RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

1)

NAME OF THE
CANDIDATE AND
ADDRESS

MS. CHITHIRA VARGHESE

1ST YEAR M.Sc. NURSING.
PRAGATHI COLLEGE OF NURSING #33 BYRATHI
EXTN, NEAR EBENEZER HOSPITAL, HENNUR
BAGALUR
MAIN
ROAD,
KOTHANURPOST,
BANGALORE:560077

2)

NAME OF THE
INSTITUTION

PRAGATHI COLLEGE OF NURSING

#33 BYRATHI EXTN, NEAR EBENEZER HOSPITAL,
HENNUR BAGALUR MAIN ROAD, KOTHANUR
POST, BANGALORE:560077

3)

COURSE OF STUDY
AND SUBJECT

DEGREE OF MASTERS IN NURSING

PSYCHIATRIC NURSING

4)

DATE OF
ADMISSION TO THE
COURSE

5)

TITLE OF THE
STUDY

03/06/2013

A STUDY TO ASSESS THE EFFECTIVENESS OF NURSING

INTERVENTIONAL PACKAGE ON REDUCTION OF

STRESS AMONG ELDERLY RESIDING IN SELECTED
OLD AGE HOME, BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

6. BRIEF RESUME OF THE INTENDED WORK

Page | 1

INTRODUCTION
The word stress was originally an engineering term used to refer to the amount of force
that a beam or other physical support could bear without collapsing under the strain. The
problem comes when we push ourselves beyond our limitations, beyond what we were intended
to bear without permanent damage. Everyone is under stress; a response to an environmental
demand is a stress. Stress is a normal part of everyday life. As long as we keep that stress within
reasonable limits, there is no problem. But when we allow it to exceed its reasonable limits,
trouble begins1.
Old age has its derivation from a Greek word Geras. The word Geron means old
man. Ageing is not a disease, but the final stage of normal life 2. Ageing: the normal process of a
time related change begins with birth and continues throughout life. According to Erik Erickson,
this state is a culmination of many previous intra psychic and intrapersonal changes. 2 Owing to
retirement from job and due to reduction in income, elderly persons have a feeling of loneliness,
rejection and insecurity. Also, the quality of life is determined by socio-economic security,
psychological wellbeing and perceived satisfactory health. Today there are about 77 million aged
people in India3.
In this modern world we face stress in every phase of life. Old age population suffers
both physical as well as mental changes in life. Biological or bodily changes, loss of partner,
change in family structure and role, economic dependency, all which contributes to the mental
health problems. Stress management is the need of the hour. Geriatric nursing synopsis from
rguhsgstressing us out and plaguing us with anxiety attacks. Healthy way to manage stress:
meditation, guided imagery, self-hypnosis, yoga, exercises, music therapy, laughter therapy,
relaxation techniques e.g. head to toe relaxation, and relaxation through aerobic exercises, play

Page | 2

with pet, curl up with a good book, work in garden, spend time in nature, watch comedy, go for a
walk etc. Among these Yoga is a popular technique through which stress can be managed by
practicing regularly. Controlled breathing, asanas, bhandhas, mudras, and chakras are the steps to
be followed4.
Yoga is an ancient practice to keep the body flexible and attain spirituality. Yoga is one
among those wonderful arts that brings a perfect blend of physical, mental, intellectual and
emotional strength. Many people have been beneficial with the practice of yoga from common
people around to famous personalities. Even the medical practitioners believe that this ancient
therapy yoga is successful because it creates a balance in the nervous and endocrine system
which directly influences all the other systems and organs of the body. Apart from the physical
benefits, the thorough practice of yoga interconnects emotional, mental and spiritual level as
well. The very essence of yoga is attaining the mental peace. Further, it also improves
concentration and relaxed state of living5.
Mudra is a Sanskrit word derived from the root mud, please or delight and
dravaya, the causal form of dru, to draw forth. It has been defined because its performance is
said to give pleasure and satisfaction to the object of reference, which in turn rebounds on the
practitioner6. The term Mudra has been used with different meanings at different periods of time.
In this study I will refer it as meaning gesture and attitude. Every Mudra can be seen as a
symbolic expression of psycho-physiological, emotional, devotional and aesthetic attitudes
which the practitioner is to ultimately experience.

