BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

NOUFAL P.I.1ST YEAR M.SC. (NURSING)PSYCHIATRIC NURSING

YEAR 2009-2011

CAUVERY COLLEGE OF NURSING # 42 / 2B, 2C, TERESIAN COLLEGE

SIDDARTHA LAYOUTMYSORE.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA, BANGALORE

ANNEXURE-IIPROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION1. NAME AND ADDRESS OF THE

CANDIDATEMR. NOUFAL P.I.

Ist YEAR M.SC. NURSINGCAUVERY COLLEGE OF NURSING#42 / 2B,2C,TERESIAN COLLEGE,SIDDARTHA LAYOUT, MYSORE.

2. NAME OF THE INSTITUTION CAUVERY COLLEGE OF NURSINGMYSORE.

3. COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSING,PSYCHIATRIC NURSING

4. DATE OF ADMISSION TOTHE COURSE 15-06-2009

5. TITLE OF THE TOPICEFFECTIVENESS OF PSYCHO- EDUCATION PROGRAMME ON COMMON PSYCHIATRIC EMERGENCIES IN TERM OF GAIN IN KNOWLEDGE AMONG FINAL YEAR B.SC.NURSING STUDENTS IN SELECTED NURSING COLLEGES AT MYSORE.

5.1 STATEMENT OF THE PROBLEM

A STUDY TO EVALUATE THE EFFECTIVENESS OF PSYCHO- EDUCATION PROGRAMME ON COMMON PSYCHIATRIC EMERGENCIES IN TERM OF GAIN IN KNOWLEDGE AMONG FINAL YEAR B.SC.NURSING STUDENTS IN SELECTED NURSING COLLEGES AT MYSORE.

6. BRIEF RESUME OF THE INTENTED STUDY: -

2

6.1 INTRODUCTION

“A desire to be in charge of our own lives a need for control, is born in each of us .It

is essential to our mental health, and our success, that we take control.”

( Robert F.Bennet).

In the whole world, psychiatric care is usually regarded as something to be avoided

although so much progress has been seen in the field of psychiatry such as

improvement in psychotropic drugs, variety of psychotherapies; the public perceives

psychiatry as dealing largely with mental illness rather than with life problem. Mental

illness is maladjustment in living. It produces disharmony in a person’s ability to

comfortably or effectively meet human needs and function with in a culture. In other

words mentally unhealthy person losses his ability to respond according to

expectations he has him self and the demand, the society has for him.

An emergency is defined as an unforeseen combination of circumstances which calls

for an immediate action. A medical emergency is defined as a condition which

endangers life or cause great suffering to the individual patient .A psychiatric

emergency is a disturbance in thought mood and or action which causes sudden

distress to the individual and or sudden disability, thus requesting immediate

management. (Wikipedia.org)

Psychiatric emergency contact through the world generally involve,

The presence of an urgent situation defying usual pattern of coping.

The failure of ones social network to circumscribe or to ameliorate the crisis.

Convenient access to the emergency service.

These contacts can be conceived of as complex interaction between the person and

his /her environment which generally fall into the two categories.

3

1. They are life threatening emergencies – involving violence of self/or other or a

detoriated pattern of functioning giving rise to an imminent concern for his/her self-

protection and wellbeing

2. They are crisis resulting from life transitions, traumatic experiences,

maturational /developmental stages, psycho pathological decompensations, existential

despair and routine problems in daily living. (Brisk and

Bassuk 1984)

The word suicide was first used by Sir Thomas Browne1642 in his religion media,

suicide is now being recognized as a major public health problem in the complex

scenario of development and life style changes and suicide is a very important issue

attending across diverse disciplines and sectors such as health, religion, spirituality

low and welfare. Suicide is the act of killing one self intentionally performed by the

person with the full knowledge or expectation of the fatal outcome. Suicide is an

important issue in the Indian context.10th September world suicide prevention day .It

is formally announced on 10th semptember2003. The theme for the year 2009 is

“Suicide prevention in different culture”.

