RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION1. NAME OF THE CANDIDATE

AND ADDRESS

Mr. S.G.MURALIGOUTHAM COLLEGE OF NURSINGMANJUNATHNAGAR,WEST OF CHORD ROAD, RAJAJINAGAR,BANGALORE-560 010

2. NAME OF THE INSTITUTION GOUTHAM COLLEGE OF NURSING,

MANJUNATHNAGAR,

WEST OF CHORDROAD,RAJAJINAGAR,

BANGALORE – 560 010.

3. COURSE OF STUDY AND

SUBJECT

I YEAR M.Sc. NURSING

PSYCHATRIC NURSING

4. DATE OF ADMISSION TO

COURSE

16.10.2007

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5. TITLE OF THE TOPIC A STUDY TO DETERMINE EFFECTIVENESS OF STRUCTERED

TEACHING PROGRAMME ON PSYCHO

SOCIAL PROBLEM AMONG

ORPHANAGE CHILDREN IN SELECTED

HOMES IN BANGALORE

6. BRIEF RESUME OF THE INTENDED WORK:

6.1. NEED FOR THE STUDY

An orphanage is an institution or asylum for the care of a child bereaved of

both father and mother; sometimes, also, a child who has been one parent living.

The death of one or both parents makes the child of the very poor a word of the

community. The obligation of support is imposed upon parents or grandparents by

nearly every system of laws; but there is no such obligation on any other relative.

Naturally sympathy, however, and willingness to bear a distributed burden for the

common good, rather then to enforce an individual one, contributes to the

acceptance of the care of orphans as a public duty.

Orphans should be placed under the care of public guardians. Men’s should

have a feared for the loneliness of orphans of the souls of their departed parents. A

man should love the unfortunate orphan of whom is guardian as if he were his own

child. He should be as careful and as diligent in the management of the orphan’s

property as of his own or even more careful still.

The first orphanages called Orphanotrophia, were founded in the 1st century

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amid various alternative means of orphan support (Jewish law for instant

prescribed care for the widow and orphan, and Athenian law supported all orphans

of those killed in military service until the age of eighteen). The care of orphans

was particularly commended to bishops and, during the middle ages, to monsistors.

Many orphanages practiced some form of binding-out in which children, as soon

as they were old enough, were given as apprentices to house holds. This would

ensure their support and their learning an occupation. Historically certain birth

parents were often pressured or forced to give up their children to orphanages:

those of children born out of wedlock or into poor families; those with disabilities

or of children born with disabilities; and those with girls born into patriarchal

societies such practices are assumed to be quite rear in the modern western world,

thanks to improved social security and changed social attitudes, but remain in force

in many countries.

The practice of adoption, though long accepted as a social phenomenon, is

only recently gaining popularity in India. Due to the paucity of adequate follow

ups, evaluation of these adopted children is incomplete. The purpose of studying

the well – being of these children offer adoption, they were followed up at the

various places, is orphanages, instititutions, juvenile’s courts and adoption

agencies, responsible for this care. Orphans who lived in a setting where the entire

staff participated in decisions affecting the children, and where the children were

encouraged to become staff members, showed significantly fewer behavioral

symptoms of emotional distress. Orphanages are the only means of survival for was

orphans, a group setting where the staff shares in the responsibilities of child

management, is sensitive to the individuality of the children.

According to WHO there are 150 million orphans world wide. By 2015 there

will be nearly 400 million orphans. In India children (0-17 years) are orphaned due

to all causes, 2005, estimate 25,700,000 unicef India statistics.

“India’s population stands at 1.3 billion among them 5.7 million are children”

1. 25,700,000 Children ages 0-17 years are orphans.

2. In Karnataka 58 orphanage center are present among that Bangalore

having10 centers.1

The problems of orphanages are such as their own large families to care for,

severe economic strains, pathetic situations, grand parents were found to be less

able to provide discipline and adequate socialization, basic needs for food, clothing,

shelter and health care, observed that adopted or fostered children often receive

