RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

Ms. VEDHA POOMANI MARY PUSHPAM.V

I YEAR M.Sc NURSING

PSYCHIATRIC NURSING

YEAR 2011-2012

SRI VENKATESHWARA COLLEGE OF NURSING,

98, MARUTHI INDUSTRIAL ESTATE,

PEENYA 2nd STAGE, BANGALORE-58

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME AND ADDRESS OF THE CANDIDATE

Ms.VEDHA POOMANI MARY PUSHPAM.VI YEAR M.Sc NURSINGSRI VENKATESHWARA COLLEGE OF NURSING,NO:98,MARUTHI INDUSTRIAL ESTATE,PEENYA 2nd STAGE,BANGALORE-58

2. NAME OF THE INSTITUTION

Sri venkateshwara college of nursing, No:98,Maruthi industrial Estate,Peenya 2nd stage,Bangalore-58

3. COURSE OF STUDY AND SUBJECT

1 Year M.Sc nursingPsychiatric nursing

4.DATE OFADMISSION TO THE COURSE 15th June-2011

5. TITLE OF THE STUDY

A study to determine the effectiveness of pranayama on stress among 1st year B. Sc nursing students in a selected nursing college at Bangalore.

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“The sad truth is that excellence makes people nervous” -James Jefferson

Stress is a word derived from the Latin word stringere, meaning to

draw tight, and was used in the seventeenth century to describe hardship

and affliction. During the late eighteenth century (as Hinkle records),

stress denoted ‘force, pressure, strain, or strong effort’, referring

primarily to an individual, or to the individual's organs or mental powers.

Stress causes physical and mental health problems. Persistent stress can

impair students’ academic achievement and personal or professional

development.1

Stress in the 21st century is not something new, not anything

unknown. The percentage of people affected by stress is increasing day

by day. It is an unpleasant psychological and physiological state caused

due to some internal or external demands that goes beyond our capacity.

Stress is a state of disequilibrium that occurs when there is a disharmony

between demands occurring within an individual’s internal or external

environment and his ability to cope with that demands.2

Stress from many sources has been reported by student nurses. The

sources are like academic sources, parental expectations and competition

for grades, relationships and career choices. Academic sources of stress

like examinations, long hours of study, assignments and grades, lack of

free time, lack of timely feedback after their performance, special

elements of the academic program like arrangement and conduction of

workshops, also produce stress among student nurses. And also clinical

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sources of stress like while taking care of critically ill patients,

interpersonal conflict with peer group, insecurity about personal clinical

competence, fear related to complete their clinical requirements, dealing

with uncooperative patients, work overload, prolonged standing, learning

psychomotor skills, e.g. administering injections and performing

catheterization, have also been associated with high levels of stress.3

In addition, stress leads to psychological morbidity which may

have profound adverse consequences for individual nursing students.

Nursing student’s experiences of their clinical practice provide greater

insight to develop an effective clinical teaching strategy in nursing

education. They experienced stress as a result of feeling incompetent and

lack of professional nursing skills and knowledge to take care of various

patients in the clinical setting. There are numerous stressors for the

students to develop stress in nursing education like, using critical thinking

skills during their written examination. When compared with general

student population the nursing students perceive more stress.4

One major source of stress for nursing students is having various

types of information to support critical thinking and decision-making

while learning the nursing role. So many relaxation techniques are there

to reduce the level of stress. Pranayama is one of the relaxation technique,

in which mainly focus on the regulation of breathing pattern through

which releasing the obstacles from energy field. This is very much useful

to reduce the level of stress.5

Hence, a regulated and mindful breathing pattern has been held vital

to maintaining the highest level of physical health by yoga. Another

positive result of conscious breathing is its calming effect on the

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emotions, reducing fear and anxiety in the nervous system.