(Rubenstein 2002 and IJP 2007)

Stupor and catatonia is defined as a state of diminished consciousness in which the

patient remains mute and still although the eyes remain open and may follows

external objects; catatonia is one of the few psychiatric disorders that have true

objectives signs on examination. It consists of cluster of motor signs and behavioral

disturbances.

Violence: “If we had taken vision and feeling of all ordinary life, it would be likely

earning the grass grows and the squirrels’ heart beat, and we would die of that roar

which lies on the other side of the silence”.

4

Psychiatric nurses, with their biopsychosocial and spiritual approach, are the ideal

professionals to teach a variety of health subjects. Psycho educational groups are set

up to teach about psychological subjects, they also embers to communicate about

emotional concerns. These groups may be time limited or may be supportive for long

term treatment generally written hand outs or audiovisual aids are uses to focus on

specific teaching points.

6.2 NEED FOR THE STUDY

Today’s world is a complex one. Suicide is a leading cause of death world wide and

one of the three leading cause of death for young people under 25. Every year

approximately one million people die by suicide-one death every 2 minutes. The

WHO estimate that by the year 2020 the annual toll of suicide death will have risen to

one and a half million and suicide will represent 2.4% of the global burden of disease.

Indians are bombarded with various stresses. This has a deleterious effect in the mind

of an individual .Psychiatric journal states that suicide is an important issue in the

Indian context more than one lakh lives are lost every year to suicide in our country.

National suicide rate is 11 per 1, 00,000 population. For males the age group of 30 to

44, the suicide rate is a whopping 508 per 100,000 persons, for women it is 220.The

fact that 71% of suicide in India are by persons below 44 years impose a huge social,

emotional and economic burden on our society. In India every 5 minutes a person

commits suicide and attempt to kill himself .South India records around 50,000

suicide deaths per year. (IASP, www.rediff.com 2008)

17 out of every 1, 00,000 persons commit suicide in Bangalore. The suicide rate is at

12 per lakh in Mumbai and in Chennai it is 11 per lakhs and 10 per lakhs in New

Delhi. Majority of attempted suicide were among the young (20-29 age groups) more

among male (53%) than female (47%) and from poor middle class and nuclear

families.

5

Prevalent rate of catatonia has been recorded between 6% and 38% for acute

psychiatric episode and only about 7% to 17% of those patients meet criteria for

catatonia schizophrenia.

10% to 69% of women report being physically aroused by an intimate male partner at

some point in this life. Women globally and in India live in a social environment

where violence is an immediate reality over riding socio demographic differences of

cultural back ground, class, education, and acceptation and so on. From 17 to 21 years

are the peak age of violent offenders, in the U.K. half of all violent offences occur

either in or near or public house. Violent and aggressive behaviors are highly

prevalent among chronically hospitalized psychiatric patients, of these patients who

were in the New York state hospital system for longer than one month, 7 % were

assaulted at least once within three month period.

The investigator their own experience in the field of nursing, found that many

nursing students having lack of knowledge regarding common psychiatric

emergencies. Thus the investigator felt that structured teaching programme will

enhance the students to refine their interview technique and learns how to deal with

common ailments (suicide, stupor and catatonic syndrome and aggression and violent

behavior) with which they need to be familiar, further these future practitioners need

the skills to appropriately assess risk for suicide as they will be on the front lines

seeing patients at risk. In addition to the 4th year nursing students clerkships in

psychiatry provides an important place and time to recruit future residents in the field

any measures that could improve students skill or increase their enthusiasm for the

specialty would be useful to academic psychiatry.

6

6.3 STATEMENT OF THE PROBLEM

A study to evaluate the effectiveness of psycho education programme on common

psychiatric emergencies in term of gain in knowledge among final year Bsc. Nursing

students in selected nursing colleges at Mysore.

6.4 OBJECTIVES

To assess the knowledge regarding common psychiatric emergencies

among final year Bsc Nursing students.

