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PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
DISSERTATION PROPOSAL
“A STUDY TO ASSESS THE STRESS AND COPING
STRATEGIES AMONG PARENTS OF THALASSEMIA CHILDREN AT
VANIVILAS HOSPITAL IN BANGALORE WITH VIEW TO
DEVELOPE AN INFORMATION BOOKLET ON STRESS REDUCTION
STRATEGIES”.
SUBMITTED BY,
MR. RAMBABU . D.
I YEAR M.Sc, NURSING
(PSYCHIATRIC NURSING)
VARALAKSHMI COLLEGE OF NURSING,
BANGALORE – 560 057
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
CANDIDATE AND
ADDRESS
MR. RAMBABU.D.
I YEAR M.Sc, NURSING
VARALAKSHMI COLLEGE OF NURSING,
19, KIADB ROAD, CHOKKASANDRA,
T.DASARAHALLI, BANGALORE-57.
2.NAME OF THE
INSTITUTION VARALAKSHMI COLLEGE OF NURSING.
T.DASARAHALLI, BANGALORE-57.
3. COURSE OF STUDY
AND SUBJECT
DEGREE OF MASTER OF NURSING
PSYCHIATRIC NURSING
4.DATE OF
ADMISSION TO
COURSE
3O- 06- 2008
5. TITLE OF THE TOPIC
THE STRESS AND COPING STRATEGIES
AMONG PARENTS OF THALASSEMIA
CHILDREN.
6. BRIEF RESUME OF THE INTENDED WORKINTRODUCTION
Research on the relationship between stress, social support and coping has grown
substantially in recent years. This has been fueled by a growing interest in the social
psychological and familial aspects of the experience of illness. Stress has been broadly
defined as “virtually every from of disturbance of equilibrium”. Yet critics of the event
initiated model of stress are careful to note that a complete state of equilibrium rarely if
ever exist prior to the emergence of a particular stressor .Most stress theorists assume a
direct inverse correlation between stress and the availability of social support; difficulties,
financial problems and adverse social consequences.1
The family experiences, perceives, and responds to the illness can affect they
assume that social support enhances the coping process and reduce stress. The nature of
stress has been shown to span over several aspects of family life such as daily care
demands, emotional distress, interpersonal the social-psychological adjustment of the
family member as well as the course and outcome of the disease.
Coping is the cognitive and behavioral efforts to manage specific external and
internal demands appraised as taxing or exceeding the resources of the individual. A
distinction that is often made in coping literature is between active and avoidant coping
strategies are either behavioral or psychological responses designed to change the nature
of the stressor it self or how one thinks about it. Whereas avoidant coping strategies lead
people into activities or mental states that keep them from directly addressing stressful
events. Fathers most commonly coped by emotional withdrawal whereas mothers coped
through emotional release.2
Every year, about 8 million babies worldwide are born with gene-related birth
defect. Blood disorders (such as sickle cell disease and thalassemia) more then 307,000
births worldwide yearly. More then 3 million children die of genetic birth defects by age
of 5 years. Thalassemia is a genetic blood disorder that affects person’s ability to produce
hemoglobin. It comes from the Greek word “thalasanemia” which means “anemia by the
sea”. It was also known as Mediterranean Anemia.3
Thalassemia occurs most frequently in people of Mediterranean, Middle Eastern,
African, Italian, Greek, Thailand, Asian, Chinese and Indian.4
Through the tribal communities constitute a major part of India; unfortunately they
are highly vulnerable to many hereditary disorders causing high degree of morbidity and
mortality. Every year 10,000 children with thalassemia are born in India, which
constitutes 10% of the total number in the world, and 1 out of every 8 carriers of
thalassemia worldwide lives in India.5
6.1 NEED FOR THE STUDY
Stress is a complex, dynamic process of interaction between a person and his or
her, it is war one reacts person mentally and emotionally to the various conditions. Stress
was divided in to several subclasses based on the type of problems faced by respondents
i.e. worried stress, family related stress, relationship related stress, financial stress,
personal stress, and bereavement stress.
The diagnosis of this chronic disease is stress including that the parents develop a
variety of coping strategies in response to that stress. Coping has been defined as “The
things people do in their own behalf to avoid the stress that would otherwise result from
problematic condition of life.” Coping strategies was divided into subcategories i.e.