Regulated and mindful breathing, dynamic movement of the head,

shoulders and arms during the practice of breathing and meditation

promote concentration and relaxation.6

6.2 NEED FOR THE STUDY

A physical, mental or emotional response to events causes bodily

or mental tension. Simply put, stress is any outside force or event that has

an effect on our body or mind.7

According to National Crime Records Bureau survey India’s

suicide rate has risen 8 per cent a year for 10 years. According to a 2007

estimate, 45 per cent of suicides involve people between 15 and 29. The

motive when students kill themselves is invariably academic pressure -

these accounts for 99 per cent suicides in the age group 12-18.8

The study shown that about 36.9% of nursing students in India

were affected with stress. Statistics show that India has the highest

suicide rate in the world, marginally behind China, but ahead of the west

95-100 people commit suicide in India every day. And of these

a whopping 40% are in the adolescent age group.9

Nursing students have the same academic stressors as other

college students such as midterm and final examinations, research papers

and other assignments. In addition, however, nursing students also

experience a clinical component, which is highly stressful. Students have

a large amount of preparatory work before their clinical assignment. In

their clinical rotations, students must exhibit a high level of responsibility

and accountability in dealing with patients. They use highly technical

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equipment. Time management can be a pressure as they have many tasks

that must be accomplished in a short period of time. Students may face

hostility or rejection from patients and their families. Many times the

atmosphere on the nursing unit may be unfriendly or aloof, which adds to

the student’s sense of self-doubt and insecurity. Additionally, students are

in continuous contact with faculty and often believe that every task or

interaction is being evaluated.10

It is obvious that stress is present among nursing students. Due to

this continuous stress the students are facing different kind of problems in

their life. This excessive stress may leads into anxiety, depression, lack of

interest in studies, insomnia, failures in exams, discontinuity from studies

etc. Even some students are attempt for suicide due to stress and without

knowing the coping strategies to manage stress.

It is well known that either a quick or constant stress can induce

risky mind body disorders. Besides prescribed drugs, there are extremely

effective holistic methods to tackle the impairing influence of stress.

Some of them are yoga postures (asana), breathing (pranayama), and

meditation (dhyana), include increased body awareness, release of

muscular tension and increased coordination between mind-and body. It

helps in better management of stress and ensures an overall feeling of

well being. The ancient therapeutic traditions as well as modern medical

research speaks about the intimate relationship between our breathing

patterns and our physical, emotional, mental, and spiritual health. They

have shown how natural healthy respiration not only increases longevity

and supports our overall well-being and self-development.11

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Researchers at the All India Institute of Medical Sciences in New

Delhi have discovered a clear link between rhythmic breathing process

and a state of relaxed alertness and recommended the practice of

Pranayama for beating stress.

A study was conducted to assess psychological morbidity and

sources of stress and coping strategies among medical students of Nepal.

Sample collected from 75 students. The result of the study shows that, a

large proportion of students in both clinical and basic science having

potential problems. The stressors experienced by the students were

mainly related to academic and psychosocial concerns.12

A study was conducted to reduce stress among nursing

students in Victoria University. He conducted stress reduction program.

In that meditation, yoga, relaxation techniques are included as part of the

programme. Nursing students actively participated in this programme for

8 week session. The results were very positive.13

A study shown that nursing students often have difficulty in

adjusting the academic environment of higher education, as well as

difficulty adjusting to the environment of a nursing unit.

The state of the mind and that of the body are intimately related. If

the mind is relaxed, the muscles in the body will also be relaxed. Stress

produces a state of physical and mental tension. In yoga, physical

postures and breathing exercises improve muscle strength, flexibility,

blood circulation and oxygen uptakes as well as hormone function. In

addition, the relaxation induced by meditation helps to stabilize the

autonomic nervous system with a tendency towards parasympathetic

dominance. Physiological benefits which follow yoga practitioners

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become more resilient to stressful conditions and reduce a variety of

important risk factors for various diseases, especially cardio-respiratory

diseases.14

Measures such as Yogic breathing are a unique method for

balancing and stress related disorders. Yoga, developed thousands of

years ago, is recognized as a form of mind-body medicine. In yoga,

breathing improves blood circulation and oxygen uptake as well as

hormone functions. In addition, the relaxation induced by meditation

helps to stabilize the autonomic nervous system with a tendency towards

parasympathetic dominance. Physiological benefits which follow help

yoga practitioners become more resilient to stressful conditions and

reduce a variety of important risk factors for various diseases, especially

cardio-respiratory diseases.15

All the above information shows that nursing students are more prone

to get stress and stress related problems due to various reasons. So it is

must that some relaxation techniques to be used to reduce stress in

nursing students. Pranayama is one among the relaxation techniques, also

it is easy to learn, and easy to follow in day to day life for the students.