6.1 NEED FOR STUDY

Ageing is a normal, universal and inevitable change, which takes place even with best of
nutrition and health care. Elderly people are vulnerable to physiological, mental and social crisis
Page | 3

and to a typical presentation of illness common to the age. In India, 3.9% of the population
comprises people above 65 years of age and expected to reach 21.8% by 2030. In Karnataka, out
of a population of 5.5 crore, 8% are elderly citizens. 1 st of October every year has been observed
as World Elders Day globally. At present ageing has become a leading demographic issue in
21st century because of the dramatic change in technology, urbanization, industrialization and
changes in health care industry7.
Ageing process occurs in every living species, as also in human beings by graying of hair,
wrinkles of skin, hardening of arteries, aches and pain in joints, weakening of eyesight etc. The
aged often complain that their memory power was decreased over the past few years. They tend
to forget more recent events. These are the features of advancing years. WHO report of 2004
states that 236 elderly people per 1000 suffer from mental illness mainly due to stress, heart
disease, stroke, cancer, Alzheimers disease, dementia and loss of intellectual abilities like
memory and learning, attention, concentration and orientation, thinking, problem solving etc 8.
Ageing process occurs at different levels - social, chronological, behavioral, physiological,
morphological, cellular, and molecular level. Thus ageing is a natural process and should be
welcomed. Elderly subjects present a challenge and resource for healthcare providers,
particularly in nursing9.
Stress is a complex factor which creates social and psychological problems for the
individual and thus to the society. Adaptation to ageing is crucial to ones happiness; failure to
adapt can result in depression. Adaptive coping will alter may be seriously due to major stressors
like financial problems, physical illness, change in body functioning, increased awareness of
approaching death, and numerous losses of individual experiences during the period of life.

Page | 4

Stress management through self management: our body is like a splendid palace, which is
matchless in its form and function. So we believe that yogic philosophy of deep relaxation will
be achieved through the process of rebound effect, synchronisation, and core alignment11.
Yoga has many positive effects on the body. It is probably the oldest self development technique
in existence, and this is the reason why many people these days are opting yoga in their daily
routines. Yoga seems to relieve stress and also gives one an overall health12.
Several practices are recommended in the yoga to achieve this state of inner rest; these
are classified under four major headings called Raja yoga, Karma yoga, Bhakti yoga and Jnana
yoga. Raja yoga practices include healthy yogic diet, cleansing techniques (kriyas), yoga asanas
and pranayama. These exist a direct relationship between the rate of breathing and rate of flow of
thoughts in the mind. Pranayama uses voluntarily reduction of the rate of breathing to reduce the
stressed state of mind. Meditations of various types, devotional practices (Bhakti yoga) and
introspective self analysis (Jnana yoga) that leads to the state of inner peace and bliss are other
yoga techniques for stress management. The practice of Karma yoga is an essential part of the
practices for modern stressed mind. It helps to work with great efficiency and free oneself from
stresses. The secret of Karma yoga is to change the mind set of ones attitude towards the
purpose of living and action13.
Mudras, there are 108 in number, are regularly practiced by hatha yogis. It is a
combination of asanas and pranayama. Some mudras are excellent for those suffering from
gastric problems. Mudra yoga is the attitude of energy flow. Dr. Valli said that health is in our
hand, seven mudras for amazing health benefits like gyana mudra, prithvi, varuna, vayu, surya,
shunya and prana14.