proactive, reflective, strategic, preventive, and avoidance coping. 6
To day, an Increasing number of children are admitted to hospitals with treatment
regimens that require the families’ constant vigilance and supportive care. Serious illness
and disability often have a devastating impact on family life. Yet, families lack a
psychosocial map for the experience of the illness. Most of the literature on the impact of
chronic illness has focused on mothers. Mothers are often neurotic, depressed,
introverted, lacking in self confidence, fear and helplessness, confusion, anger, anxiety,
and generally more distressed than either fathers of chronically illness children or
mothers of healthy controls.2
The participants were 46 African children (24girls, 22boys; mean
age=11.96years;age range: 8 to 17 years) from the outpatient sickle cell clinics at the
university of north Carolina Hospital, and Duke university Medical Center.Sixty-seven
percent of the children were diagnosed with sickle cell anemia, 16% had hemoglobin SC
disease, and 18% had thalassemia syndromes. The mean educational level of the parents
who participated in the study was 12.8 years of schooling. Fifty-one percent of the
parents were married, 28% were divorced, and 2% were widowed. Fifty- one percent of
the parents were currently employed on a fulltime basis, 5% were employed on a part-
time basis,31% were unemployed, and 5% were disabled.7
Thalassemic children need monthly blood transfusion and regular iron chelation
with blood malignancies are treated with chemotherapy protocols and marrow
transplantation. Thus, parents of these children are exposed to practice emotional
suffering for their off springs’ devastating health problem. They are usually responsible,
guilty and hopeless, as well as worried about the health and future.8
Several studies have indicated that presence of a patient or disabled child in the
stress and depression in parents. Mothers usually take active roles in the care of their ill
children and even might favorite activities. Thus, they bear greater stresses than fathers
and are at higher. Divorced mothers had higher depression score than the other two
groups (married mothers and widows) Married mother and living with husband can be
related with lower depression scores.9
The inherited disorders of hemoglobin are responsible for on extremely complex
series sickle cell anemia and thalassemia can cause chronic ill-health and life-threatening.
It was carried out at Dharwad of North Karnataka. Out of the fifty cases, twenty children
were carriers of thalassemia were suffering from thalassemia major. The population of
Dharwad appears to be a responsible extensive screening of the population is needed to
assess the prevalence of hemoglobin in identification of carriers of hemoglobinopathies
and further in taking adequate the measures.10
As part of the personal experience of this investigator, and also as witnessed
among parents of thalassemia children , the level of stress were distressing lending to
many physical and psychological problems like anxiety, depression, Insomnia, weight
loss which leads them to unable to cope with others, failures and low achievements.
6.2 REVIEW OF LITERATURE
Suksiri Prasomsuk et al conducted a study on lived experiences of mother
carrying for children with thalassemia major in Thailand. This quantitative study
explored the lived experiences of 15 mothers of children with thalassemia major by
conducting semi structured interviews; the data were analyzed utilizing content analysis.
Six themes of were identified: lack of knowledge about thalassemia, psychosocial
problems, concerns for the future, social support systems, financial difficulty and the
effectiveness of health services. These findings suggested that a holistic, culturally
sensitive nursing approach should be considered when carrying for children with
thalassemia.11
Afrhan Sharghi et al conducted a study about depression in mothers of children
with thalassemia blood malignancies: a study from Iran. Cross-sectional study. 294
mothers were recruited in 3 groups. Mothers of children with thalassemia, blood
malignancies, and a control group. The result of this study can contribute to the
development of a screening program, depression burden and promoting quality of life for
mothers of children with malignancies.12
Pradeep Rao et al Conducted study on psychopathology and coping in parents of
chronically ill children in Mumbai, North India. 30 parents whose children who had
thalassemia were randomly selected from the thalassemia day care centre of a teaching
general hospital. The parents were interviewed on a semi structured Performa and also
rated on stress and mechanisms of coping scales. Chronic illness in children affects the
psychological health of the parents. Active coping strategies are associated with fewer
distress indices and thus if inculcated may improve the ability to bear the burden of the
illness without becoming themselves affected by psychiatric illness.13
Sapountzi – Krepia Z et al Conducted a study about a qualitative study on the
experiences of mothers caring for their children with thalassemia in Athens, Greece.
Using a semi structured questionnaire, the researchers interviewed convenient sample of
19 mothers who have children with thalassemia. A considerable failure to provide
information regarding carrier testing prior to married or genetic screening for thalassemia
during early pregnancy at the time of the participants pregnancies was noted. Emotional
distress, fear of death, and difficulty in dealing with feelings were some of the mothers
concerns.14
Brown Ronald et al Conducted a study on analysis of parenting problems
for caregivers of children with thalassemia. A situational analysis of problematic
situations was conducted for 37 caregivers of children with thalassemia who ranged in
age from 5-13 years. Participants responded to a semi structured interview related to
caring for a child with thalassemia. The interview included the domains of medication
adherence, nutrition, minimizing and coping with pain episodes, social problems,
academic difficulties and children’s expression of negative feelings related to having
thalassemia. Caregivers described a total of 356 problems. Almost all caregivers reported
experiencing problems with their children’s nutrition, minimizing pain episodes and their
children expressing feelings about having thalassemia. Moderately challenging and
emotionally upsetting problems were reported for coping with symptoms. Nutrition
issues were more frequently reported for younger children. Findings have salient clinical
implications for the care of children with thalessemia.15
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE STRESS AND COPING STRATEGIES
AMONG PARENTS OF THALASSEMIA CHILDREN AT VANIVILAS
HOSPITAL IN BANGALORE WITH VIEW TO DEVELOPE AN
INFORMATION BOOKLET ON STRESS REDUCTION STRATEGIES”.