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worse treatment then the biological children, in the same family and found that the

education, nutrition and health status of children adopted into impoverished

families suffered from lack of resources necessary for their basic need emotional

problems there are several reasons. First there is a lack of adequate information on

the nature and magnitude of the problem, cultural belief that children do not have

emotional problems and lack of attention from adults, psychological problems such

of lack of knowledge of how to handle it appropriately in many cases children are

punished for showing their negative emotions, social problems, lack of group

attention children are grieved by the loss of their parents. Therefore are at risk of

growing up depression anger inattentive in classes and it is feared that many

children may find it difficult to adopt to the new changes, social change may be

shown in like bereavement, to adopt to it create stress and this stress shown in

symptoms of confusion, anxiety, depression and behavior disorders such as

disobedience the same symptoms may cause learning problems children who are

frustrated, fearful and depressed may fail to concentrate in class and therefore

perform badly.2

The orphanage children are social burden for our country, as India is still

developing country and having poor socio-economic status. From above studies it

is seen that orphanage children are having various psychosocial problems in some

aspects. As a result, they can not mix up with the society. The researcher felt that

there are various problems faced by orphanage children. Such as, isolation, guilt,

maladjustment, antisocial behavior, depression and so on. Since the investigator felt

that a study on to determine the effectiveness of STP on psychosocial problem

among orphanage children will help to minimize the psychosocial problems of

orphanage children.

6.2. REVIEW OF LITERATURE: Review of literature is a key step in research process the typical purpose for an

analyzing a reviewing existing literature is to generate research question to identify

what is known research question to identify what is known and what is not about a

topic, the major goal of the review of the literature is to develop a strong

knowledge base to carry out research and non research scholarly activities.

1) Studies related to emotional problem among orphan age children.

Report on a study that aimed to establish the level of emotional problems

among 115 children aged 9-16 years (average 13.4), who were living in two

orphanages in the Gaza Strip. The children's age of admission to the orphanage

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(average 8.8 years) was higher than in traditional orphanages in other countries.

This was related to the reasons for admission, following their father's death, and the

inability of their remaining family to care for them. However, children retained

substantial contact with their family of origin by visiting during school holidays

(88.6%) or being visited at the unit (97.4%). Using previous standardized mental

health measures completed by the children and their main careers, children

demonstrated high rates of anxiety, depressive and post-traumatic stress reactions.

These mental health problems were strongly inter-related but were not found to be

associated with social/care variables. Potential implications of the findings for

orphanages and other residential units in developing countries are discussed. These

should take into consideration the socio-cultural characteristics of each country and

limited local resources; involve non-governmental organizations and local

communities; tackle wider stigmatizing attitudes; and instill a child-centered

philosophy within these settings.3

A study was conducted on emotional reaction social situation Anticipating

and responding to a partner's emotional reactions are key components in the

comprehension of daily social discourse. Kindergarten children with language

impairment (LI) and age-matched controls (CA) were asked to label facial

expressions depicting 1 of 4 emotions (happy, surprised, sad, and mad) and to

identify those expressions when given a verbal label. Children then chose among

these facial expressions when asked to infer emotional reactions from stories (3-

sentence scenarios) presented in 1 of 3 modalities: verbal, visual, and combined.

Although all children were able to identify and label the facial expressions, children

with LI had difficulty integrating emotion knowledge with event context in order to

infer a character's feelings. When these inferencing errors occurred, children in the

LI group were more likely to provide emotions of a different valence (e.g.,

substituting happy for mad) than were children in the CA group. Inferencing ability

was related to language comprehension performance on a standardized test. The

findings suggest that inferencing errors made by children with LI occur during the

early stages of social processing and may contribute to social difficulties often

experienced by this group of children.4

2)Studies related to psychosocial problem among orphanage children

A study related to the psychological effect orphan hood a study of orphans in

Rakai district. This paper examines the psychological effect of orphan hood in a

case study of 193 children in Rakai district of Uganda. Studies on orphaned

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children are not examined the psychological impact. Adopted parents and schools

have not provided the emotional support these children often need. Most adopted

parent’s lack of information on the problem unable to offer emotional support; and

school teachers do not know how to identify psychological and social problems.