Hence, the researcher felt to determine the effectiveness of pranayama on

stress among nursing students.

6.3 STATEMENT OF THE PROBLEM

A study to determine the effectiveness of pranayama on stress

among 1st year B. Sc Nursing students in selected Nursing College,

Bangalore.

6.4 OBJECTIVES

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• To assess the level of stress among 1st year Nursing students.

• To determine the effectiveness of pranayama on stress among 1st year

Nursing Students in selected Nursing college, Bangalore.

• To associate the level of stress among 1st year Nursing students with

their selected demographic variables.

6.5 OPERATIONAL DEFINITION

Assess

To observe or impact or examine the pranayama performed by students.

Effectiveness

It refers to the significant reduction of stress level as determined by

before & after Pranayama.

Pranayama

Pranayama is the art of harmonizing breathing. It has the capacity

of freeing the mind from stress.

Stress

Stress is defined as a physical, mental, or emotional response to

events that causes bodily or mental tension. Simply put, stress is any

outside force or event that has an effect on our body or mind.

1st year B. Sc Nursing students

Students who are doing their 1st year B. Sc Nursing programme.

6.6 ASSUMPTIONS:

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• Well being of the Nursing students is ensured by the reduction of

stress.

• All the 1st year B. Sc Nursing students will have some level of

stress.

• Pranayama can help to reduce the level of stress.

6.7 HYPOTHESES

• There will be a significant difference in the level of stress among

1st year B. Sc Nursing students, before and after the practice of

pranayama.

• There will be a significant association between the post test levels

of stress with selected demographic variables of 1st year B. Sc

Nursing students.

6.8 REVIEW OF LITERATURE

The review of literature is defined as a broad, comprehensive in

depth, Systematic and critical review of literature scholarly publications,

unpublished Scholarly printed materials, audiovisual materials and

personnel communications.

Review of literature is an important aspect of research, is help to

make sure that what has been done in relation to the problem. There were

several studies has been conducted in relation to stress among nursing

students and the role of pranayama in the reduction of stress.

A study was conducted to assess the level of stress and burnout in

nursing students; 158 students entered the study and 147 completed; 37

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were male and 121were female at entry. The study shown that, the

students suffered greater levels of psychological morbidity and burnout.16

A study was conducted to assess the effect of yoga on academic

performance in relation to stress. The sample was taken from 800

adolescent students. Experimental and control group were given pretest in

three subjects. A yoga module like yoga asanas, pranayama was

administered on experimental group for 7 weeks. The experimental and

control groups were post tested. The result shows that the students, who

practiced yoga performed better in academics.17

A study was conducted to know about the experienced stressors

and coping strategies among nursing students. The sample of 115

students was used. Interpersonal and environmental sources of stress were

reported more frequently than intrapersonal and academic sources. Most

students reported finding new friends (76.2%), working with people they

did not know (63.4%) as interpersonal sources of stress, new

responsibilities (72.1%), as intrapersonal sources of stress more than

others. The most frequent academic source of stress was increased class

workload (66.9%) and the most frequent environmental sources of stress

were being placed in unfamiliar situations (64.2%) and waiting in long

lines (60.4%). Interpersonal and environmental sources of stress were

reported more frequently than intrapersonal and academic sources. Mean

interpersonal (P=0.04) and environmental (P=0.04) sources of stress were

significantly greater in first year than in fourth year students.18

A study was conducted to find out the causes of stress among

nursing students. A questionnaire was distributed to 110 nursing students,

and the results indicate that stress exists for students in both the clinical

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and academic aspects of the programme. Financial constraints and