To evaluate the effectiveness of psycho education programme on

common psychiatric emergencies among final year B.sc Nursing

students.

To determine the association between the knowledge of common

psychiatric emergencies among final year B.sc Nursing students with the

selected demographic variables such as age, sex, locality etc.

6.5 RESEARCH HYPOTHESIS

H1: The mean post test will be significantly higher than the mean pre-test

score regarding knowledge on common psychiatric emergencies among final year

B, sc nursing students.

H2: There will be a significant association between the knowledge on common

psychiatric emergencies and selected demographic variables such as age, sex ,

locality etc..

6.6 ASSUMPTIONSThe study assumed that:

Successful psycho education programme helps the final year Bsc.Nursing

students to care of patients with psychiatric emergencies.

Information provided by the nursing student’s after the psycho education

programme reflect their knowledge on common psychiatric emergencies.

7

Nurses can play a major role in taking care of patients with psychiatric

emergencies.

6.7 OPERATIONAL DEFINITIONS

Effectiveness:

It is the outcome of the teaching programme that has been identified in term of

gain in knowledge regarding common psychiatric emergencies.

Psycho- education Programme:

It refers to well planned instructional programme on different psychiatric

emergencies such as suicide, stupor, catatonia and violence.

Knowledge:

The word knowledge denotes that the facts on a psychiatric emergencies and it

includes suicide stupor, catatonia and violence. It will be measured by knowledge

questionnaire.

Psychiatric Emergencies

It is a condition where in the patient has the disturbance of thought, affect and

psychomotor activity leading to a threat to his existence or threat to the people in the

environment. It includes suicide, stupor, catatonia and violence.

Final Year Nursing Students:

They are both male and female students who are undergoing Bsc nursing 4 years

degree course in selected institutions affiliated to RGUHS.

6.8 CONCEPTUAL FRAMEWORK

The study is based on KENNYS OPEN SYSTEM model.

6.9 DELIMITATIONS

The study is delimited to the nursing students who are doing their

B.sc. nursing final year degree programme.

The data collection period is limited to 6 week only.

8

6.10 REVIEW OF LITERATURE

Review of literature is an important step in the development of any research

project. It helps the investigator to analyze what is known about the topic and

describe method of inquiry used in earlier world including their success and

shortcomings. It gives a broad understanding of the problem, keeping those aspects in

mind the investigator probed into available resource of document ,information’s and

studies related to knowledge on common psychiatric emergencies among 4th year B.sc

nursing students.

The literature relevant for their study was reviewed and has been organized in the

following sequence.

Studies related to common psychiatric emergencies and mental illness

among students

Studies related to suicide

Studies related to stupor and catatonic syndrome

Studies related to violence

Studies related on psycho education programme

Studies related to common psychiatric emergencies and mental

illness among students.

A study conducted on medical students in emergency psychiatry. In this

students were randomly selected. Five independent study cases were given to

University of Michigan third year medical students during their psychiatric clerkship,

and their performance on a pre and post test knowledge of emergency psychiatry

management was compared between students who did and did not use the

independent study cases. All of the students improved in their knowledge of

emergency psychiatric management, but the students who completed the cases had

significantly better performance on the post rotation quiz. Case based independent

9

study is an effective method to improve exposure to emergency psychiatry cases

during a third year medical student clerkship.

A study conducted on qualitative outcome analysis project on a clinical

teaching guide for psychiatric mental health nursing. Students were randomly

selected. This paper describes a study evaluating the impact of journal keeping on

student nurses attitude toward psychiatric client and self awareness in relation with

other third year nursing students completing a psychiatric rotation kept journals

which were used to reflect on thoughts and feelings engendered by their clinical

experience. Two students control groups were used one completing a psychiatric

rotation without keeping journals and the second completing a medical surgical

rotation. All students completed the opinions about mental illness, the Fundamental

interpersonal relations, orientation behavior and comfort in working with psychiatric

clients scales prior to and ant the end of their clinical experience. Findings support the

use of journals to assist students in exploring and changing their attitudes but not

necessarily in changing their interpersonal style.

