RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.

NAME OF THE CANDIDATE

Mr. LYJU PAULOSE,

AND ADDRESS

GOUTHAM COLLEGE OF NURSING,

MANJUNATHANAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE 560 010.

2.

NAME OF THE INSTITUTION

GOUTHAM COLLEGE OF NURSING,

MANJUNATHANAGAR,
WEST OF CHORD ROAD,
RAJAJINAGAR,
BANGALORE 560 010.

3.

4.

COURSE OF STUDY AND

M.Sc. NURSING I YEAR

SUBJECT

PSYCHIATRIC NURSING

DATE OF ADMISSION TO

05.06.2008.

COURSE
5.

TITLE OF THE TOPIC

A STUDY TO ASSESS THE

EFFECTIVENESS OF GUIDED
IMAGERY TECHNIQUE IN
REDUCTION OF STRESS AMONG
THE RESIDENTS OF SELECTED OLD
AGE HOMES IN BANGALORE

6.

BRIEF RESUME OF THE INTENDED WORK:

6.1.

NEED FOR THE STUDY:

We are ageing not just as individual or communities but also as a world
In the year 2004 it was accounted that old age population is 236/10,000 in the
world. In 2006, almost 500 million people worldwide were 65 and older. By
2030 that total is projected to increase one billion, accounting 13% of the total
population.
In 2004 old age population in India contributes 1/20 in the total population.
In the year 2002 there were more than 81million elderly in India and this figure
is expected to go up over 324 million in the year 2050. According to our
parliament discussion (5.12.2007) Indias population of senior citizen above 60
would reaches 173 million by 2026. In Kerala, Tamil Nadu and Karnataka 13%
of the total population comes above the age group of 60+ by 2016.1
From 2004 onwards, October first has been celebrated as World elders day.
so, elderly citizen are in need for urgent attention
A study conducted in old age homes in the care of the elderly in Gujarat
projected the results suggest that while the physical ties of the elderly man and
women, with their adult children home weekend or snapped completely
psychological and emotional bond with them remains strong. That produces
stress among them.2
An article was written on the travails of a greying nation mentioned that
India is an example of a developing count, which lacks organized services for
the elderly in the health, social or economic sectors. The health services
available for the elderly in India are generally contained within the health
services for the general population, without any special or specific initiatives for
this group. It is estimated that 45% of the elderly have chronic disease and
disabilities. One among this disease is stress. So specialized geriatric is
necessary.3

Major reason for old age persons to join old age home is to meet basic

needs (50%) and negligence rejection by family members (40%) based on the
study conducted by the Department of Human Development and Family studies,
Haryana agricultural University, Haryana. Psychological stress among them is
high. So, Stress among the old age home residents is high.4
A recent study was conducted in the university of Chicago; the study
shows that loneliness is injurious to health, especially in old age. Loneliness and
physical ageing can prove to be destructive combination, resulting in more stress
hormones flowing through the body.5
Community study of depression in old age denoted that one-month
prevalence of psychiatric disorder was 37.7% with 15.3% depressive neurosis
and 5.9% major depression. Health status of elderly in developing countries
projected that; three- quarters of all deaths could be ageing-related. Over 10% of
Indias elderly suffer from depression. Mental health concerns of the elderly
include depression delirium and dementia. Magnitudes of health problems
among old age clients are high. With the growth in the number of older people,
an increase of mental health problems might be expected. Reducing the amount
of suffering and dependence sue to poor mental health in old age is a priority
requiring a good understanding of the determinants of psychological distress.
The Journal named Nurses of India; Bangalore celebrated April 2008 as Stress
awareness month So, it is necessary to reveal the stress among the old age
clients and some technique to solve this problem. Old age and stress. 6
A study conducted by to assess that level of mental health among the
residents in an old age home at Calcutta, India. Out of total of 60 residents,
26.6% had very poor mental health level and majority 48.3% had a poor level of
mental health. The same study revealed the main psychological problem among
old age home residents. Frustration was experienced by 67.2%, feeling of
insecurity was experienced by 76.4% and loneliness by 54%. The
majority76.6% of the subjects were females and the commonest reason for 40%
of them joining in the old age home was not to be a burden of family
members. 7
A recent study was conducted on cognitive behavioral approach to the

treatment of functional problems presented by the elderly. It is argued that there

is some evidence is to suggest that a number of methods may help to reduce
certain psychological problems in the elderly. In India, Voluntary Health
Association reported that 50% of elderly require psychiatric or psychological
intervention at the point in their twilight years. At the same time cost
containment issues to be considered. Thus, Guided imagery was one of the
techniques that could promote relaxation and reduces stress; improve mood,
control high blood pressure, alleviative pain, boost the immune system and
lower blood cholesterol and glucose level. All these benefits are required for old
age persons. So it is needed to conduct a study to determine the effectiveness of
guided imagery technique on stress among the old age home residents.8
Through the above reviews it is understood that Guided Imagery is
effective in reducing the stress among elderly population. This is acting as a
useful method for reduction of stress. Hence the Investigator has taken up the
study on Effectiveness of Guided Imagery Technique in reduction of stress
among the residents of selected old age homes in Bangalore for conducting the
research
6.2.