Page | 5

Mudra is very powerful. If we practice these mudras regularly, we can see the wonderful
health benefits. The wellbeing of a person lies in his/her own hands and it is true when all these
elements are in a balanced state. Our hands have tremendous energy in them and every finger
represents one of the five fundamental elements called the panchabhoothas, namely, prithvi, agni,
vayu, jal and akash. When all elements are in a balanced state, it leads to harmony and a state of
wellbeing, whereas imbalance can lead to disharmony. Mudras improves memory and
concentration, ensure peace of mind, prevent insomnia, correct indigestion problem, reduces all
physical weaknesses and dullness, reduces anxiety, improves immunity, and incites spiritual
feelings. Overall these Mudras reduce the physical and emotional stress15.
A study conducted by McFarlane D on Kirtan Kriya Exercises (KKE) in Amen clinic
Newport Beach 2003 (Kriya refers to set of movements or mudras, a Kirtan is a song). It is a 12
minute singing exercise that the people have been practicing. The meditation involves repetitive
finger movements or mudras plus singing the sounds or mantra. It was hypothysed that KKE
would show that activation of frontal lobe and hypocampus. 11 subjects were brought into test
the hypothesis. The subjects brain physiology was measured before and after KKE by using
SPECT (Single Photon Emission Computed Tomography) Scan shows before KKE there was
dimples in the front of the brain, shows lack of complete blood flow and thalamus not visible.
After KKE, the SPECT scan shows that the dimples had disappeared and increased blood flow
and the thalamus is now visible in the centre of brain. Perhaps a study demonstrates that KKE
may help in memory improvement and sets the emotional tone of mind and emotional bonding16.
Todays world is in need of mental peace and a stress-free life is great. Most of us experience a
feeling of disconnectedness with ones inner self, a feeling of mental restlessness. The
investigator as a student and clinical instructor had opportunity to care the elderly in old age
Page | 6

homes. The investigator found that old age people have some level of stress and they were not
taking any measures to avoid from that, as per the knowledge of investigators no studies done
related to the nursing interventions in reduction of stress among elderly. This motivates the
investigator to do this study.

6.2 REVIEW OF LITERATURE

The extensive review of literature has been done and it is organized according to following
headings:

Section 1; literature related to Stress among elderly residing in old age home
A study was conducted to examine psychological distress in older people receiving home
nursing care at University of Agder, Kristiansand, Norway. A linear regression analysis was
applied in a cross-sectional sample of 214 patients aged 75 years and older. Psychological
distress was measured using the General Health Questionnaire (GHQ). 23 (10.7%) reported
experiencing psychological distress using a cutoff point of 4 or more on a GHQ case score.
Commonly reported risk factors such as sex, household composition and perceived social
support, and objective measures of somatic and mental health and bodily dysfunctions were not
related to psychological distress. Suggested reasons for this are greater acceptance of bodily and
functional shortcomings and of changes related to goal achievement in old age17.
An explorative study was conducted to describe the experiences of stress of 12 older
people from Australian residential aged care facilities at School of Nursing, Midwifery and
Postgraduate Medicine, in Western Australia. A measure of fatigue was assessed from stage one
findings, with reference to the literature. In stage two of the study, the Frail Elder Stress
Assessment Tool was subjected to panel review, piloting, and refinement. The refined tool
Page | 7

comprises 20 items in three subscales: Stress effects; stress resources; and adaptation to stress.
Further work is required to establish the tool's psychometric properties, but it should then be
useful for both research and clinical assessment purposes18.
A study was conducted to compare quality of life among senior citizens living in home
for aged and family set up in Gokulam College of Nursing, Erode district, Salem. Convenience
sampling technique was used to select senior citizens in both home for aged and family set up.
The sample was limited to 50 from home for aged and 50 from senior citizens in the family both
male and female were included. Structured interview schedule was used to collect the data.
Findings revealed that quality of life higher among senior citizens living in family set up than the
senior citizens living in home for aged 19.
A descriptive survey study conducted to assess the emotional problems among elderly
people in a selected old age home at K.G.F. Kolar. A purposive sampling technique was used to
select 50 elderly people as a sample. Socio-demographic data and general health questionnaire
were used as tools. Data was analysed by adopting descriptive and inferential statistics. The
results revealed that 38% of the subjects were suffering with major health problems, 16% of
them were having minor health problems, 46% were healthy and nearly half of the sample 46%
was suffering from emotional problems20.
A study was effectiveness of an exercise interventions designed to improve balance in
older people living in the community or in institutional care at Glasgow Caledonian University,
UK. Databases like Cochrane Bone, Joint and Muscle Trauma Group Specialized Register, the
Cochrane Central Register of controlled Trails , MEDLINE, EMBASE, other databases and lists
of articles were searched randomized controlled trails and quasi randomized trials testing
Page | 8