Studies Related to Suicide

Skarb.T, et.al (2006) conducted a retrospective study on alcohol problems

mental disorder and mental health among suicide attempters 5-9 years after treatment

by child and adolescent outpatient psychiatry. Samples are collected by convenient

random sampling. In this 100 patient were personally interviewed 5-9 years of

treatment referral about alcohol problems and mental disorder. Also, they completed

questionnaire about 11 indicator of mental health. At the follow - up that who has

attempted suicide during the follow- up period had more alcohol problems and mental

disorder than the non- attempters . However no association was found between

suicide attempt in the follow up period and the mental health indicators. Among the

attempters a high psycho-social burden as indicated by mental health disorders and

poor mental health were associated with suicide and in intensive to die.

10

Conwell Y (2000) conducted a comparative study on self destructive acts

that occur in older people are more lethal. Samples were randomly selected. This

greatest lethality is function of several factors including reduced physical resistance

(greater physical illness burden), greater social isolation, diminished likelihood of

rescue and a greater determination to die. 55.81% were males in the study groups

described by Ponnudurai et, al (1986) and62% by Latha et.al (1996), Ghulam et.al

(2004) had analyzed the characteristics of 83 cases of which 45 were male and 38

were female ratio being 1:8:1.

Studies related stupor and catatonic syndrome

Tan UR et.al (2006) conducted a descriptive study on treatment of catatonic

stupor with combination of modified electroconvulsive treatment and olanzapine;

Samples were selected by purposive random sampling .The 20year old man getting

treatment for chronic and refractory catatonic stupor. This patient, with a pre existing

diagnose of autism, posturing, non verbal communication, akinesia was diagnosed as

with catatonic stupor. After hospitalization, the disease had progressed despite the

treatment with a typical antipsychotic drug, olanzapine .Modified together with

olanzapine caused a dramatic clinical improvement follow-up out patient;traeatment

with olanzapine improved his social functions.

Suzuki K et.al (2006) conducted an experimental study on epileptic

seizures superimposed on catatonic stupor. Samples were selected by convenient

random sampling .In these 3 cases of epileptic seizures super imposed on psychiatric

catatonic stupor with out a prominent predisposing factor including high fever of

encephalitis. None of the patients had a personal (or) family history of neurologics

disease including epilepsy. In all three patients, catatonic stupor persisted after

resolution of the epileptic seizures with administration of phenytoin, in two of three

patients, catatonic stupor resolved with electro convulsive therapy, which caused no

marked adverse effects. ECT deserves consideration when catatonic stupor persists

after resolution of epileptic seizures.

11

Studies Related to Violence

Nitschke –Jansseen M.et.al. (2006) conducted a retrospective study on

factors contributing to the use of seclusion and restraint. This study intended to

investigate clinic and patient related factors which contribute to increasing and

intensified incidents of seclusion and restraints. All incidents of coercive measures in

a Swiss clinic during the year 2002 and 2003 were evaluated retrospectively. Data

included detailed information about each coercive incident as well as patients and

personnel involved. Regarding clinic related factors fairly different handling could be

found comparing different wards. Besides the psychopathological aspects of the

patients and structural characteristics of the clinic different understanding of disease

management, the nature of the therapeutic relations and environmental factors

contribute to frequency. A detailed evaluation of the use of coercive intervention can

help to prevent unnecessary and incriminatory violence.

Lincoln TM et.al (2006) conducted a comparative study on patients in

forensic and general psychiatry. Samples were randomly selected. Do risk assessment

measures detect differing risk of future violence? In this 50 patients were recruited

from a forensic hospital and 29 from general psychiatric hospital. In the weeks

preceding discharge, structured assessments of the future risk of violent behavior

were completed using the HCR-20. There was little difference in the risk presented

and elevated risk of widened because on historical factors, while the risk among

patients from general psychiatry was due to clinical symptoms. Some criminal

offence could be prevented if more time and effort were spent in general psychiatric

practice in identifying patients at high risk for violence and in reducing symptoms of

psychosis before discharge.