REVIEW OF LITERATURE:
The investigator has done the extensive review of literature to obtain
comprehensive knowledge base and in depth information about Guided Imagery
Technique on stress among the old age home residents. The review of literature
were presented under the following headings,
A. Studies related to stress and old age
B. Studies related to Guided Imagery Technique
A. Studies related to stress and old age:
A study was conducted in rural and urban areas of Vellore regarding
dependent, independent and related health needs and problems of the elderly on
200 respondents. This study revealed that 78.5% were depressed due to
loneliness and poverty. 9
A study was conducted on a sample of 15 subjects from 5 old age homes.
Their reasons for joining old age home were as follows: 28.3% inmates took

their own decisions to get admitted, whereas for others family members took
decision. Family disharmony was the commonest reason for 64.2% of them. No
dependents for 62.9% of them. Inadequate accommodation to stay for 66.7% of
them. Clinical examination shows that, 67.2% were frustrated and 76.7% felt in
secured. Charles A Walker and Linda Box Curry identified that Relocation
stress syndrome is a nursing diagnosis characterized by symptoms such as
anxiety, confusion, fear, helplessness, indecisiveness, suicidal thoughts and
suspicion, hopelessness and loneliness. It usually occurs in older adults shortly
after moving from a private residence to nursing home or assisted living facility.
Eight nursing home residents and 8 assisted living facility residents were
interviewed 2 to 4 weeks after admission, when symptoms of relocation stress
syndrome are most likely to appear. This study indicated that the relocation
stress syndrome may be overestimated.10
A study was done to determine that multiple losses rendered to the elderly
vulnerable to loneliness and that the ensuring loneliness adversely affects the
cognitive status of the elderly loss of people, places and things that gave
meaning to life and represent accomplishments and pride result in a loss of self
esteem and a diminished sense of value of others. Anxiety is common in old age
and is frequently caused by the loss of self-esteem and the ability to adapt.11
An experimental study was done among the old age home residents
regarding the level of mental health. The study concluded that the levels of
mental health among the old age home residents are poor and Guided Imagery
Technique is an effective nursing intervention to reduce stress.12
A study based on the observation on residents of old age home was found
that socioeconomic and demographic factors dont have substantial influence on
old age people in making a decision to stay old age homes, but the main reason
seems to be the difference in the value system of the older and younger
generations.13
B. Studies related to Guided Imagery Technique:
Mind-body medicine uses methods as calming the mind, relaxing the
body, expressing emotions, changing negative thoughts and controlling physical
5

functions. The method mind body medicine includes meditation, bio feed
back, Guided Imagery, hypnosis, group therapy, behavior therapy, cognitive
restructuring and individual psychotherapy. Guided Imagery is also called
Visualization therapy this method uses mental imagery to focus and direct the
users imagination to affect their actions; This is an alternative therapy of holistic
healing. Although older adults face multiple development and ecological issues
and have a variety of psychosocial needs only a small proportion of older adults
seek counseling assistance and their needs have often been overlooked by using
these intervention.14
Guided Imagery uses the power of thought to influence psychological
and physiological states. This study showed that the use of Guided Imagery
tapes prior, during and post colorectal surgery had a significant decrease in pain,
anxiety and narcotic consumption.15
An article emphasized the uses of Guided Imagery in health care. It
discusses how it can significantly reduce stress, pain, side effects of treatments,
blood pressure, headaches and strength immune functioning. Patients are
encouraged to be active participants in their care. Patients, family members and
staff have demonstrated positive benefits.16
A study was conducted among surgical patients regarding the
effectiveness of muscle relaxation exercises in reduction of anxiety. In this she
had stated in her review one of the methods to relieve anxiety is imagery.
Imagine can be begun with several minutes of relaxation exercises, then the
patient been instructed to imagine himself in a calm tranquil place. Example, a
spot where he / she feels comfortable and safe such as favorite room in his home
or imagine that

