RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME AND ADDRESS Ms.VEDHA POOMANI MARY PUSHPAM.V OF THE CANDIDATE I YEAR M.Sc NURSING SRI 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 1 Year M.Sc nursing Psychiatric nursing

3. COURSE OF STUDY AND SUBJECT

DATE OF ADMISSION 4. TO THE COURSE

5. TITLE OF THE STUDY A study to determine the effectiveness of pranayama on stress among 1st year nursing students in a selected nursing college at Bangalore.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION The sad truth is that excellence makes people nervous 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 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.1 In addition, stress leads to psychological morbidity which may have profound adverse consequences for individual nursing students. Nursing students 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.2 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. Students often perform procedures that can cause serious harm to their patients and fear of making a mistake. They use highly technical 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 students 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.3

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.4 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 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.5
6.2 NEED FOR THE STUDY It is obvious that stress is present among nursing students . Excessive stress can be harmful to student's academic performance. Additionally, students who perceive their stress levels as very high often will become depressed.6

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 selfdevelopment.7
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.8 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.9

Dr.Young studied the reduction of stress among nursing students in Victoria University. He conducted stress reduction programme. 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.10 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.11 Nursing students suffer from stress due to long hours of study, multiple assignments, lack of free time, lack of timely feedback and lack of faculty response to student needs.12 Parshad O. Published the Role of yoga in stress management. 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 become more resilient to stressful conditions and reduce a variety of important risk factors for various diseases, especially cardio-respiratory diseases.13

Lindop identified conflict between the ideal and real clinical practice was also a source of stress. He also found that time management problems, when trying to complete nursing tasks, added to a students perception of stress.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.16
STATEMENT OF THE PROBLEM

A study to determine the effectiveness of pranayama on stress among 1st year Nursing students in a selected Nursing college, Bangalore.
OBJECTIVES To assess the level of stress among Nursing students. To determine the effectiveness of pranayama on stress, among Nursing Students

 To associate the level of stress among 1st year Nursing students with their selected demographic variables.
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 the differences between pre test and post test stress scores.
Pranayama

Pranayama is the art of harmonizing breathing. It has the capacity of freeing the mind from stress.
Stress

Stress is defined as a constant state in which one is subject to physical or mental pressure, tension, or strain.
1st year nursing students Students who are doing their 1st year B.Sc Nursing programme. 6.6 ASSUMPTIONS:

Well being of the Nursing students is ensured by the reduction of stress. All the Nursing students will have some level of stress. Pranayama can help to reduce the level of stress.
6.7 HYPOTHESES

H1 : There will be a significant difference in the level of stress among the Nursing students, before and after the practice of pranayama. H2 : There will be a significant association between the post test levels of stress with selected demographic variables.

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 were male and 121were female at entry. The study shown that, the students suffered greater levels of psychological morbidity and burnout. 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. 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.

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 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. Firstly academic stress factors. The second and third components concern relationships, the former involving teachingrelated staff, and the latter involving the clinical experience. The last two components suggest that finance and death of patients are independent sources of stress. 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. 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%). 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. A study was conducted to know the effectiveness of pranayama on stress, by mikkyo Gardens, 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. A comparative study has been done to analyze the effects of Progressive Muscle Relaxation (PMR) and breathing exercises among students. Forty-two students were divided randomly into two groups and taught PMR or breathing exercises. Both groups practiced for five weeks and were given the Smith Relaxation States Inventory before and after each session. As hypothesized, PMR practitioners displayed greater increments in relaxation states (R-States), Physical Relaxation and disengagement, while breathing practitioners displayed higher levels of R-State Strength and Awareness. Slight differences emerged at weeks 1 and 2; major differences emerged at weeks 4 and 5. A delayed and potentially reinforcing after effect emerged for PMR only after five weeks of training increased levels of Mental Quiet and Joy. 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. 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 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.6 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) 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. 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 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. 7 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. 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.12

7.0 MATERIALS AND METHODS

7.1 SOURCES OF DATA Data will be collected from 1 st year B.sc nursing students in selected colleges 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, fathers education, mothers education, fathers occupation, mothers occupation, performance in previous school experience, hobbies, siblings, type of family. Study variables

Independent variables Pranayama

Dependent Variable: Level of stress among 1st year nursing students iii.Setting The study will be conducted in selected college at Bangalore.

Vi. Population The study population comprises of the 1st year B.Sc Nursing students v.Sample All the first year 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 first year. Nursing students who are willing to participate in the study. Exclusion criteria Nursing students who are suffering from any other illness. Nursing students who are already in practice of pranayama vii.Sampling technique Sampling technique adopted for selection is random sampling technique.

viii. Tools for data collection

The structured interview scheduled consist of following section 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 investigater demonstrate pranayama.After the regular practice of pranayama,the 4th week the stress level has been assessed. Duration of study: 4 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. xi. Projected outcomes Afer 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 demonstrate 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.Goel B.S. Psycho-Analysis and Meditation (1st edition). New Delhi: Paragon Enterprises, 1986, 304-309. 2.Janaki S.S Sanskrit and science (1st edition). Chennai: Vignesha printers, 1997, pp133- 136. 3.Miss Lonsri Wongchai Mental Health and Psychiatric Nursing (1st edition). Chiang: Mai University, 199
4.Sarma K.Lakshman Practical Nature- cure (7th edition). Pudukkottai: The Nature Cure Publishing house, 1945, pp-2-277.

5.Suma Varughese et al .www.lifepositive.com. Mind psychology-stress at work Google.com.

6.Townsend. C Essentials of Psychiatric Mental Health Nursing (1st edition).Canada: F.A.Davis Company, 1991, p-711.8, pp-779-799

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11.Hamill, C. (2000). The phenomena of stress as perceived by project 2000 student nurses: A case study. Journal of advanced nursing, 21, pp-528-536. 12.Lindop, E. (1999). Individual stress and its relationship to terminating nurse training. Nurse Education Today, 11, PP-110-120. 13.Matsumoto, Smith JC. (2001) compared the psychological effects of progressive muscle relaxation (PMR) and breathing exercises. Journal of Clinical Psychology Volume 60 Issue 1, Pages 131 136. 14.Mikkiyo gardens (2007), The science of pranayama, October 20, 4 comments, pp-45- 56. 15.Naiemeh Seyedfatemi, Maryam Tafreshi and Hamid agani (2007) Experienced stressors and coping strategies among Iranian nursing students BMC Nursing articles Nov 13, pp 75- 86. 16. Nirmal (1998), A Comparative co relational study to assess the psychosocial stress to assess and coping patterns with certain demographic variables and nursing students, Nursing Journal of India, Vol XXXXX, No.8, p-170. 17.Parshad, O. (2004) Role of Yoga in wellness & management of life-style diseases. 18th SRC Annual National Conference on Science and Technology, Nov. 23 -26, Knutsford CourtHotel, New Kingston. 18.Watson, R., Deary, I., Thompson, D. and Li, G. (2008) A study of stress and burnout in nursing students in Hong Kong: A questionnaire survey. International Journal of Nursing Studies, 45 (10). pp. 1534-1542. ISSN 0020-7489 19.K.Consolo,S.Fuoner,S.Staib Effects of breathing exercise on stress level of nursing students.Teachingand learning in nursing,Volume 3.Issue 2, page 67-7120. 12.. 20. 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. 21. 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; 22. Chattha R. Treating the Climacteric Symptoms in Indian Women with an Integrated Approach to Yoga therapy. Menopause New York NY. Sep 2008; 15(5): 862-70. 23.Mostafa Amr Assessing the stress level among Mansoura nursing students.

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