RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE ... · Web viewHowever, children retained...
Transcript of RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE ... · Web viewHowever, children retained...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION1. NAME OF THE CANDIDATE
AND ADDRESS
Mr. S.G.MURALIGOUTHAM COLLEGE OF NURSINGMANJUNATHNAGAR,WEST OF CHORD ROAD, RAJAJINAGAR,BANGALORE-560 010
2. NAME OF THE INSTITUTION GOUTHAM COLLEGE OF NURSING,
MANJUNATHNAGAR,
WEST OF CHORDROAD,RAJAJINAGAR,
BANGALORE – 560 010.
3. COURSE OF STUDY AND
SUBJECT
I YEAR M.Sc. NURSING
PSYCHATRIC NURSING
4. DATE OF ADMISSION TO
COURSE
16.10.2007
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5. TITLE OF THE TOPIC A STUDY TO DETERMINE EFFECTIVENESS OF STRUCTERED
TEACHING PROGRAMME ON PSYCHO
SOCIAL PROBLEM AMONG
ORPHANAGE CHILDREN IN SELECTED
HOMES IN BANGALORE
6. BRIEF RESUME OF THE INTENDED WORK:
6.1. NEED FOR THE STUDY
An orphanage is an institution or asylum for the care of a child bereaved of
both father and mother; sometimes, also, a child who has been one parent living.
The death of one or both parents makes the child of the very poor a word of the
community. The obligation of support is imposed upon parents or grandparents by
nearly every system of laws; but there is no such obligation on any other relative.
Naturally sympathy, however, and willingness to bear a distributed burden for the
common good, rather then to enforce an individual one, contributes to the
acceptance of the care of orphans as a public duty.
Orphans should be placed under the care of public guardians. Men’s should
have a feared for the loneliness of orphans of the souls of their departed parents. A
man should love the unfortunate orphan of whom is guardian as if he were his own
child. He should be as careful and as diligent in the management of the orphan’s
property as of his own or even more careful still.
The first orphanages called Orphanotrophia, were founded in the 1st century
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amid various alternative means of orphan support (Jewish law for instant
prescribed care for the widow and orphan, and Athenian law supported all orphans
of those killed in military service until the age of eighteen). The care of orphans
was particularly commended to bishops and, during the middle ages, to monsistors.
Many orphanages practiced some form of binding-out in which children, as soon
as they were old enough, were given as apprentices to house holds. This would
ensure their support and their learning an occupation. Historically certain birth
parents were often pressured or forced to give up their children to orphanages:
those of children born out of wedlock or into poor families; those with disabilities
or of children born with disabilities; and those with girls born into patriarchal
societies such practices are assumed to be quite rear in the modern western world,
thanks to improved social security and changed social attitudes, but remain in force
in many countries.
The practice of adoption, though long accepted as a social phenomenon, is
only recently gaining popularity in India. Due to the paucity of adequate follow
ups, evaluation of these adopted children is incomplete. The purpose of studying
the well – being of these children offer adoption, they were followed up at the
various places, is orphanages, instititutions, juvenile’s courts and adoption
agencies, responsible for this care. Orphans who lived in a setting where the entire
staff participated in decisions affecting the children, and where the children were
encouraged to become staff members, showed significantly fewer behavioral
symptoms of emotional distress. Orphanages are the only means of survival for was
orphans, a group setting where the staff shares in the responsibilities of child
management, is sensitive to the individuality of the children.
According to WHO there are 150 million orphans world wide. By 2015 there
will be nearly 400 million orphans. In India children (0-17 years) are orphaned due
to all causes, 2005, estimate 25,700,000 unicef India statistics.
“India’s population stands at 1.3 billion among them 5.7 million are children”
1. 25,700,000 Children ages 0-17 years are orphans.