He is on the beech seeing the sky

Smelling the ocean

Hearing the waves and

Crashing on the shore.17

A study was done on psychological techniques to boost the immune

system among breast cancer patients - Guided Imagery was provided with
progressive muscle relaxation, standard surgery, chemotherapy and radiotherapy.
At the end of the 9-month study, these women also had a higher level of
lymphokines, which help to prevent disease from spreads. The women reported
a better quality of life.18
A study was conducted by a cardiac team implemented a Guided Imagery
programme to compare cardiac surgical outcome between two groups of
patients. A questionnaire was developed to assess the benefits of Guided
Imagery programme. These who are willing to take participate in the study were
administered the questionnaire, Patients who completed the Guided Imagery
programme had a shortened average length of stay in the hospital; the cost of
medicine was reduced. Overall the patients hold a high level of satisfaction with
the care and treatment in Guided Imagery was considered a complementary
means to reduce anxiety, pain and length of stay among cardio surgery patients.19
6.3.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of guided imagery technique in reduction of
stress among the residents of selected old age homes in Bangalore.

6.4.

OBJECTIVES OF THE STUDY:

1. To assess the level of stress in pre test among experimental group and
control group.
2. To evaluate effectiveness of Guided Imagery Technique using pre test
and post test knowledge score of experimental group.
3. To assess the correlation between stress level of elderly and guided
imagery technique in experimental group.
4. To find association between level of stress and selected demographic
variables in experimental group and control group.

6.5.

OPERATIONAL DEFINITIONS:

1. Assess: In my study it refers to measurement of the effectiveness of

Guided Imagery technique in elderly.
2. Effectiveness: It refers to the significant reduction of stress level as
determining by the difference between pre test and posttest stress scores.
3. Guided Imagery Technique: In this study it refers the use of relaxation
and mental visualization to improve mood or physical well-being.
Guided Imagery Technique is two-part process. The first component
involves developing a state of deep relaxation through breathing exercise
and muscle relaxation technique. The second component of the exercise
is imagery or visualization itself. This technique is known as relaxation
imagery used in this study.
4. Stress: It refers to verbal responses of old age home residents in the
rating scale ranging from mild stress to severe stress: in relation to the
factors such as physical, anticipatory, psychological, socio-economic and
environmental factors. Stress will be measured in terms of stress scores.
5. Residents: old age clients who are admitted in the selected old age
homes between the age group of 60-70years.
6. Old age home: In the present study it is a place for the old aged people
to stay.

6.6.

HYPOTHESIS:
H1:

There will be a significant difference between the pre-test knowledge

score of elderly with the post-test knowledge score in the experimental group.
H2:

There will be a significant reduction in the level of stress among elderly in

the experimental group than the level of stress in the control group.

H3:

There will be significant association between the level of stress among

elderly and selected demographic variables in experimental and control group.

H4
6.7.

The mean post test knowledge scores of experimental group will be

significantly Higher than the post test score of control group.

ASSUMPTIONS:
It is assumed that: 1. Information provided by the old age home residents would represent
their true stress;
2. Level of stress varies from individual to individual
3. The subject who receives Guided Imagery Technique will be able to
reduce the stress;
4. Guided Imagery Technique helps to improve the relaxation of old age
home residents;
5. Guided Imagery Techniques helps to provide better nursing care to the
clients.

6.8.

DELIMITATIONS:
The study will be delimited to the selected old age homes at Bangalore.

7.

MATERIALS AND METHOD

7.1

SOURCE OF DATA

Old age people residing at selected old

age homes at Bangalore.

7.2

METHOD OF COLLECTION OF DATA

7.2.1. SAMPLING CRITERIA

INCLUSION CRITERIA

1. Residents of selected old age

homes.
2. Those who were co-operated
during the study.
3. Age group of 60-70years were
included
9

4. Those clients who could

understand Kannada.
5. Both male and female persons
will be included.
1. who are seriously ill during the

EXCLUSION CRITERIA

period of data collection

2. Clients who had some other
severe memory
disturbances/psychiatric
disturbances/ sensory deficits.
3. Old age residents who were
previously exposed to Guided
Imagery Technique.
4. Old age residents who are
having cognitive deficit.
7.2.2. RESEARCH DESIGN

The research that is chosen for the study

is True Experimental Design in nature.

7.2.3

VARIABLES UNDER STUDY:

1. INDEPENDENT VARIABLE
Guided Imagery technique.
2. DEPENDENT VARIABLE
Level of stress.
3. ATTRIBUTE VARIABLE
Sex, education, socio-economic
status.

7.2.4. SETTING

Study will be conducted at selected old

age homes at Bangalore.