Studies Related to Psycho-Education Programme

Agara AJ,Onibi OE (2007) conducted a intervention study on the effects

of groups psycho education (GPE) on compliance with scheduled clinic appointments

in neuron- psychiatric hospital in southwest hospital in Nigeria; a randomized control

12

trail(RCT). The study population consisted of 48 admitted patients for psychiatric

disorders, including schizophrenia and depression 25 patients admitted were

randomly selected to undergo 4 sessions of GPE before discharge from hospital and

23 patients. Patients in the treatment group were consistently met compliance with

scheduled clinic appointments than those in the experiments groups (p =0.0009 DF =

34;t =test at 95% CI) there was also no significant difference in compliance with visit

among patients with different diagnosis[treatment groups ,p =0.90, DF = 12, EG ; p =

0.33,DF = 11] GPE is effective in improving patients compliance with scheduled

clinic appointments after discharge of a period of 9 months.

Ders-yan Han, et.al. (2006) conducted a study on effects of psycho

education for depression on help-seeking willingness: Biological attribution versus

destigmatization. 299 college students were randomly assigned to biological

destigmatization, combined, and control groups. Result showed that biological

education had significant main effect to elevate help- seeking willingness, but

destigmatization education did not. In addition, no interaction effect existed between

the two independent variables. The authors suggested that biological education makes

people legitimize depression as a disease entity, so that it would be a practical

approach to increase people’s motivation to solve their emotional afflictions,

especially in societies that emphasize emotional constraints. In contrast although

destigmatization information reduce peoples negative appraisals to the depressed

individuals, it does go a step further to increase peoples motivation to seek

professional he. Further studies are needed to clarify the mechanisms of educational

effects.

7 MATERIALS AND METHOD OF STUDY

7.1 SIGNIFICANT OF THE STUDY

The study implies the importance of increasing knowledge regarding psychiatric

emergencies and evaluating the effectiveness of psycho education programme on

psychiatric emergencies among final year Bsc nursing students.

13

7.2 SOURCE OF DATA

The data will be collected from the final year B.sc. Nursing students.

7.3 RESEARCH DESIGN

Quasi experimental one-group pretest-post test design.

Group Pre-test Treatment Post-test

Experimental O1 X O2

Keys:

O1 = Pre test knowledge regarding common psychiatric emergencies.

X = Application of Psycho education programme on common psychiatric

emergencies.

O2 = Post test knowledge regarding common psychiatric emergencies after the

psycho education programme.

7.4 METHODS OF DATA COLLECTION

Data collection is planned through using a structured questionnaire on their

knowledge regarding psychiatric emergencies.

Part A: Demographic variables include age, sex , locality etc.

Part B: Structured questionnaire on knowledge regarding psychiatric emergencies.

Part C: Psycho education programme on common psychiatric emergencies.

7.5 SAMPLING PROCEDURE

7.5.1 CRITERIA FOR SAMPLE SELECTION

Inclusive criteria

Nursing students both male and female

Nursing students who are doing their final year B.sc. nursing degree programme

14

Students who are between the age group 19-27 years.

Exclusive criteria

Nursing students who are doing I,II,III year B.sc. nursing

Nursing students who are not wiling to participate

Nursing students who are doing Diploma in Nursing programme.

7.5.2 POPULATION

The target population selected for this is Final year B.sc. Nursing students.

7.5.3 SAMPLES

Final year B.sc. nursing students those who fulfill the inclusive and exclusive

criteria.

7.5.4 SAMPLE SIZE

Sample consists of 60 B.Sc. Nursing students who are doing their Final year

Degree programme in selected Nursing colleges.

7.55 SAMPLING TECHNIQUE

Simple random sampling technique will be used

7.56 SETTINGS

The setting selected for the study is selected Nursing colleges at Mysore.