Teachers need to be retrained in diagnosing social problems and given skills to deal

with them.2

A study was conducted to assess whether the structure of the parental

background (birth, restructured, widowed, and single) or the context (severe social

disadvantage or care) in childhood is associated with psychological problems in

adolescence and adulthood. Data collected on 8,441 cohort members of the

National Child Development Study were used to explore the impact of parental

background on maladjustment at age 16, as assessed by the Rutter. A Health and

Behavior Checklist, and psychological distress at age 33, as assessed by the

Malaise Inventory. The result showed restructured parenting (without disadvantage

or care) was not a risk factor for maladjustment at age 16. Rather, a childhood

experience of care or social disadvantage was significantly related to psychosocial

problems at age 16. Psychological distress at age 33 was associated with

maladjustment at age 16. A childhood experience of care was associated with a

tendency to adult psychological distress in men, as was growing up with a single

parent.5

Forty-one orphans whose fathers and/or mothers had died from AIDS, and

were living in the poor suburbs of Dar Es Salaam, Tanzania, were compared with

41 matched non-orphans from the same neighborhoods. The subjects were given an

arithmetic test and a semi-structured questionnaire concerning any internalizing

problems, their attendance at school and their experiences of punishment, reward

and hunger. The scale of internalizing problems comprised 21 items adapted from

the Rand Mental Health and Beck Depression Inventories concerning mood,

pessimism, somatic symptoms, and sense of failure, anxiety, positive affect and

emotional ties. Most orphans lived with aunts and uncles. Compared with non-

orphans, they were significantly less likely to be in school but those who did attend

school had similar arithmetic scores. Significantly more orphans went to bed

hungry. Orphans had markedly increased internalizing problems compared with

non-orphans and 34% reported they had contemplated suicide in the past year.

Multiple regression analysis indicated that the independent predictors of

internalizing problem scores were sex (females higher than males), going to bed

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hungry, no reward for good behavior, not currently attending school, as well as

being an orphan. The orphans not only had unmet basic needs, but also had

markedly increased internalizing problems, thus their long-term mental health

would be in jeopardy. There is an urgent need to expand and improve current

intervention programmes not only to meet the basic needs but also to include

psychosocial support, counseling services for the orphans, and training for their

careers and teachers.6

3) Studies related to problem of institutionalization of orphanage children.

A study Conducted on the orphans of Eritrea ; are orphanages part of the

problem or past of the solution, this study compared the mental health and

cognitive development of 9 to 12 yrs old Eritrean war orphans living in two

orphanages that differed qualitatively in patterns of staff interaction and styles of

child care man age nest method the directors and several child care workers at each

institution were asked to complete staff organization and child management

questionnaires, the psychological state of 40 orphans at each institution was

evaluated by comparing this behavioral symptoms and performance on cognitive

measures results : orphans affecting the children, and where the children were

encouraged to become self-reliant through personal inter actions with staff

members, showed significantly fewer behavioral symptoms of emotional distress

than orphans who lived in a setting where the director made decisions, daily

routines were determined by explicit rules and schedules, and interactions between

staff members and the children were impersonal.7

A study conducted on attachment and indiscriminately friendly behavior

were assessed in children who had spent at least 8 months in a Romanian

orphanage (Ro) and two comparison groups of children ;a Canadian– born, non

adopted, never institutionalized comparison group (KB) and an early adopted

comparison group adopted from Romania before the age of 4 months (EA),

attachment was assessed using 2 measures : an attachment security questionnaire

based on parent on parent report and a separation Reunion procedure that was

coded using the procedure that was coded using the preschool assessment at

Attachment. Indiscriminately behavior was examined using parent’s responses to 5

questions about this children’s behavior with new adults. Although Ro children’s

did not score differently from either CB or EA children on the attachment security

measure based on parent report, they did display significantly more insecure

attachment patterns than did children in the other 2 groups, In addition, Ro

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children displayed significantly more indiscriminately friendly behavior than both

CB &EA children, who did not direr in terms of indiscriminate friendliness Ro

children insecure attachment patterns were not associated with any aspect of this

institution environment, but were related to particular child and family

characteristics, specifically, insecure Ro children had more behavior problems

scored lower on the Stanford. Binet Intelligence scale, and had parents who

reported significantly more parenting stress than Ro children classified as secure.8

A study conducted on impact of institutionalization on child development

during the past 10 yrs Romanian orphanages have had the opportunity to revisit

developmental questions regarding the impact of curly deprivation are examined by

reviewing both the early and more recent literature on studies of children who spent

the 1st few years of life in institutions special attention is given to the Canadian

study of Romania’s adoptee. Findings across time and studies are consistent in

showing the negative impact of institutionalization on all aspects of children’s

development (intellectual, physical, behavioral, & social emotional) the impact of

institutionalization is greatest when coupled c risk factors in the post institutional

environment.9

4) Studies related to intellectual problem of orphanage children.