2. In Karnataka 58 orphanage center are present among that Bangalore
having10 centers.1
The problems of orphanages are such as their own large families to care for,
severe economic strains, pathetic situations, grand parents were found to be less
able to provide discipline and adequate socialization, basic needs for food, clothing,
shelter and health care, observed that adopted or fostered children often receive
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worse treatment then the biological children, in the same family and found that the
education, nutrition and health status of children adopted into impoverished
families suffered from lack of resources necessary for their basic need emotional
problems there are several reasons. First there is a lack of adequate information on
the nature and magnitude of the problem, cultural belief that children do not have
emotional problems and lack of attention from adults, psychological problems such
of lack of knowledge of how to handle it appropriately in many cases children are
punished for showing their negative emotions, social problems, lack of group
attention children are grieved by the loss of their parents. Therefore are at risk of
growing up depression anger inattentive in classes and it is feared that many
children may find it difficult to adopt to the new changes, social change may be
shown in like bereavement, to adopt to it create stress and this stress shown in
symptoms of confusion, anxiety, depression and behavior disorders such as
disobedience the same symptoms may cause learning problems children who are
frustrated, fearful and depressed may fail to concentrate in class and therefore
perform badly.2
The orphanage children are social burden for our country, as India is still
developing country and having poor socio-economic status. From above studies it
is seen that orphanage children are having various psychosocial problems in some
aspects. As a result, they can not mix up with the society. The researcher felt that
there are various problems faced by orphanage children. Such as, isolation, guilt,
maladjustment, antisocial behavior, depression and so on. Since the investigator felt
that a study on to determine the effectiveness of STP on psychosocial problem
among orphanage children will help to minimize the psychosocial problems of
orphanage children.
6.2. REVIEW OF LITERATURE: Review of literature is a key step in research process the typical purpose for an
analyzing a reviewing existing literature is to generate research question to identify
what is known research question to identify what is known and what is not about a
topic, the major goal of the review of the literature is to develop a strong
knowledge base to carry out research and non research scholarly activities.
1) Studies related to emotional problem among orphan age children.
Report on a study that aimed to establish the level of emotional problems
among 115 children aged 9-16 years (average 13.4), who were living in two
orphanages in the Gaza Strip. The children's age of admission to the orphanage
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(average 8.8 years) was higher than in traditional orphanages in other countries.
This was related to the reasons for admission, following their father's death, and the
inability of their remaining family to care for them. However, children retained
substantial contact with their family of origin by visiting during school holidays
(88.6%) or being visited at the unit (97.4%). Using previous standardized mental
health measures completed by the children and their main careers, children
demonstrated high rates of anxiety, depressive and post-traumatic stress reactions.
These mental health problems were strongly inter-related but were not found to be
associated with social/care variables. Potential implications of the findings for
orphanages and other residential units in developing countries are discussed. These
should take into consideration the socio-cultural characteristics of each country and
limited local resources; involve non-governmental organizations and local
communities; tackle wider stigmatizing attitudes; and instill a child-centered
philosophy within these settings.3
A study was conducted on emotional reaction social situation Anticipating
and responding to a partner's emotional reactions are key components in the
comprehension of daily social discourse. Kindergarten children with language
impairment (LI) and age-matched controls (CA) were asked to label facial
expressions depicting 1 of 4 emotions (happy, surprised, sad, and mad) and to
identify those expressions when given a verbal label. Children then chose among
these facial expressions when asked to infer emotional reactions from stories (3-
sentence scenarios) presented in 1 of 3 modalities: verbal, visual, and combined.
Although all children were able to identify and label the facial expressions, children
with LI had difficulty integrating emotion knowledge with event context in order to
infer a character's feelings. When these inferencing errors occurred, children in the
LI group were more likely to provide emotions of a different valence (e.g.,
substituting happy for mad) than were children in the CA group. Inferencing ability
was related to language comprehension performance on a standardized test. The
findings suggest that inferencing errors made by children with LI occur during the
early stages of social processing and may contribute to social difficulties often
experienced by this group of children.4
2)Studies related to psychosocial problem among orphanage children
A study related to the psychological effect orphan hood a study of orphans in
Rakai district. This paper examines the psychological effect of orphan hood in a
case study of 193 children in Rakai district of Uganda. Studies on orphaned
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children are not examined the psychological impact. Adopted parents and schools
have not provided the emotional support these children often need. Most adopted
parent’s lack of information on the problem unable to offer emotional support; and
school teachers do not know how to identify psychological and social problems.
