehabilitation among drug
abuse patients at selected rehabilitation
centers, Bangalore.
Prior to data collection written permission
Data collection
will be obtained by the Concerned
authority of the selected rehabilitation
centers. The Data will be collected by the
Investigator herself. Further the data will
be collected from the drug abuse patients
before and after the Intervention by using
structural interview questionnaire.
Collected data where planned to be
Data analysis,
analyzed using descriptive statistics and
inferential
Presentations and interpretation
statistics.
Mean,
Median,
Mode, Percentile, and Standard Deviation
will be used for Descriptive Statistics.
Chi-Square
Test
will
be
used
for
inferential statistics. Analyzed Data will
be presented in the form of Tables,
Diagrams, Graphs based on the Findings.
7.3 Yes, My study will be investigated among drug abuse patients admitted in
selected rehabilitation centers at Bangalore.
7.4 Ethical
committee
Effectiveness of structured teaching
program on occupational rehabilitation
Title of the topic
among drug abuse patients at selected
rehabilitation centers, Bangalore
Name of the candidate
Ms. K. Subapandi
Course and the subject
Masters of science in nursing
Psychiatric nursing Specialty
Name of the guide:
Prof. Mrs. Kalai selvi
Head of the department
Psychiatric Nursing
Diana college of Nursing,
Bangalore-64
Ethical committee
Approved
Members of ethical committee
1. Prof. Veda Vivek
Principal and HOD
Department of Community Health Nursing
Diana college of Nursing, Bangalore-64.
2. Prof. Elizabeth Dora
Head of the department
Department of Child health Nursing
Diana college of Nursing, Bangalore-64.
3. Prof. Kalaivani
Head of the department
Department of OBG
Diana college of Nursing, Bangalore-64.
4. Prof. Vasantha Chitra
Head of the department
Department of Medical Surgical Nursing
Diana college of Nursing, Bangalore-64.
5. Prof. Surendra,
Biostatistician
GKVK, International Airport Road,
Jakkur Bangalore.
6. Prof. Mrs. Kalai selvi
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64.
List of references
7. Li-Tzy Wu, ScD, (2003), Substance Use, Dependence, and Service
Utilization Among the US Uninsured Non elderly Population, American
Journal of Public Health, Volume 93, No. 12.
8. Carol J. Boyd et al (2007), Prescription Drug Abuse and Diversion Among
Adolescents in a Southeast Michigan School District, arch pediatrics
adolescent med/volume 161, mar 2007 .pp 276.
9. Ovandir Alves et al.(2004), Yon amine Drug abuse among workers in
Brazilian regions, Rev saude publica,38(4) 552-556.
10. catalano rf et al,(1990-1991), Evaluation of the effectiveness of adolescent
drug abuse treatment, assessment of risks for relapse, and promising
approaches for relapse prevention , Social Development Research Group,
School of Social Work, University of Washington, Seattle 98115.
11. Bogner JA et al, A comparison of substance abuse and violence in the
prediction of long-term rehabilitation outcomes after traumatic brain injury”
Ohio Regional Traumatic Brain Injury Model System, Department of
Physical Medicine and Rehabilitation, Ohio State University, Columbus,
OH, USA.
12. Rani A. Hoff et al( 1999), The Cost of Treating Substance Abuse Patients
With and Without Co morbid Psychiatric Disorders American Psychiatric
Association.
13. John R. Knight* et al, (1999), Reliabilities of Short Substance Abuse
Screening Tests Among Adolescent Medical Patients, Pediatrics Vol. 105
No. 4 Supplement April 2000,
pp. 948-953
14. Kenna George et al, (2008), Risk factors for alcohol and other drug use by
healthcare professionals, Journal –substance abuse Treatment, prevention
and policy. Volume 3.
15. Nathan, Peter et al (1996.), Tobacco, Caffeine, Alcohol, and Carpal Tunnel
Syndrome in American Industry, A Cross-Sectional Study of 1464 Workers.
Journal of Occupational & Environmental Medicine. 38(3):290-298, March
1996.
16. Morris Bell et al . (2002), Work Rehabilitation and Patterns of Substance
Use Among Persons With Schizophrenia, American Psychiatric Association.
17. Jenny Keen et al (2001) Residential rehabilitation for drug users: a review
of 13 months' intake to a therapeutic community, Oxford Journals, Number
5 Volume 18, Pp. 545-548
18. Platt, Jerome J. (1995), Vocational rehabilitation of drug abusers,.
19. Psychological Bulletin. Volume 117(3), May 1995, Pp 416-433.
20. Niraula SR (2006) , Role of rehabilitation centers in reducing drug abuse
problem in a town of Eastern Nepal Katmandu University Medical Journal
(2006), Vol. 4, No. 4, Issue 16, 448-454
21. MCCABE Sean Esteban ( 2008) Archives of pediatrics & adolescent
medicine, ISSN vol. 162, no3, Published by American Medical
Association, Chicago, IL, Pp 225-229
22. Sullivan, Michael J. L.( 2003) Psychologically Based Occupational
Rehabilitation: The Pain-Disability Prevention Program, Clinical Journal of
Pain. 19(2):97-104
23. Willeke E(1999), Occupational & Environmental Medicine. 56(7):488
24. Chan, Elaine Y L (2007): Occupational rehabilitation services provided by a
community workers health centre in Hong Kong ,vol 30 (issue 1) : pp 5-9
25. Sager, Lorraine et al (2005) Injured workers' perspectives of their
rehabilitation process under the New South Wales Workers Compensation
System. Australian Occupational Therapy Journal. 52(2):127-135, June.
26. Anthony J. Kerrigan, Ph.D., Vocational Rehabilitation Outcomes of
Veterans With Substance Use Disorders in a Partial Hospitalization Program
Psychiatric Serve 51:1570-1572, December 2000
27. Bimla kapoor,(2005), text book of Psychiatric Nursing, I edition, New Delhi,
Kumar publications.
28. Sreevani (2005),Text books of Mental health Nursing,Jaypee publications,II
edition.Pp 269-275.
29. Dr.K.Lalitha(2007), Mental health and Psychiatric Nursing,VMG book
house,11 edition,35-48.
Websites
www.google.com. /www.psychnet.com
www.yahoo.com. /www.simsha.com.
9. Signature of the candidate
10. Remarks of the guide
The research topic selected for this
candidate is significant and feasible.
The study is related to occupation
rehabilitation. Hence, there is a need to
assess
the
knowledge
of
patients
regarding occupation rehabilitation.
11.Name and Designation of Guide
Signature
Prof. Mrs. Kalai selvi
Head of the department
Department of Psychiatric Nursing
Diana college of Nursing, Bangalore-64
HOD
Signature
Remarks of the Chairman
& Principal
Signature
The study is researchable
forwarded for needful action.
and