7.57 PILOT STUDY

10 percent of the population size is planned for the pilot study.

7.6 VARIABLESIndependent variables:

Psycho education programme on common psychiatric emergencies.

Dependent variables:

Knowledge on common psychiatric emergencies

15

7.7 PLAN FOR DATA ANALYSIS

Descriptive Statistics:

Demographic variable, effectiveness will be analyzed using frequency,

percentage, mean and standard deviation.

Inferential Statistics:

- Pre and Post test difference will be analyzed by paired t- test within the group.

- Demographic variables and post level of effectiveness will be analyzed using

Chi-Square test.

7.8 PROJECTED OUTCOME :

The study will enable to identify the knowledge on common psychiatric

emergencies among IV year B.sc. Nursing students.

The findings of the study will help the students to give proper management in

case of patients with psychiatric emergencies especially during their future

carrier.

The study will help to create awareness among IV year B.Sc. Nursing students

regarding common psychiatric emergencies.

7.9 ETHICAL CONSIDERATIONEthical clearance will be obtained from the institutions/authorities concerned

to the particular settings and also from ethical committee.

16

8 REFERENCE:1. Gail. W. Stuart. Michele T. Lararia (2005). Principles and practice of

Psychiatric Nursing. 7th Edition. Mosbi Publications.

2. Harold. Benjamin (2000). Concise Text Book of Clinical Psychiatry. 1 st

Edition. Lippincot.

3. Sreevani R (2004). A Guide to Mental Health and Psychiatric Nursing. 1st

Edition. Jaypee Publications.

4. Neeraj Ahuja 2002). Text Book of Psychiatry. 5th Edition. Jb Publications.

5. Bimla Kapoor (2004). Text Book of Psychiatric Nursing.1st Edition. Kumar

Publishing House.

6. Kaplan and Sadock (1998). Synopsis of Psychiatry. 1st Edition. Waverly

Private Limited.

7. Lalitha K (1995). Mental Health and Psychiatric Nursing.gajanas Book

Publishers.

8. Ruth Parmelee. Rawlins Sophronia R Williams (1993). Mental health and

Psychiatric Nursing. 3rd Edition. Mosby’s Publications.

9. Laura D Hirshbein (2001). Emergency Psychiatry American Journal of

Psychiatry 26(2).18-21.

10. Skarb.T, et.al.. (2006). Alcohol problems, Mental disorder and Mental among

Suicide attempters. Nord Journal of Psychiatry 60(5) :351-8.

11. Conwell Y (2000) the catatonic dilemma expanded. Annual Genetic

Psychiatry 5:11.

12. Suzuki K. et/al (2006) Catatonic Stupor. Programme Neuropsychiatry

Pharmacology Biology of Psychiatry 30(6): 1170-81.

13. Tan UR et.al (2006). Treatment of Catatonic Stupor. Clinical Neuro

pharmacology 29(3) 154-6.

14. Winship G (2006). Further thoughts on process of Restraints. Journal of

Psychiatry Mental Health Nurses. 13(1) 55-60.

17

15. Hepburn K et.al (2007). Psycho-education Programme. Journal of

Gerontological Neuro-science 33(3): 30-6.

16. Hummel.p.et. al (2000). Suicide attempt by Male and Female. Psychiatric

Prax 27(1):14-8.

NETT REFERENCE:

www.pubmed.com

www.currentpsychiatry.com

www.medicalnustoday.com

www.rediff.com/news

www.violence.risk.com

www.iasp.info/wspd.com

www.en.wikipedia.org/wiki/Emergency_Psychiatry.

18

9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

THE GUIDE (IN BLOCK LETTERS)

11.1 GUIDE

11.2 SIGNATURE

11.3 CO-GUIDE (IF ANY)

11.4 SIGNATURE

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12.REMARKS OF THE CHAIRMAN

AND PRINCIPAL

12.1 SIGNATURE

19

20