academic-related concerns emerged as the most stressful areas for the

students. One third of the students reported that relationships with

teachers and staff on the ward cause some degree of stress. Factor

analysis revealed that five factors emerged as sources of stress. First

component is academic stress factors. The second and third components

concern relationships, the former involving teaching-related staff, and the

latter involving the clinical experience. The last two components suggest

that finance and death of patients are independent sources of stress.19

A study was conducted on depression, anxiety and stress among

adolescent students. The sample has been taken from 242 students. The

objective of the study was to assess depression and stress among

adolescent students. The study concludes that a significant proportion of

the students were to be having high level of depression, anxiety and

stress.20

A study was done to assess the Stress and Ways of Coping among

Nursing Students. In this descriptive research, 137 nursing students have

participated. The result of this study revealed that most of the nursing

students perceived the practice of clinical nursing at a moderately

stressful level and appraised this as a situation with emotions of

challenge. Students categorized emotions of clinical experience such as

harm/loss, threat, challenge, and benefit because of the situations during

clinical practice. The three most frequently used coping strategies were

seeking social support (65.25%), planned problem solving (23.73%), and

accepting responsibility (8.47%).21

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A study was conducted to find out the effects of diaphragmatic

breathing to reduce the stress level among nursing students. The stressors

nursing students experience both in their personal lives in their role as

students are many and varied. This study used two surveys one to

measure vulnerability to stress and then introduced diaphragmatic

breathing as a simple stress reduction technique. Diaphragmatic breathing

was taught to the students as a way to control over their anxiety prior to

examinations. The objectives of the study were to compare the student

heart rates and performance on cognitive examinations and clinical,

laboratory, practical examinations before and after using diaphragmatic

breathing to reduce heart rate and improve examinations.22

A study was conducted to know the effectiveness of pranayama on

stress. The stress hormone was measured in 121 individuals and Regular

pranayama practitioners (Group 1) were compared with beginning

practitioners (Group 2) during their pranayama sessions. The beginning

practitioners were also measured before learning pranayama, while

listening to classical music (Group 3). Among beginners, the fall in

cortisol levels was significantly greater during pranayama than when

listening to classical music, suggesting that pranayama produces a better

relaxation response.23

A study was conducted to assess stress and impairment among

nursing students, high depressive symptom was reported by 55% of the

sample. A majority of students experienced an increase in burn out

symptom and an alcohol abuse due to stress.24

A study was conducted with 131 samples to compare yoga and

other relaxation as treatment modalities to reduce stress. Personality

inventory sub-scale and general health questionnaire were used to assess

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the stress. A randomized comparative trail was undertaken comparing

yoga with other relaxation. Ten weekly 1 hour session of other relaxation

or yoga was conducted among the groups respectively. Following ten

weeks intervention stress and quality of life scores improved over time

among yoga groups more effectively than the other relaxation group. In

the study it was found that yoga appears to provide a comparable

improvement in stress compare to relaxation.25

A study was conducted to identify the main sources of stress in

nursing students and the evolution of the stressors when training in

nursing competences. The sample has been taken from 180 students. The

results of the study shows that, the most common sources of stress related

to academics (workload problem, associate with studying) other sources

of stress include clinical sources (fear of unknown situations, mistakes

with patients, handling technical equipment).26

A cross sectional study was conducted to assess stress,

psychological health among students in urban area of Chandigarh city.

The sample was collected from 2402 students. The results of the study

shows that out of 2402 students,1078(45.8%) had psychological problem,

half 1201 students perceived problems in their role as a student.930(40)

reported academic decline,180 students reported life was burden.27

A study was conducted to assess the emotional distress and

effectiveness of yoga to reduce stress among females. Out of 24 subjects

experimental group consist of 16 participants and control group consist of

8 participants. Perceived stress scale, state-trait anxiety inventory were

used to assess the stress and psychological out comes among distressed

women on entry and after three months. Two weekly 90 minutes yoga

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classes were conducted in experimental group. At the end of the study

experimental group demonstrated pronounced and significant

improvements in perceived stress. Women suffering from mental distress

participating in yoga class showed significant improvement on measures

of stress and psychological out comes.28

A study was conducted to find out the stress among mansoura

nursing students. A total number of 402 questionnaires were distributed

and 381 were returned, of these 8 were excluded due to incomplete data.