Children at the Jimma community orphanage between the ages of 5 and 14

years were given a battery of tests to assess their intellectual, social, and nutritional

well-being relative to a group of family-reared controls. On two tests of intellectual

ability, the Ravens Progressive Matrices and the Conservation test, the orphanage

children performed as well as the family children. Children who entered the

orphanage at an early age scored higher than those who entered later. On social-

emotional measures of self-esteem, the orphanage children scored higher than or

similar to the controls. However, in terms of their relationships with adults, the

orphanage children reported fewer interactions and weaker attachments to adults.

This was largely determined by the higher child: adult ratio in the orphanage than

in family homes. Also, the orphanage children were more likely to be stunted but

not more likely to be wasted than the family children. The former was attributed to

the malnutrition experienced by children before they entered the orphanage, which

in many cases was during the 1984 famine. Stunting was associated with lower

Ravens scores. The generally favorable status of the orphanage children can largely

be attributed to the no institutional orphanage rather than to their preorphanage

family life. This raises disturbing questions about family life under conditions of

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economic stress.10

A study was undertaken to assess the health, nutrition and psychosocial

profile of Institutionalized children in four States--Uttar Pradesh, Andhra Pradesh,

Karnataka and West Bengal. A sample of 3,822 children from 70 institutions in 6-

18 years age group formed the subjects of the study. It was observed that the

destitute children were mainly taken care of in three types of institutions, viz;

Voluntary, Government Aided and Government run institutions. Calorie deficiency

and deficiency of Vitamins and minerals characterized the diets of these children.

In general, there was no deficit of protein in their diets. Growth wise, these children

were retarded both in height and weight compared to standards. However, they

fared better in comparison to their age and sex counterparts in the rural and urban

poor. Psychosocial profile of these children indicated that the prevailing

environment in the institutions is less conducive for intellectual stimulation but not

so for the development of skills of self-help, locomotion, socialization and

imagery.11

6.3. STATEMENT OF THE PROBLEM

A study to determine effectiveness of structured teaching programme on

psycho-social problem among orphanage children in selected homes in Bangalore.

6.4. OBJECTIVES OF THE STUDY:

1. To assess the psycho social problem among orphanage children.

2. To assess the effectiveness of STP among orphanage children.

3. To find association between psychosocial problem demographic

Variable.

6.5. OPERATIONAL DEFINITIONS:

1. Assess: - Measurement of Knowledge of orphanage children to minimize

the psychosocial problems on pretest and posttest.

2. Effectiveness :-Refers to significant gain in knowledge as determined by

significant change is free and post test scores

3. Structured teaching programme – Refers to systematically prepared

teaching programme for orphanage children to impart then knowledge using

relevant teaching methods and a.v. aids which provides information

regarding psychosocial problems.

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4. Psycho-social:-It refers to the mental and social environment of an

Individual

5. Orphan :-A child who has lost both parents, though death or less

Commonly, are parent.

6. Orphanage :- As institution for the housing and care of orphan

6.6. HYPOTHESES:

H1-re will be significant difference in the post test and pre test scores

of psychosocial problems of orphanage children.

6.7. ASSUMPTIONS:

It is assumed that:

1.Care givers of orphanage children will be willing to express

psychosocial cope up with psychosocial problems.

2. Subjects will be able to cope up with psychosocial problems.

6.8. DELIMITATIONS:

1. The study is delimited to orphanage children who are attending selected

orphanage.

2. Orphanage children who have available during the period of study.

3. Study if delimited 6-12 years only

Student who can understand read and write Kannada.

6.9. PROJECTED OUTCOME:

1. The study will help to find out psychosocial problems

STP will help cope up the psychosocial problem of orphanage children.

7. MATERIALS AND METHODS

7.1 SOURCE OF DATA Orphanage children in selected orphanage

homes Bangalore.

7.2 METHOD OF COLLECTION OF DATA

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7.2.1. SAMPLING CRITERIA

INCLUSION CRITERIA

1. Orphanage children age of 6-12 yrs.

2. Those willing to participate in the

study.

3. Those who can read and understand

Kannada.

4. Those orphanage children present

during the study.