exercise interventions designed to improve balance in older people were included. 34 studies
with 2883 participants included and were randomized to receive the interventions like: a single
exercise intervention or a multiple exercise intervention and a control group (usual activities or
attention or recreational activity). Three pairs of members of the review team independently
assessed relative risk and confidence intervals. Results revealed statistically significant
improvement in balance ability was observed for exercise interventions compared to usual
activity. Interventions involving gait, balance, co-ordination and functional exercises, muscle
strengthening, and multiple exercise types appear to have the greatest impact on indirect
measures of balance21.
An exploratory study was conducted to assess the physical health and incidence of
limitation in activities of daily living (ADL) of senior citizens residing in selected slum of Pune
city in Dr. D.Y. Patil Collge of Nursing, Pimpri. This study consisted of 100 participants, 69 were
female and 31 were male senior citizens residing in Dalety and Talzai slum area. A structured
interview schedule was prepared for assessing physical health and incidence of limitations in
ADL. This study revealed that, incidence of limitation was faced in ADL such as walking,
climbing stairs, travelling, shopping, and leisure activities22.
A cross sectional study was conducted to assess the prevalence of disability in ADL of
elderly above 60 years of age. Among 326 elderly persons in the area, 312 participated in this
study. The study instruments included a pre-tested interview schedule, sphygmomanometer,
weighing machine and measuring tape. Disability in ADL was assessed by using the Katz index.
Activities of daily living were task of self maintenance, mobility, communication, home
management and living that enable an individual to achieve personal independence. Sociodemographic characteristics like age, marital status, gender, educational status, occupation,
Page | 9

chronic disease and perceived health status were studied and used for analysis. The mean age
was 69.7(+8.1) years. 38 (12.2%) elders were found to be disabled in ADL. Significant
associations were seen between disability in ADL and older age (p<0.001), living without spouse
(p<0.01), being illiterate (p<0.01), being unemployed (p<0.05), presence of chronic diseases
(p<0.01) and perceived health status as not healthy (p<0.001). This study concludes that
identified risk factors need to be addressed in prevention and control strategies23.
Section 11; literature related to Yoga and Mudras on stress reduction among
elderly residing in old age home.
A pilot study was conducted to compare the effects of 2 mind-body interventions:
mindfulness-based stress reduction (MBSR) and cognitive-behavioral stress reduction (CBSR) in
New Mexico. 50 older subjects were recruited from the community and took part in MBSR (n =
36) and CBSR (n = 14) courses. MBSR was an 8-week course using meditation, gentle yoga, and
body scanning exercises to increase mindfulness. CBSR was an 8-week course using cognitive
and behavioral techniques to change thinking and reduce distress. They were observed on 8
variables like Perceived stress, depression, psychological well-being, neuroticism, binge-eating,
energy, pain, and mindfulness were assessed before and after each course. Pre test and post test
scores for each intervention were compared by using paired t tests. This study concludes that
MBSR subjects improved on all eight variables, with all of the differences being significant.
CBSR subjects improved on six of eight variables, with significant improvements on
psychological well-being, perceived stress, depression, neuroticism, binge-eating, and
mindfulness. Multivariate analyses showed that the MBSR subjects had better outcomes across
all variables, when compared with the CBSR subjects24.