6.3 OBJECTIVES OF THE STUDY
6.3.1 To assess the Stress among Parents of Thalassemia Children.
6.3.2 To assess the Coping Strategies among Parents of Thalassemia Children.
6.3.3 To correlate the Stress and Coping Strategies among Parents of Thalassemia
Children.
6.3.4 To determine the level of Stress and Coping Strategies among Parents of
Thalassemia Children.
6.3.5 To develop information booklet on Stress Reduction Strategies
6.4 HYPOTHESIS
H 1 There is no significant relationship between Stress and Coping Strategies among
Parents of Thalassemia Children.
H 2 There is no significant association between Stress and selected Demographic
variables of Parents of Thalassemia Children.
H 3 There is no significant association between Coping Strategies and selected
Demographic variables of Parents of Thalassemia Children.
6.5 OPERATIONAL DEFINITION
ASSESSMENT
In this study it refers to the organized, systematic continuous of collecting Data
from the Parents regarding Thalassemia Children.
STRESS
In this study it refers to the psychological, physiological and sociological
imbalance experienced by the Parents towards their Children’s of Thalassemia which is
measured by stress rating scale.
COPING STRATEGIES
In this study it refers to the specific actions (or) behaviors adopted by the Parents
in order to manage the stress which is experienced during treatment of their Children.
PARENTS
It refers to Father and Mother who stays with the Children for more than three
days.
CHILDREN
It refers to the Children less than eighteen years who are in Thalassemia ward.
THALASSEMIA
It refers to a group of inherited blood disorder characterized by reduced (or)
absence of hemoglobin to oxygen carrying proteins inside the red blood cells.
INFORMATION BOOKLET
A printed booklet which will contain information regarding stress reduction
strategies.
6.6 ASSUMPTION
Stress is a universal phenomena which is unique to every individual.
Stress and coping are universally proportional.
6.7 DELIMITATION OF THE STUDY
The study is limited to the Parents who are taking care of Thalassemia Children in
Vanivilas hospital.
6.8 VARIABLES
DEPENDENT VARIABLES
Stress and coping strategies of Parents of Thalassemia Children.
INDEPENDENT VARIABLES
Consists of selected demographic variables such as age, sex. Religion, education,
place of living and health sources.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
The data will be collected from the Parents of Thalassemia Children at
Vanivilas Hospital in Bangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 RESEARCH DESIGN
Non-Experimental Descriptive Research Design.
7.2.2 RESEARCH APPROACH
A Descriptive Survey Research Approach.
7.2.3 RESEARCH SETTING
The study will be conducted at Vanivilas Hospital in Bangalore.
7.2.4 POPULATION
In this study population consists of Parents of Thalassemia Children.
7.2.5 SAMPLE SIZE
The samples of study consists of 60 Parents of Thalassemia Children at
Vanivilas in Bangalore.
7.2.6 SAMPLING TECHNIQUE
Non Probability convenient Sampling Technique.
7.2.7 CRITERIA FOR SAMPLING
INCLUSIVE CRITERIA Parents
Who are willing to participate in the study.
Who are staying with the children for not less than two months.
Who can understand and speak Kannada and English.
EXCLUSIVE CRITERIA Parents
Who are not willing to participate in the study.
Who have any pre-existing physical and mental illness.
7.2.8 METHODS OF DATA COLLECTION TOOL
A structural questionnaires schedule will be used to assess the stress and
coping strategies of Parents of Thalassemia Children.
Description of Instruments: The structural questionnaire consists of 3 parts.
Part - I Demographic Performa.
Part - II Stress scale.
Part – III Coping check list.
7.2.9 DATA ANALYSIS PLAN
The data will be analyzed by using descriptive and inferential analysis.
DESCRIPTIVE STATISTICS
Frequency, mean, mean percentage and standard deviation will be used.
INFERENTIAL STATISTICS
Co-efficient and correlation test will be used.
7.3 DOES THE STUDY REQUIRE ANY INTERVENTION TO BE
CONDUCTED PARENTS (OR) OTHER HUMANS?
Yes.
7.4 HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM
YOUR INSTITUTION ?
Yes, Permission will be obtaining from;
The research committee of Varalakshmi College of Nursing.
Authorities of Vanivilas Hospital.
