ABSTRACT OF PLAN OF THESIS

A pre-experimental study to assess the

TITLE effectiveness of guided meditation technique on
stress reduction among elderly people residing in
selected old age homes of Tricity.
Master of Science in Mental Health (Psychiatric)
FOR THE DEGREE Nursing
Ms. Ruchi
NAME OF THE M.Sc. Nursing 1st year
CANDIDATE. Mental Health (Psychiatric) Nursing
Mrs. Sonia Sharma
GUIDE HOD
Mental Health (Psychiatric) Nursing Department
Mrs. Daljeet Kaur
CO-GUIDE Assistant Professor
Mental Health (Psychiatric) Nursing Department
Mata Sahib Kaur College Of Nursing
INSTITUTE Mohali,Punjab

UNIVERSITY Baba Farid University Of Health Sciences

Faridkot Punjab.

The objective of the study is to assess the effectiveness of guided meditation

technique on stress reduction among elderly people residing in selected old age homes
of Tricity. This is a pre-experimental study that will be conducted on 100 elderly
people residing in selected old age homes of Tricity, who will fulfill the inclusion
criteria. Conclusion and discussion will be made according to the findings of the study
and comparing results of present study with the previous studies.

SYNOPSIS

1
STATEMENT OF A pre-experimental study to assess the effectiveness
PROBLEM
of guided meditation technique on stress reduction
among elderly people residing in selected old age
homes of Tricity

GUIDE Mrs. Sonia Sharma

HOD
Mental Health (Psychiatric) Nursing Department

CO-GUIDE Mrs. Daljeet Kaur

Assistant Professor
Mental Health (Psychiatric) Nursing Department

SUBMITTED BY Ms. Ruchi

M.Sc. Nursing 1st year
Mental Health (Psychiatric) Nursing

Name and Address of College-Mata Sahib Kaur College of Nursing

Mohali(Chandigarh Kharar Highway)

Name of the candidate Ruchi

2
Department Mental Health (Psychiatric) Nursing
Department
Title A pre-experimental study to assess the
effectiveness of guided meditation
technique on stress reduction among
elderly people residing in selected old
age homes of Tricity .
Examination M.Sc. Nursing 1st year
Date of admission 13-10-2018
In which research committee has the Mata Sahib Kaur College of Nursing
plan of thesis been presented and Mohali
approved
Professor/Head of Department Mrs. Sonia Sharma
Supervisor Mrs. Sonia Sharma
Co-Supervisor Mrs. Daljeet Kaur

MEMBERS OF THE Name Signature

RESEARCH AND ETHICAL
COMMITTEE
Head of the Institute/College Dr. Rajinder Kaur
Dhadda
Principal, Mata Sahib Kaur College of Dr. Rajinder Kaur
Nursing, Mohali. Dhadda
Vice-Principal, Mata Sahib Kaur Mrs. Shivani Sharma
College of Nursing, Mohali.
H.O.D-Community Health Nursing Mrs. Heera Mani

H.O.D-Obstetrics and Gynaecology Mrs. Shivani Sharma

Nursing
H.O.D-Medical Surgical Nursing Mrs. Rashmi Choudhary

H.O.D- Child Health Nursing Mrs. Kh. Nita Kumari

H.O.D- Mental Health Nursing Mrs. Sonia Sharma

Faculty Members Mrs. Rashmi Choudhary

Mrs. Neha Kapoor
INTRODUCTION

BACKGROUND

3
“ God Will Never Give You Anything Which You Can Not Handle , So Do Not
Stress”
- Kelly clarkson

Human development is the process of growth and changes that takes place between
birth and maturity. There are stages of human development which include infancy,
childhood, adolescence, adulthood and old age. Ageing is an inevitable developmental
phenomenon bringing along a number of changes in the physical, hormonal and social
condition. This continues throughout life through childhood and adolescence into
adulthood. Mental health is important at every stage of human life.1