Page | 10

An article was published on a structured review of 8 mind-body interventions for older

adults with chronic nonmalignant pain in the following mind-body therapies: bio-feedback,
progressive muscle relaxation, meditation, guided imagery, hypnosis, tai chi, qi gong, and yoga,
at Department of Medicine, Division of General Internal Medicine, University of Pittsburgh,
USA. A manual search of references from retrieved articles was also conducted. Of 381 articles
retrieved through search strategies, 20 trials that included older adults with chronic pain were
reviewed. 14 articles included participants aged 50 years and above, while only 2 of these
focused specifically on persons aged >or=65 years. An additional 6 articles included persons
aged >or=50 years. There is some support for the efficacy of progressive muscle relaxation plus
guided imagery for osteoarthritis pain. In an uncontrolled biofeedback trial that stratified by age
group, both older and younger adults had significant reductions in pain following the
intervention. Tai chi, yoga, hypnosis, and progressive muscle relaxation were significantly
associated with pain reduction in this studies25.
A comparative study was conducted on yoga and relaxation to reduce stress and anxiety.
The study intended to determine if either of the modality reduced the subjects stress, anxiety,
blood pressure, and improved quality of life. The sample comprised of 131 subjects with mild to
moderate level of stress recruited from South Australia. The subjects were given ten weekly 1
hour sessions of relaxation of Hatha yoga. The findings showed that following 10 week
intervention, stress, anxiety and quality of life score improved over time. Yoga was more
effective than relaxation in improving mental health26.
An article was published on sleep can be improved by mindfulness-based stress reduction
(MBSR) in Department of Family Medicine and Community Health, University of Minnesota,
USA. MBSR was reported that pre intervention and post intervention measures of sleep quality
Page | 11

or duration. 38 articles were identified for review. 7 met inclusion criteria. Lack of standardized
outcome measures precluded pooling of results for quantitative data analysis. Sleep report
measures varied (standardized scales, single item, and sleep diaries). 4 studies (all uncontrolled)
found that MBSR significantly improved measures of sleep quality or duration. Controlled
studies have not clearly demonstrated the positive effects of MBSR on sleep quality and
duration. However, there is some evidence to suggest that increased practice of MBSR technique
is associated with improved sleep and the participants experience a decrease in sleep-interfering
cognitive processes (e.g. worry or tension)27.
An article published on understanding the technique of Yoga Mudra or the symbol of
yoga-A survey study in Yoga-Mimamsa. The practice of Mudra has been recognized in
Hathapradipika and Gheranda Samhita as an important means to facilitate ones spiritual pursuit.
However, no detailed description regarding the technique of this practice is available in these
yogic treatises. Modern Yoga experts viz. Swami Kuvalayanada, Swami Sathyananda Saraswati
and B.K.S. Iyengar have described the technique of Yoga Mudra in their literature. It was found
to be an acceptable technique because of its wide application for both therapeutic and spiritual
purposes28.
A pilot study was conducted to assess the feasibility of an 8 session mindfulness
meditation program for community-dwelling older adults with chronic low back pain (CLBP)
and to develop initial estimates of treatment effects at USA. It was designed as a randomized,
controlled clinical trial. Participants were 37 community-dwelling older adults aged 65 years and
older with CLBP of moderate intensity occurring daily or almost every day and an 8-week
mindfulness-based meditation program or to a wait-list control group. 8-week and 3-month
follow-up measures of pain, physical function, and quality of life were assessed. 89 older adults
Page | 12

were screened and 37 found to be eligible and randomized within a 6-month period. They
meditated an average of 4.3 days a week and the average minutes per day was 31.6. Compared to
the control group, the intervention group displayed significant improvement in the Chronic Pain
Acceptance Questionnaire. This study concludes that an 8-week mindfulness-based meditation
program is feasible for older adults with CLBP. The program may lead to improvement in pain
acceptance and physical function29.
A study was conducted to identify the effects of mindfulness meditation on older adults
with chronic low back pain (CLBP) at Department of Medicine, Division of General Internal
Medicine, University of Pittsburgh, Pennsylvania; a qualitative study based on grounded theory
was used. Participants were 27 adults > or = 65 years of age with CLBP of at least moderate
severity and of at least 3 months duration. It was found that several themes reflecting the
beneficial effects of mindfulness meditation on pain, attention, sleep, and achieving well-being.
A number of participants reported improved sleep latency as well as quality of sleep. Participants
described achieving well-being during and after a meditation session that had immediate effect
on mood elevation but also long-term global effect on improved quality of life and nonpharmacologic treatment of chronic pain for older adults. This study concludes that Communitydwelling older adults with chronic low back pain experience numerous benefits from
mindfulness meditation including less pain, improved attention, better sleep, enhanced wellbeing, and improved quality of life30.
A study was conducted on wellness through a comprehensive yogic breathing programme
on 103 older adults from a small university, city of Sweden. The subjects were instructed in a 6day intensive programme of Sudarshan kriya and related practices (SK & P) which they
practiced daily for six weeks. The study found that the participants in SK & P group lowered
Page | 13