Thus 373 questionnaires were analyzed. The result of the study shows

that the five most frequently reported stressors were, fear of future, self

reported anxiety, increased class workload, accommodation problems,

congested class rooms. The study concludes that 40.2% of nursing

students who reported high stress which was higher than other studies.29

A study was conducted on perceived stress and effect of yoga in

Swami Vivekananda Yoga Research Foundation, Bangalore with 120

participants. Green climacteric scale, perceived stress scale was used to

assess the stress level. A randomized comparative trail was undertaken

comparing yoga with simple physical exercises. Eight weekly one hour

session of yoga (suryanamaskara, pranayama, dhyana) and simple

exercises was conducted among the groups respectively. The result of the

study showed significant reduction of stress among yoga group than the

group participated in simple exercise program.30

7.0 MATERIALS AND METHODS

7.1 SOURCES OF DATA

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Data will be collected from 1st year B. Sc Nursing students in

selected college at Bangalore.

7.2 METHOD OF COLLECTION OF DATA COLLECTION

i.Research design

Quasi experimental research design is used to assess the level of

stress among nursing students.

ii.Research variables

Demographic variables

Age, family income, father’s education, mother’s education,

father’s occupation, mother’s occupation, performance in previous

school experience, hobbies, siblings, type of family.

Study variables

Independent variables

Pranayama

Dependent Variable:

Level of stress among 1st year B.Sc Nursing students

iii.Setting

The study will be conducted in selected college at Bangalore.

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iv. Population

The study population comprises of the 1st year B.Sc Nursing

students

v. Sample

All the 1st year B. Sc Nursing students who fulfill the inclusion

criteria are considered as sample and the sample size was 40.

vi. Criteria for sample selection

Inclusion criteria

Nursing students of 1st year B. Sc Nursing.

First year B. Sc Nursing students who are willing to participate in

the study.

Exclusion criteria

• 1st Year B. Sc Nursing students who are suffering from any other

illness.

• 1st Year B. Sc Nursing students who are already in practice of

pranayama

vii. Sampling technique

Sampling technique adopted for selection is random sampling

technique.

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viii. Tools for data collection

The structured interview scheduled consists of following sections:

Section A- To assess the demographic variables

Section B- Rating scale to assess the level of stress.

ix. Method of data collection

After obtaining the prior permission from the authorities the

investigator meet the students and obtain informed concerned to assess

the stress level and to each pranayama exercise. Pre test will be

conducted to assess the stress level. After assessing the investigator

demonstrate pranayama. After the regular practice of pranayama, the 7th

day the stress level has been assessed by using the same rating scale.

Duration of study: 4-6 Weeks

x. Plan for data analysis

The data collected will be analyzed by means of quasi-

experimental, statistics and inferential statistics.

Descriptive study: Frequency, percentage distribution of

demographic variables and mean, standard deviation will be used to

assess the level of stress.

Inferential statistics: Chi-Square test will be used to find out the

association between selected demographic variables.

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xi. Projected outcomes

After the study, the researcher will know the level of

improvement in stress among the nursing students in selected college,

which will help the investigator to conclude about the importance of

using pranayama.

7.3 Does the study require any investigation or intervention to the

client or other human being or animal?

Yes, investigator demonstrates the pranayama to the students.

7.4 Has ethical clearance been obtained from any your college?

Yes, Permission will be obtained from the college

8. LIST OF REFERENCE

1. R. Sreevani, A Guide to mental health and psychiatric nursing, 2nd

edition, Jaypee brothers medical publications; 2008:208- 214.

2. Anbu T, Text book of psychiatric nursing, 1st edition, EMMESS

Medical publishers; 2010:198.

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3. William k. Bernandas, Sources of stress in nursing students,

Volume 8;2009;712-735.

4. Prism’s Nursing practice, Journel of clinical nursing, Training and

carrer development, Volume 3; Sep 2008:124-132.

5. Von scheela I, Hansson G. , Psycho-physiological stress among

nursing students; Nov 2009:329-347.

6 . Abha Khetarpa, G.K.Kochar, Stress and Preventive Management,

The Internet Journal of World Health and Societal Politics,

Volume 3;2008:56-78.