Mental health is defined as the level of psychological well-being or an absence of

mental illness. It is the state of someone who is functioning at a satisfactory level of
emotional and behavioural adjustment. The WHO states that the well being of an
individual is encompassed in the realization of their abilities, coping with normal
stresses of life, productivity work and contribution to their community2

Stress is a person’s response to physiological or biological stressor. Stress is a body’s

method of reacting to a challenge such as a threat, challenges or physical and
psychological barrier. According to the stressful event, the body’s way to respond to
stress is by sympathetic nervous system activating which results in the fight-or-fight
response. The autonomic nervous system and hypothalamic-pituitary-adrenal axis are
two major system that respond to stress. Stress typically describe a negative condition
or a positive condition that can have an impact on a person’s mental and physical
wellbeing.3

Small amount of stress may be desired and even healthy. Positive stress helps improve
athletic performance. Selye’s explained his stress model based on physiology and
psychobiology, as the General Adaptation Syndrome. There are mainly three stages of
General Adaptation Syndromes, one is alarm stage, second is resistance stage and
third is exhaustion stage. He proposed that there are four variation of stress, good
stress and bad stress, overstress and under stress.4

Aging is the process of becoming older. In humans, aging represents the accumulation
of changes in human being over time, those changes are physical, psychological and

4
social. Nobody can escape from the aging. Ageing is among the greatest known risk
factors for most human disease.5

There have been many transformation in recent years that have had an impact on
society in different sectors- societal, financial and personal. Life style have changed
some for the better and some with negative consequences. However, the senior
citizens, referred to as elders, face certain problems as a consequences of the social
transformation. One of these involves old age homes, because of these old age homes
and also the absence of family, this situation cause health related and psychological
problems in old age people.6

At any stage, stress is apart of life. Young and old alike have to face difficult situation
and overcome obstacles. As people reach old age, wound heal more slowly and colds
become harder to shake. Successful agers tend have a few things in common. They
stay connected to friends and family, they exercise and find way to reduce and
manage stress. Emotional stress is more subtle, but if chronic, the eventual
consequences can be as harmful. Overtime, the brain can slowly lose its skill at
regulating hormone level. As a result older people who feel worried or anxious tend to
produce large amount of stress hormones, and alarm does not shut down as quickly.
Several studies have found that high cortisol goes hand in hand with poor memory so
we might be able to chalk up certain senior moments to stress.7

Meditation has become one of the most popular ways to relief stress among people of
all walks of life. Meditation can be a quick- fix reliever to help you reverse your
body’s stress response and physically relax. It can also be a part of your daily routine
and help you build resilience to stress. Also it can be a technique you use to get
centered when you are thrown off by emotional stress. Meditation leaves you feeling
better, refreshed, and ready to face the challenges of your day with a healthy attitude.
Regular practice for weeks or months, you can experience even greater benefits.
Meditation affect the body in exactly the opposite ways that stress does-by triggering
the body’s relaxation response. It restores the body to calm state, helping the body
repair itself and preventing new damage from the physical affect of stress. It can calm
your mind and body by quieting the stress –induced thought that keep your body’s
stress response triggered.8

5
Meditation is a simple and fast way to reduce stress. Meditation can wipe away the
day’s stress, bringing with it inner peace. Spending even a few minutes in meditation
can restore your calm and inner peace. Anyone can practice meditation. It’s simple
and inexpensive, and it does not require any special equipment. Meditation is
considered a type of mind body complementary medicine. Meditation can produce a
deep state of relaxation and tranquil mind. During meditation, you focus your
attention and eliminate the stream of jumble thought that may be crowding your mind
and causing stress. This process may result in enhanced physical and emotional well
being. In guided meditation person forms mental image of peace or situation you find
relaxing.9

Guided meditation is a process by which one or more participants meditate in

response to the guidance provided by a trained practitioner or teacher, either in person
or via a written text, sound recording, video, or audiovisual media
comprising music or verbal instruction, or a combination of both. It is a practice
where an individual uses a technique- such as mindfulness or focusing their mind on a
particular object, through or activity, to train attention and awareness, and achieve a
mentally clear and emotionally calm and stable state. Meditation may be used with the
aim of reducing stress, anxiety, depression and pain and increasing peace, perception
self concept and wellbeing. Guided Meditation has been practiced since antiquity in
numerous religious tradition and beliefs.10