their degree of anxiety, depression and stress, and also increased their degree of optimism
(ANOVA; P < 0.001). The participants in yoga experienced the practice as a positive event that
induced beneficial effect. The study suggests that older adult participants may improve their
wellness by learning and applying a programme based on yoga and yogic breathing exercises31.
A study conducted on Influence of Yoga & Ayurveda on self-rated sleep in a geriatric
population, at Swami Vivekananda Yoga Research Foundation, Bangalore, India. Of the 120
residents from a home for the aged, 69 were stratified based on age (5 year intervals) and
randomly allocated to 3 groups i.e., Yoga (physical postures, relaxation techniques, voluntarily
regulated breathing and lectures on yoga philosophy), Ayurveda (a herbal preparation), and Waitlist control (no intervention). The groups were evaluated for self assessment of sleep over a 1
week period at baseline, and after three and 6 months of the respective interventions. This study
revealed that, the Yoga group showed a significant decrease in the time taken to fall asleep
(approximate group average decrease: 10 min, P<0.05), an increase in the total number of hours
slept (approximate group average increase: 60 min, P< 0.05) and in the feeling of being rested in
the morning based on a rating scale (P<0.05) after 6 months. The other groups showed no
significant change. This study concludes that Yoga practice improved different aspects of sleep in
a geriatric population32.

STATEMENT OF THE PROBLEM:

A study to assess the effectiveness of nursing interventional package on reduction of stress
among elderly residing in selected old age home, Bangalore.

6.3 OBJECTIVES

Page | 14

6.3.1 To assess the pre interventional level of stress among elderly residing in selected old age
home, Bangalore.
6.3.2 To assess the post interventional level of stress among elderly residing in selected old age
home, , Bangalore.
6.3.3 To assesses the effectiveness of nursing interventional package on reduction of stress
among elderly residing in selected old age home, Bangalore.
6.3.4

To find out the the mean reduction level of stress among elderly with selected

demographic variables.

6.4 HYPOTHESES
H01: There will not be significant difference between pre interventional and post interventional
levels of stress among elderly residing in selected old age home, Bangalore.

H02: There will not be a significant association between mean reductions in level of stress with
selected demographic variables.

6.5 ASSUMPTIONS

Elderly residing in selected old age home may have some level of stress.
Nursing interventional package may reduce the level of stress among elderly residing in

selected old age home Bangalore.

6.6 OPERATIONAL DEFINITION

Effectiveness: It refers to which nursing interventional package has its impact on stress
reduction among elderly residing in selected old age home Bangalore.

Page | 15

Nursing interventional package: It includes the systematic practice of back massage, yoga
therapy and meditation which will progressively relax the body and mind of an elderly and result

in reduction of stress.
Stress: It refers to the physical and emotional factors which affect the bodily functioning of
elderly.

Elderly: it refers to the older adult in the age group of 65 years and above.

7. MATERIAL AND METHODS

7.1 SOURCES OF DATA
Data will be collected from elderly residing in selected old age home Bangalore.

7.2.1 RESEARCH APPROACH

In the present study Evaluative approach was used

7.2.2 RESEARCH DESIGN

Quasi experimental design was used.

7.2.3 SETTING OF THE STUDY

Selected old age home Bangalore.