7. Brisson C, Larocque B, Bourbonnais R. Impact of academic Stress

on Health status . Journal of public health ;Dec 2009: 92(6).

8. National Crime Records Bureau (NCRB), Student suicides in

India; Wednesday Feb 2010.

9. B. Kent Houston, Robert, Sources of stress and stress management,

Journal of stress management; July2009:56-78.

10. Soares JJ, Gossi G, Sudin , Burn out among students,Complications

due to stress; 2007:10(2).

11. Chen Dr. Lin YY, Chung KP, Reduction of stress in relation to

breathing, A Multi level Model Approach; Jan 2008 : 33(1).

12. Chandrasekhar T Sreeramareddy, et al, Psychological morbidity,

Sources of stress and coping strategies among undergraduate

medical students of Nepal; Aug 2007.

13. Dr. Young, Reduction of stress among nursing students, The

University of Victoria community newspaper; July 2000: 55-65.

14. Parshad, O, Role of Yoga in wellness & management of life-style

diseases, 18th SRC Annual National Conference on Science and

Technology; Nov 2004:23 -26.

15. Parshad O, Role of Yoga in Stress Management, The West Indian

Medicasl Journal ; June 2004 53(3):191-194.

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16. Watson R, Deary I, Thompson D and Li G, A study of stress and

Burn out in nursing students in Hong Kong, International Journal

of Nursing Studies 45 (10); 2008:1534-1542.

17. Kauts A, et al, Effect of yoga on academic performance in relation

to stress, International journal of yoga; January: 2009: 39-43.

18. Naiemeh Seyedfatemi, Maryam Tafreshi and Hamid agani ,

Experienced stressors and coping strategies among Iranian nursing

students, BMC Nursing articles; Nov 13 2007: 75- 86.

19. Fiona Timmins, Stress in 12 areas among nursing students, Journal

of Nursing Management, Volume 13 ; 2002: 477 – 482.

20. Bhasin SK, Sharma R, Saini NK, Depression, anxiety and stress

among students , Indian Journal of Pediatrics; Feb 2010 :161-5.

21. Lonsri Wongchai, A guide to Mental Health and Psychiatric

Nursing, 1st edition, Chiang, Mai University; 1998:779-799.

22. K.Consolo,S.Fuoner,S.Staib, Effects of breathing exercise on

stress level of nursing students, Teaching and learning in nursing,

Volume 3,Issue 2; 67-71.

23. Mikkiyo gardens, The science of pranayama; October 20:45- 56.

24. Mary R. Haack, Stress and impairment among nursing students,

Article; Apr 06 2007.

25. Smith C, Hancock H, Blake-Mortimer J, Eckert K, A Randomize

Comparative Trail of Yoga and Relaxation to Reduce Stress and

Anxiety, Complementary Therapies in Medicine; June 2007 15(2):

77-83.

26. Pulido-Martos M, Augusto-Landa, J. and Lopez-Zafra E, Sources

of stress in nursing students: a systematic review of quantitative

studies, International Nursing Review;2011:1466-7657.

27. Priti Arun, BS Chavan, Stress and suicidal ideas in adolescent

students at Chandigarh, Original Article, Volume: 63; Aug 2009:

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281-287.

28. Michalsen A, Grossman P, Rapid Stress Reduction and Anxiolysis

among Distressed Women as a Consequences of three month

Intensive Yoga Program, International medical journal of

experimental and clinical research; December 2005.

29. Mostafa Amr,et al, Stress among Mansoura (Egypt) baccalaureate

nursing students, The Pan African Medical Journal; March 2011.

30. Chattha R. Treating the Climacteric Symptoms in Indian Women

with an Integrated Approach to Yoga therapy, Sep 2008; 15(5):

862-70.

9. Signature of the candidate :

10. Remarks of the guide :

11. Name and designation of

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11.1 Guide :

11.2 Signature :

11.3 Co-guide :

11.4 Signature :

11.5 Head of the department:

11.6 Signature :

12.1 Remarks of the Principal :

12.2 Signature :

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