As a society, we have become very conscious about how important it is to have a fit,
healthy body – the gym are full. Through mindfulness meditation practice our mind
can become more capable, focused and clear, enabling us to better handle stressful
and damaging situation. This is how meditation for stress reduction enables us to
experience a calmer life. Mindfulness meditation is also a good baseline practice for
stress prevention so that when adverse situations occur we do not let them get out of
control. Meditation gives us the space to sort out which demands on our energy,
attention, and emotional are valid and which are not. We experience relief when
meditation gives us the space in our mind and in our lives.11

NEED OF THE STUDY

Aging is the normal process of the related changes, which begins with birth and
continues throughout the life. Old age is the final phase of the life span. Ayurveda

6
termed old age as “Vardhakya” which begins from the age 60. In old age, the need
for economic, health and emotional wellbeing assume special significance because of
gradual reduction in abilities. In year 2014 old age population was 236/10,000 in the
world. In 2016, almost 500 million people worldwide is 65 and older. By 2030 it is
estimated that total is projected to increase by one billion, accounting 13% of the total
population. In India old age population contributes 1/20 in the total population. In the
year 2002 there were more than 81 million elderly in Indian and this figure is
expected to go up over 324 million in the year 2050. According to parliament
discussion India’s population of senior citizen above 60 would reaches 173 million by
2026.12

According to report of United Nations Population Fund 2017: India has around 100
million elderly at present and number is expected to increase 20% in 2050. The
factors which are responsible is more related with increase in life expectancy and
decline in number of children being given birth to in a year. So, elderly citizen are in
need for urgent attention. Population above 60 years will be double in size between
2001 and 2026, the elders will account for 12.17% of overall population in 2030.12

A news report by the Ministry for Statistics and Program Implementation, Bharat
has 103.9 million elderly, people above long time 60, about 8.5 percent of the
universe. These numbers are reliant on the 2011 census. The elderly universe has
grown at about 3.5 per cent per year, double the rate for the universe as a whole; a
2014 report by the non-profit Help Age Bharat shows that while India will be the
youngest body politic in the world by 2020, by 2050, as many as 325 million people,
or 20 per centime of the population, will be 'elderly'. While the overall population of
India will have grown by about 40 per cent between 2006 and 2050, the report adds,
the elderly population will have grown by 270 per cent.12

Major reason for old persons to hitch old age house is to fulfill basic wants (50%) and
negligence rejection by relations (40%) psychological stress among them is high. So,
Stress among the maturity home residents is high. Recent individuals usually have
restricted regenerative talents and additional at risk of un-wellness, syndromes,
injuries, and illness than younger adults. The old additionally face alternative social
issue around retirement, loneliness , and aging.13

7
Stress becomes big a part of the health care environment. Whereas several ancient
stress management techniques is also effective. Guided meditation may be a present
development and it helps North American nation be of perceive and address reality
plays a very important role in stress management and it should be recognized and
inspired. Meditation may be a observe of orientating your mind, body and spirit by
going deep among to access the facility of your belief to make what you actually
want. Guided imagination medical aid or image is another therapy that's non-invasive,
drug free, can be practiced simply to ease chronic stress, speed the healing method.14

Guided meditation is a practice of aligning your mind, body and spirit by going deep
within access the power of your brief to create what you truly desire. They are
researched and proven approaches that have lasting benefits for radiant health,
happiness and self- empowerment. Meditation shows down brain wave activity and
subdue stress. Meditation helps calm the adrenal allow them to rest, relieving them
from over producing stress hormone.15

Though a lot of researcher had made efforts to gain an insight of stress and its
reduction. The researcher had many opportunities to interact with the elderly people
during clinical posting and realized that they were very stressed. Various remedies are
available for stress reduction among them the effective one is Guided meditation
technique as it make people happier and more committed, as well as improve their
interpersonal skills. Since researcher belongs to post graduate in Psychiatric nursing
interested to provide Guided meditation technique to elderly people after gaining skill
in the therapy and also felt that this therapy can be practiced after simple instruction.
Researcher also believe that if the stress of elderly people are addressed adequately it
may prevent the ill effects of stress related health problems. So the researcher felt, the
study will help old age people to avoid stress and to prevent such complication in later
period of time.