8. LIST OF REFERANCES (VANCOUVER STYLE FOLLOWED)
1. Shrley.A.Hill. Cognitive Coping Strategies Among Mothers Of Children With
Thalassemia. Wings Of Gause Wayne State University Press Publishers; 79-89
2. Akbar Hussain and Ipshita Juyal. Stress Appraisal and Coping Strategies among
Parents Of Chronic ill Children. Journal of the Indian Academy of Applied
Psychology.July2007;Volume 33: 172-182
3. Sucursala. Dr.Felix,Str.Dr. Romanian Thalassemia Association Contact Information.
Romanian Institute Of Hematology And Blood Transfusion; Extension 2006
4. Rund.D. and Rachmilewitz.E.Thalassemia New England Journal Of Medicine. 2005
September; Volume 353:1135- 1146
5. M.Sengupta ,Ph.D. Thalassemia Among The Tribal Communities Of India, The
Internet Journal of Biological Antropology. Volume1: 2008
6. Gyan Mudra. A Study Of Perceived Stress, Impact And Coping Strategies. The
International Journal of Interdisciplinary Social Sciences.Volume2; Issue 4 : 325-334
7. Karen.M.Gill, Ph.D, Kelly K.Antony,BS,James W.Carson, MA,Rupa Reddig-
Lalliger,MD,Charles W. Daeschner,MD And Russell E.Ware,D,PhD Daily Coping
Practice Predicts Treatment Effects In Children With Thalassemia Disease. Journal
Of Paediatric Psychology. December 2006; Volume 26: 163-173
8. Saviolo-Negrin, N; Cristante, F;Zanon,E Canclini, M; Stocco,D;Girolami,A.A
Psychology Parents with a Hemophilic Child; A Quantitative approach, Hemophilia.
1999; 5: 63-68.
9. Olsson.M.B; Hwang.C.P, Depression in Mothers And Fathers of Children with
Intellectual Differences. Iranian Institute Of Health sciences Research, 2001; 45:535-
543.
10. Shivashankara.A.R. Jailkhani R, Kini A. Hémoglobinopathies in Dharwad, North
Karnataka: A Hospital.February 2008; Volume 21: Issue 1:593-599.
11. Suksiri Prasomsuk, Arunee Jessrisuparp,Thawalwong Ratanasiri,and Amornrat.
Lived Experiences Of Mothers Caring For Children With Thalassemia Major In
Thailand, Journal For Specialist In Peadiatric Nursing, January
2007;Volume12:Issued 1.
12. Afran Shargli, Mogan Karbakhsh, Bhrooz abaei, Alipas. Depression In Mothers Of
Children with Thalassemia Blood Malignancies:A Study From Iran, Clin Pract
Epidemol Mental Health.October 2006; Volume 2,
13. Pradeep Rao,Prakash V. Pradhan and Henal Shah. Psychopathology And Coping In
Parents Of Chronically ill Children, Indian Journalof PaediatricsOctober2007;Volume
71.
14. Sapountzi-Krepia. Z.Roupa,M.Gourni,F,Mastorakou,E.Vojiata,A.Kouyioumtzi,S.Van
Sheel. A Qualitative Study On The Experience Of Mothers Caring For Their Children
with Thalassemia In Athens, Greece, Journal Of Peadiatrics Nursing,2004;Volume
21;Issue2:142-152.
15. Brown RonaldT.PhD, Ivers-Landis, Carolyn.PhD. Drotar, Dennis PhD,Bunke,Vicki
PhD,Lambert,Richard G.PhD,Walker,A.Adrienne M.A. Factors Associated with The
Attitudes and Expectations of the Patient’s Suffering from Thalassemia; Scandinavian
Journal Of Caring Sciences.May 2004; Volume 18; Issue 2: 2004, 177-187.
9 SIGNATURE OF THE STUDENT
10 REMARKS OF THE GUIDE
Child with Thalassemia is going to cause stress and less coping among the psychosocial problem among the parents who are taking care of Thalassemia children. So investigator rightly chosen the topic of this stress and coping of parents of Thalassemia children
11NAME AND DESIGNATION OF THE GUIDE
MRS. DEVI.C.G Assot. Professor,
11.1GUIDE NAME AND ADDRESS
MRS. DEVI.C.G Assot. Professor, Department of Psychiatric Nursing.Varalakshmi College Of Nursing , Bangalore- 57
11.2 SIGNATURE OF THE GUIDE
11.3 NAME OF THE HEAD OF THE DEPARTMENT
MRS. DEVI.C.G Assot. Professor, Department of Psychiatric Nursing.Varalakshmi College Of Nursing , Bangalore- 57
11.4 SIGNATURE OF THE HEAD OF THE DEPARTMENT
12 REMARKS OF THE PRINCIPAL
The research topic selected is relevant to attempts to empower the parents of Thalassemia children with stress reduction strategies.
12.1 SIGNATURE OF THE PRINCIPAL