7.2.4 VARIABLE
Independent Variable
Level of stress of elderly residing in selected old age home Bangalore.
Independent Variable
Nursing interventional package
Page | 16

7.2.5 POPULATION
The population of present study consists of elderly residing in selected old age home Bangalore.

7.2.6 SAMPLE SIZE

The sample size will be 40

7.2.7 SAMPLING TECHNIQUE

Simple random sampling technique will be used to select the sample.

7.2.8 SAMPLING CRITERIA

INCLUSIVE CRITERIA

Elderly residing in selected old age home Bangalore.

Who can speak, read and write kannada or English.
Elderly age 65 years and above.

EXCLUSION CRITERIA:

Who are critically ill.

Who have dementia, disorientation and other mental illness.

7.2.9 DATA COLLECTION TOOL

Demographic questionnaire to assess the level of stress using standard stress scale.
Structured interview schedule.
Part 1: Demographic data sheet consists of demographic variables.
Part 2: Structured stress scale on level of stress.

7.2.10. DURATION OF THE STUDY

As per university guidelines, that is 4 to 6 weeks

Page | 17

7.2.11 DATA ANALYSIS METHOD

The collected data will be analyzed through descriptive inferential statistics.
Descriptive statistics- it includes mean, frequency, percentage, range, standard
Deviation

to describe demographic variables and knowledge aspects.

Inferential statistics- it includes parametric chi square test, paired; t; test to assess the
Effectiveness of nursing interventional package and to study the association between the
Knowledge scores with selected demographic variables.

7.3

DOES

THE

STUDY

REQUIRE

ANY

INTERVENTIONS

OR

INVESTIGATIONS TO BE CONDUCTED ON PATIENTS OR OTHER

HUMANS OR ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
YES,
7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
YES, Ethical clearance certificate enclosed.

Page | 18

8. LIST OF REFFERENCES
1

Mary JJ. Stress Management for Health Care Personnel. Nightingale Nursing Times. 2009
Feb; 4(11):14.

Sankari N, Sathiyavathy N, Sandanalakshmy N. Anxiety in the Elderly. Nightingale

Nursing Times. 2009 Aug; 5(5):24.

Kavitha AK. A comparative study on quality of life among senior citizens living in home
for the aged and family setup in Erode District. Nightingale Nursing Times. 2007 Jul; 3(4):
47.

Page | 19

Bhuvaneshwari S. Healthy ways to manage stress. Nightingale Nursing Times. 2009 Jun;
5(3): 33-4.

Havalder MN. Many advantages of yoga. A Scientific Philosophical Research in Yoga.

Yoga Publications. 2009 Apr; 5(7): 10-11.

Lamb T. Health Benefits of Yoga. Yoga Mimamsa.2000 Jul; 24(2): 86-93.

Lillypet S. Nightingale Nursing Times. 2006 Oct; 2(7): 24.

Sreevani R. When old becomes a disease. Nightingale Nursing Times.2006 Oct; 2(7): 9-10.

Krishnamurthy R. Needs of elderly. Indian Journal of Community Medicine. 2007 AprJun; 2-3(2):72-6.

10 Devi ES. A descriptive study to assess the stress among elderly who lossed their spouse,
staying in their family. Nightingale Nursing Times. 2007 Jun; 3(3): 5.
11 Soni VS. Stress Escape and Yoga. A Scientific Philosophical Research in Yoga. 2009; 5(3):
26-7.
12 Nagarathna, Raghuram. Stress and Yoga. Health Action.2010 Jan; 8-9.
13 Hirsch G. Mudras- Yoga in Your Hands. 2000.
14 Valli. Health in your hand: Seven Mudras for Amazing Health Benefits. Yoga: the science.
2008 Oct; 4(5): 2.
15 www.alzhemiers prevention.org/research.htm

Page | 20

16 Thygesen E, Saevareid HI, Lindstrom TC, Engedal K. Psychological distress and its
correlates in older-dependent persons living at home. Aging Mental Health. 2009 May;
13(3): 319-27.
17 Toye C, White K, Rooksby K. Fatigue in frail elderly people. Alternative and
Complementory Medicine. 2006 May; 12(5): 202-8.