PROBLEM STATEMENT
A pre-experimental study to assess the effectiveness of guided meditation technique
on stress reduction among elderly people residing in selected old age homes of
Tricity.

8
 AIM OF THE STUDY
The main aim of the study is to assess the effectiveness of guided meditation
technique on stress reduction among elderly people residing in selected old age homes
of Tricity.
OBJECTIVES
1. To assess the pre-test level of stress among elderly people residing in selected old
age homes of Tricity.
2. To conduct sessions of guided meditation technique among elderly people
residing in selected old age homes of Tricity.
3. To assess the post-test level of stress among elderly people residing in selected old
age homes of Tricity.
4. To assess the effectiveness of guided meditation technique among elderly people
residing in selected old age homes of Tricity.
5. To find the association between post-test score with selected socio-demographic
variables.
HYPOTHESIS
H1: There will be a significant difference between pre-test and post-test level of
stress scores among elderly people residing in selected old age homes of Tricity.
H2: There will be significant association between post-test stress scores with selected
socio demographic variables.

DELIMITATIONS
The study is delimited to:
1. selected old age homes of Tricity.
2. elderly people in the age group of 50-70 years.

OPERATIONAL DEFINITIONS

Effectiveness: Effectiveness refers to the extent to which guided meditation technique

achieves outcome on stress reduction among elderly people residing in old age homes.

9
Guided Meditation: guided meditation refers to a therapeutic process that will lead
to deep relaxation and serves as a change towards positive outcome in old age people
residing in old age homes.

Stress: Stress refers to an uncomfortable emotional experience of elderly people

residing in old age homes.

Elderly people: Elderly people refers to all elderlies from 50-70 years of age group
residing in old age homes.

Old Age Homes: It refers to the social welfare organizations which takes care of
elderly people.

Tricity: Tricity refers to 3 cities namely Chandigarh, Mohali and Panchkula.

REVIEW OF LITERATURE

The chapter deal with a review of literature related to topic. This helps to gain insight
into various aspect of problem selected for the study. Review of literature plays an
important role in development of research project. An extensive review of literature

10
provides the investigator a deeper review into the problem. Extensive review of
literature has been included from published or unpublished articles, books, documents
and reports. It has an indirect relevance to the present study

Othman N, Ahmad F, Ratvo P, Morr C. 2019 conducted a cross sectional survey in

Toronto, Canada to assess the perceived impact of contextual determinants on
depression, anxiety and stress. The study was done on a sample of 148 students
among which 37 are males and 111 are females. The data was collected using
questionnaire. A total of 148 students completed the questionnaire with an age range
of 19-60 years. Overall 39.5% reported symptoms of moderate to severe depression,
23% reported moderate to severe anxiety and 80% reported moderate severe level of
perceived stress, with no significant differences between males and females. This can
be concluded that there is strong to moderate impact of several determinants on
depression, anxiety, and stress. The results suggest a need to address a variety of
factors affecting students mental health.16

Iliyas I, Dilwar T, Ahmad DS. 2018 conducted a cross-sectional study in District

Srinagar to assess the level of stress and coping among retirees. The study was done
on 100 retirees. The data was collected by using of semi-structured questionnaire, and
standardized stress inventories. The results showed that maximum numbers of retired
employees 18% had mild level of stress, 40% had moderate level of stress, 3% had
severe level of stress, 4% had extremely severe level of stress when measured on
standardized scale. This can be conclude that the perceived level of stress was
moderate among retired employees and retirees used average level of coping
strategies to deal with the retirement stress. There is need for organized family and
social support for improving physical and psychological health of retirees.17