7.2.5. SAMPLING TECHNIQUE

The technique that was adopted for this

10

study is simple random sampling using

lottery method without replacement, 30
experimental groups and 30-control
group.
Random methods will follow in
selecting old age homes, sample
selection and categorizing the groups.
7.2.6. SAMPLE SIZE

The sample size consists of 60 elderly,

who are residents of selected old age
homes.

7.2.7. TOOL OF RESEARCH

Tool used for the present study is

structured knowledge questionnaire to
assess the level of stress and knowledge
on Guided Imagery Technique, which
includes the following:
Section A- Demographic variable such
as age, sex, education, religion, marital
status.
Section B- Stress assessment scale.
Section

C-

Structured

knowledge

questionnaire about Guided Imagery

Technique.
Formal permission will be obtained

7.2.8. COLLECTION OF DATA

from the administrator of selected old

age homes.60 will be randomly selected
out of the entire population for both
experimental group and control group.
Stress assessment scale will be used to
both experimental group and control
group Guided imagery technique will be
introduced for experimental

group.

Posttest will be conducted on the 7th day

11

to both experimental group and control

group, using the same tool. The duration
of data collection will be 30days.
7.2.9. METHOD OF DATA ANALYSIS
AND PRESENTATION

The investigator will obtain data by

using

descriptive

and

inferential

statistics and the plan of data analysis

will be as follows:
1. To describe demographic
information
calculated

were
by

using

frequency and percentage.

2. To

determine

effectiveness

the

of

Guided

Imagery Technique paired

t-test

will

be

used

to

associate the stress and

demographic variables.
3. Chi-square

(2)

test

to

determine the association.

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.
Yes, the study requires Guided Imagery Technique as an invention to
reduce the stress level of the people residing in selected old age homes in
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

12

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

8.

LIST OF REFERENCES:
1. Guruswami D, Indias population of senior citizens, Article of India
Together, 2007 Dec; 97(4): p15-16.
2. Dr.Shukla R, Strees is the spice of life, Journal of Health, 2001 Feb;
27(2): p9.
3. Dr. Arvind K, Travails of a Greying Nation, 2007 March; 15(6): p22-23.
4. Syrjala K L, Stress in Elderly, Human Development and Family Studies,
2003 June; 26(26): p15-16.
5. Louise H, John C, Loneliness is Injurious to Health, Journal of Holistic
Nursing, 2007 August; 13(3): p34-37.
6. Paul, Psychology Health and Medicine, Nurses of India, 2008 April;
10(5) p17-19.
7. Kulkarni B R, Ranjan D, Effect of Relaxation with Guided Imagery on
Stress, Journal of Advanced Psychology, 1999 Sep; 13(3), p255-267.
8. Nicholas L, Moody M, Effects of Guided Imagery on Stress, Clinical
Nursing Research, 1998 June; 2(4), p478-480.
13

9. Deena N, Kakoti, Health Needs and Problems of the Elderly, Journal Of

Clinical Psychology, 1997 Jan; 27(5): p34-39.
10. Charles A W, Linda B C, Relocation Stress Syndrome, Psychosomatic
Medicine, 2001 March; 7th Edition: p177-182.
11. Smith J C, Sodergren K M, Cognitive Behavioural Relaxation Training,
Independent Nursing Intervention, 1999, 4th Edition: p103-107.
12. Wynd C A, Relaxation Imagery Used for Stress Reduction Among
Elderly, Journal of Advanced Nursing, 2000, Sep; 17(3): p294-297.
13. Rao A P, Management of Stress, Journal of Behavioural Medicine,
2001,Feb; 16(9) p65-70.
14. Dreber T, Mind, Body and Medicine, The Use of Guided Imagery With
Stress, Home Health Care Nurse, 1998, Jan; 14(16), p878-888.
15. Baider L, Uziely B, De Nour A K, Prograssive Muscle Relaxation and
Guided Imagery in Patients With Stress, General Hospital Psychiatry,
1997, August; 16, p340-347.
16. Lewis H, Uses of Guided Imagery in Health Care, The Journal Of
Invasive Cardiology, 1999, Sep; 17(4), p75-79.
17. Henry P E, Sanacore K A, Effectiveness of Muscle Relaxation in
Reduction of Stress, Journal of New York State Nurses Association,
2000, June; 18(6), p1921.
18. Norton C, Effects of Guided Imagery Technique, Journal of Mental
Imagery, 1997, April; 15(4) p73-77.
19. King J V, Lang P J, Guided Imagery Programme, The Relaxation
Response, 1998, July; 4th Edition:p 232-239.

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