EXCLUSION CRITERIA 1. Those who are absent in part counseling

study.

2. Those who are absent during the study.

7.2.2. RESEARCH DESIGN Pre-experimental design (one group pre test-

post design).

7.2.3 VARIABLES UNDER STUDY:

1. INDEPENDENT VARIABLE

2. DEPENDENT VARIABLE

3. DEMOGRAPHIC

VARIABLE

Structured teaching programme

Knowledge of orphanage children.

Age, socioeconomic status and education.

7.2.4. SETTING Study will be conducted in the selected

orphanage home.

7.2.5. SAMPLING TECHNIQUE Study will be conducted in the selected

orphanage home

7.2.6. SAMPLE SIZE 40 Orphanage children

7.2.7. TOOL OF RESEARCH Socio demographic question are will be used

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to collect data.

Structured questionnaire will be developed

by researcher to assess psychosocial

problem.

7.2.8. COLLECTION OF DATA A prior formal permission will be obtained

from orphanage home. Informal permission

will be obtained from the subjects after

explaining the purpose of study. A structured

questionnaire will be administer to assess the

demographic data and pre test knowledge

related to psychosocial problems of

orphanage A structured teaching

programme will be given to orphanage

children . Post-test conducted after 7 days.

Duration of data collection will be 30 days.

7.2.9. METHOD OF DATA

ANALYSIS AND

PRESENTATION

1. Descriptive and inferential statistics

will be used for data analysis.

2. The analyzed data will be presented

in the form of tables, diagrams and

graphs.

3. Paired‘t’ test will be used to test

significance difference in the

knowledge score between pre test

and post test knowledge scores.

4. Chi-square(χ2) test to determine the

Association between demographic

variables

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.

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Yes, the study requires administration of structured questionnaire and

administration of STP to the children in selected orphanage home, Bangalore.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION IN CASE OF 7.3?

Yes, informed consent will be obtained from the institution authorities and

subjects. Privacy, confidentiality and anonymity will be guarded. Scientific

objectivity of the study will be maintained with honesty and impartiality.

8. LIST OF REFERENCES:

1. My orphanage.Wikipedia the free encyclopedia. 2007 Sep.Available from URL:

http://www.google.com.

2. Sengendo J, Nambi J.The psychological effect of orphan hood:a study of orphans

in Rakai district. Health transition review 1997;7:105-124.

3. Thabet, Lamia, Thabat M, Aziz A, Hussein A, Sajida. Mental health problems

among orphanage children in the Gaza strip. Adaptation and fostering journal

2007;31(7):54-62.

4. Ford JA, Milosky LM. Inferring emotional reactions in social situation,

differences in children with language impairment. J speech Lang Hear Res 2003

Feb;46(1):21-30.

5. Buchanan A, Ten Brinke J, Flouri E. Parental background, social disadvantage,

public “care,” and psychological problems in adolescence and adulthood. J Am

Acad Chid Adolesc Psychiatry 2000 Nov;39(11):1415-23.

6. Makame V, Ani C, Grantham-McGregor S. Psychological wellbeing of orphans

in Dar El Salaam, Tanzania. Acta Paediatr 2002;91(4):459-65.

7.Wolff PH, Fesseha G. The orphans of Eritrea:are orphanages part of problem or

part of solution. Am J Psychiatry 1998 Oct;155(10):1307-8.

8. Chisholm K. A three year follow up attachment and indiscriminate friendliness

in children adopted Romanian orphanages. Child Dev 1998 Aug;69(4):1092-106.

9. Maclean K. The impact of institutionalization on child development. Dev

Psychopathal 2003;15(4):853-84.

10. Aboud F, Samuel M, Hadera A, Addus A. Intellectual, social and nutritional

status of children in an Ethiopian orphanage McGill University, Montreal, Canada

Soc Sci Med. 1991;33(11):1275-80.

11.Sarma KV, Vazir S, Rao DH, Sastry JG, Rao NP. Nutrition, health and

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psychosocial profile of institutionalized children Indian pediatr. 1991 jul;

28(7):767-78.

12. Webster’s Encyclopedic unabridged Dictionary of the English language

Newyork: Granercy books;1996.p.1017.

13. Basavanthappa BT. Nursing Research.1sted. New Delhi: Jaypee brothers

medical publisher; 1998.p.109-112.

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