Alphonsa KK, Jaleel AA, Vijayaraghavan R, Kumar SS. 2018 conducted a study
to assess the effectiveness of meditation therapy on psychological variable among the
elderly in old age homes. The study was done on 20 elderly in the age group of 60-80
years of both genders. Meditation therapy was given for an hour each in the morning
and evening for 4 months successively. Data was collected by using Depression
Anxiety Stress Scale. The result showed that psychological problem assessment
questionnaire score were significant in post test (p<0.001) and indicating that

11
depression anxiety and stress were reduced both in males and females as well. So it is
concluded from the findings of the study, that alternative therapies are greatly useful
in geriatric care and it could be recommended for the psychological health and well-
being of the elderly.18

Nageswaran K, Ray S. 2016 conducted a survey in Pune. The aim of the study was
to assess the perceived stress among elderly people residing in old age homes. The
study was conducted on 200 subjects who met sampling criteria. Result showed that
48.5% of samples had slightly higher than average level of perceived stress, 58.5% of
samples had moderate level of stress. This can be concluded that perceived stress was
high among people of old age homes.19

Moradi Z, Mohammadi M, Taovsi P. 2015 conducted a descriptive cross analysis in

Kermanshah, Iran. The goal of the research was to assess the stress factors among the
elderly people living in nursing homes. The study was done on 150 elderly men and
women aged 60-74 years. The data was collected by using standard questionnaire. A
total of 100 questionnaires were filled in and data was analyzed. The results revealed
that the dimension of the physiological problems has highest average and variance of
5.36 ± 21.02 and disappointment, home empty and disability and independence,
relationship problems. This can be concluded that the greater number of elderly live
with the family in Kermanshah and have sufficient support, recommended that the
government planned to reduce isolation and increase the social support for the group
of elderly nursing.20

Mani G, Udayakumar S, Annamalai K, Ramasamy J. 2014 conducted a cross

sectional study in Tamil Nadu on elderly people, aged 60 years and above residing in
old age home in Kanchi Puram District of Tamil Nadu. The aim of the study is to
assess the perceived level of stress and its correlates among residents of old age home.
The study was conducted on 100 residents aged above 60 years. The data was
collected by using of semi-structured questionnaire . The level of stress among elderly
were assessed by using perceived stress scale . Result showed that nearly 18% of the
participants had high stress score and 60% had moderate stress score. This can be
concluded that the perceived stress was high among people of old age homes. There is
a need for organized family and social support to improve the physical and

12
psychological health of elderly .21

Bag J, Sanyal D, Daniel LT, Chakrabarti A. 2014 conducted a descriptive survey

to assess the subjective well-being of elderly people living at old age homes in India.
Data was collected from 50 elderly people who were selected by total enumeration
sampling from 2 different old age homes in Kolkata. They were assessed by using
subjective well-being inventory and a self developed checklist for perceived physical
health problems. Cognitive functions was assessed by using Mini Mental State
Examination. Result showed that more than half (52%) of elderly people have
reported high subjective well-being status. Regression analysis showed that perceived
physical health problem (p< 0.001) and having children (P=0.010) were statistically
significant predictors of subjective well being. It is concluded that in order to improve
the quality of life of elderly people health workers should give more emphasis on
psychosocial aspect of the population.22

Zhang M, Dong X, Simon MA. 2014 conducted a descriptive study in Chicago. The
aim of the study was to assess the prevalence of perceived stress among U.S Chinese
older adults. The study as conducted on 3,159 subjects who met the sampling criteria.
Chinese perceived stress scale (PSS) was used to assess the degree to which life
situations are perceived as stressful among Chinese older adults. The Chinese PSS -10
consists of ten items, each of them assessing how unpredictable, uncontrollable, and
overloaded respondents felt in their lives. The scores of all items were then summed
total score ranged from 1 to 40 with higher scores indicating greater psychological
stress. Result shows that on a scale of 0-40 the participants aged 80 years and above
are likely to perceive higher level of stress. This can be concluded that approximately
one third of participants experienced higher level of stress.23