18 Kavitha AK. A comparative study on quality of life among senior citizens living in home
for aged and family set up. Nightingale Nursing Times. 2007 Jul; 3(4): 47.
19 Sreevani R. Emotional problems among elderly people in selected old age home. The
Nursing Journal of India. 2007 May; Vol XLVIII (5): 29.
20 Howe TE, Rochester L, Jackson A, Banks PM, Blair VA. Exercise for improving balance in
older people. Cochrane Database Systematic Review. 2007 Oct; (4): 17.
21 Selvi RM. An exploratory study to assess the physical health and incidence of limitations in
activities of daily living (ADL) of senior citizens residing in selected slum of Pune city.
Nightingale Nursing Times. 2007 Sep; 3(6): 16.
22 Konjengban S, Singh J. Bimol N, Singh B, Devi EV. Singh YM. Disability in ADL among
the Elderly in an urban area of Manipur. Indian Journal of Physical Medicine &
Rehabilitation. 2007 Oct; 18(2): 41-3.

Page | 21

23 Smith BW, Shelley BM, Dalen J, Wiggins K, Tooley E, Bernard J. A pilot study comparing
the effects of mindfulness-based and cognitive-behavioral stress reduction. The Journal of
Alternative and Complementary Medicine. 2008 Apr; 14 (3): 251-8.
24 Morone NE, Greco CM. Mind-body interventions for chronic pain in older adults: a
structured review. Pain and Medicine. 2007 May-Jun; 8(4): 359-75.
25 Smith C, Hancock H, Blake-Mortimer J, Eckert K. A randomised comparative trial of yoga
and relaxation to reduce stress and anxiety. Complementory and Therapeutic Medicine.
2007 Jun; 15(2): 77-83.
26 Winbush NY, Gross CR, Kreitzer MJ. The effects of mindfulness-based stress reduction on
sleep disturbance: a systematic review. 2007 Nov-Dec; 3(6): 585-91.
27 OAK JP. Understanding the Technique of Yoga Mudra or the Symbol of Yoga- A Survey
Study. Yoga-Mimamsa. 2002 Apr; 34(1): 37-48.
28 Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic
low back pain in older adults: a randomized controlled pilot study. Journal of Pain. 2008
Feb; 134(3): 310-9.

29 Morone NE, Lynch CS, Greco CM, Tindle HA, Weiner DK. "I felt like a new person". The
effects of mindfulness meditation on older adults with chronic pain: qualitative narrative
analysis of diary entries. Journal of Pain. 2008 Sep; 9(9): 841-8.

Page | 22

30 Kjellgren A, Bood SA, Axelsson K, Norlander T, Saatcioglu F. Wellness through a

comprehensive yogic breathing programme a controlled pilot study. Journal of
Complementory and Therapeutic Medicine. 2007 Jun; 15(2): 77-83.
31 Manjunath NK. Telles S. Influence of Yoga & Ayurveda on self-rated sleep in a geriatric
population. Indian Journal of Medical Research. 2005; 121(5): 683-90.

SIGNATURE OF THE STUDENT

REMARKS OF THE GUIDE

: The research topic selected for the

candidate is suitable

Page | 23

NAME AND DESIGNATION OF THE GUIDE

GUIDE NAME AND ADDRESS

: Mrs. Tensy Thomas

Asst. Professor
Psychiatric Nursing
Pragathi College of Nursing
# 33, Byrathi Extn, Near Ebenezer
Hospital, Kothanur Post, Hennur
Bagalur Main Road, Bangalore560077

SIGNATURE OF THE GUIDE

HEAD OF THE DEPARTMENT

Mrs. Tensy Thomas

Asst. Professor

SIGNATURE OF HOD

REMARKS OF THE PRINCIPAL

The research topic selected for the

candidate is appropriate.

SIGNATURE OF THE PRINCIPAL

:
Page | 24

Page | 25