Singh Y, Sharma R, Talwar A. 2012 conducted a study in New Delhi, India. The
aim of the study was to assess the immediate and long term effects of meditation on
acute stress, cognitive functions and intelligence. The participants were 34 healthy
male. To study the effect of meditation on stress level, intelligence and cognitive
functions participants meditated for 1 month for 15 minutes after playing a computer
game to induce stress. As a result induced stress from the computer games resulted in
a significant increase in stress and heart rate. Long term meditation brought

13
significant improvement IQ whereas participants stress level decreases. This can be
concluded that practice of meditation reduces psychological stress response ad
improve cognitive functions with a practice of meditation for a longer duration.24

Sreevani R. 2007 conducted a descriptive study on emotional problem among elderly

people in selected old age homes. The participants were 50 elderly people. Purposive
sampling technique was used for selecting samples. The data was collected by using
of semi-structured questionnaire. Data was analyzed by adopting descriptive and
inferential statistics. The results revealed that 38% of subjects suffering from major
health problems 16% of them were having minor health problems and nearly half of
the sample 46% was suffering from emotional problems.25

METHODOLOGY

RESEARCH APPROACH - Quantitative approach.

14
RESEARCH DESIGN - Pre -experimental research design (one group pre test – post
test design).

POPULATION- Population includes elderly people residing in selected old age

homes of Tricity, who fulfills the inclusion criteria.

SAMPLE - 50-70 years of elderly people residing in selected old age homes of
Tricity.

SAMPLE SIZE - 100 elderly people.

SAMPLING TECHNIQUE- Convenient ( Non- Probability) sampling technique.

SETTING - Study will be conducted in selected old age homes of Tricity.

VARIABLE UNDER STUDY

INDEPENDENT VARIABLE: Guided meditation technique.

DEPENDENT VARIABLE: Stress

INCLUSION CRITERIA/EXCLUSION CRITERIA

INCLUSION CRITERIA

The study include elderly people who will be:

1. both males and females

2. In age group of 50-70 years
3. available at the time of data collection.
4. able to speak and understand Hindi or English.
5. willing to participate in the study.

EXCLUSION CRITERIA

The study exclude elderly people who will be:

1. ill during the period of data collection.

15
2. having some severe memory disturbances and hearing deficits.

RESEARCH TOOL

Modified Depression Anxiety Stress Scale will be used to assess the level of stresss
among elderly people

CONTENT VALIDITY

The content validity of the tool will be determined by expert’s opinion on the
relevance of the items.

PILOT STUDY
The pilot study will be conducted on 10% of sample with similar characteristics of
main study to find out the feasibility of the study and tool. The pilot study will be
conducted among 10 elderly people residing in selected old age homes of Tricity

RELIABILITY OF THE TOOL

It will be estimated by Split-half method with Karl Pearson’s Coefficient of
correlation formula.

ETHICAL CONSIDERATION
 Formal written permission will be obtained from the ethical committee of Mata
Sahib Kaur College of Nursing to conduct the research study.
 Formal written permission will be obtained from the Director of the old age
homes of Tricity.
 Written consent will be obtained from the samples after explaining the purpose
and need to the client

PLAN FOR DATA ANALYSIS

The data will be collected, organized, tabulated and analyzed by descriptive and
inferential statistics.

DISCUSSION

It will be based on the statistical, current trends and previous related research.

PLAN OF DATA COLLECTION

100 Elderly people (50-70 years) will be selected by using non probability convenient
sampling technique.
16
 Assess the pre -test level of stress score by using Depression Anxiety Stress Scale among
elderly people residing in selected old age homes of Tricity.

Assess the post -test level of stress score by using Depression Anxiety Stress Scale among
elderly people residing in selected old age homes of Tricity.

Conduct sessions of guided meditation technique for 15 minutes upto 7 days after taking
certification.

Data will be collected, organized, tabulated and analyzed by the descriptive and
inferential statistics

17
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