Teachers need to be retrained in diagnosing social problems and given skills to deal
with them.2
A study was conducted to assess whether the structure of the parental
background (birth, restructured, widowed, and single) or the context (severe social
disadvantage or care) in childhood is associated with psychological problems in
adolescence and adulthood. Data collected on 8,441 cohort members of the
National Child Development Study were used to explore the impact of parental
background on maladjustment at age 16, as assessed by the Rutter. A Health and
Behavior Checklist, and psychological distress at age 33, as assessed by the
Malaise Inventory. The result showed restructured parenting (without disadvantage
or care) was not a risk factor for maladjustment at age 16. Rather, a childhood
experience of care or social disadvantage was significantly related to psychosocial
problems at age 16. Psychological distress at age 33 was associated with
maladjustment at age 16. A childhood experience of care was associated with a
tendency to adult psychological distress in men, as was growing up with a single
parent.5
Forty-one orphans whose fathers and/or mothers had died from AIDS, and
were living in the poor suburbs of Dar Es Salaam, Tanzania, were compared with
41 matched non-orphans from the same neighborhoods. The subjects were given an
arithmetic test and a semi-structured questionnaire concerning any internalizing
problems, their attendance at school and their experiences of punishment, reward
and hunger. The scale of internalizing problems comprised 21 items adapted from
the Rand Mental Health and Beck Depression Inventories concerning mood,
pessimism, somatic symptoms, and sense of failure, anxiety, positive affect and
emotional ties. Most orphans lived with aunts and uncles. Compared with non-
orphans, they were significantly less likely to be in school but those who did attend
school had similar arithmetic scores. Significantly more orphans went to bed
hungry. Orphans had markedly increased internalizing problems compared with
non-orphans and 34% reported they had contemplated suicide in the past year.
Multiple regression analysis indicated that the independent predictors of
internalizing problem scores were sex (females higher than males), going to bed
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hungry, no reward for good behavior, not currently attending school, as well as
being an orphan. The orphans not only had unmet basic needs, but also had
markedly increased internalizing problems, thus their long-term mental health
would be in jeopardy. There is an urgent need to expand and improve current
intervention programmes not only to meet the basic needs but also to include
psychosocial support, counseling services for the orphans, and training for their
careers and teachers.6
3) Studies related to problem of institutionalization of orphanage children.
A study Conducted on the orphans of Eritrea ; are orphanages part of the
problem or past of the solution, this study compared the mental health and
cognitive development of 9 to 12 yrs old Eritrean war orphans living in two
orphanages that differed qualitatively in patterns of staff interaction and styles of
child care man age nest method the directors and several child care workers at each
institution were asked to complete staff organization and child management
questionnaires, the psychological state of 40 orphans at each institution was
evaluated by comparing this behavioral symptoms and performance on cognitive
measures results : orphans affecting the children, and where the children were
encouraged to become self-reliant through personal inter actions with staff
members, showed significantly fewer behavioral symptoms of emotional distress
than orphans who lived in a setting where the director made decisions, daily
routines were determined by explicit rules and schedules, and interactions between
staff members and the children were impersonal.7
A study conducted on attachment and indiscriminately friendly behavior
were assessed in children who had spent at least 8 months in a Romanian
orphanage (Ro) and two comparison groups of children ;a Canadian– born, non
adopted, never institutionalized comparison group (KB) and an early adopted
comparison group adopted from Romania before the age of 4 months (EA),
attachment was assessed using 2 measures : an attachment security questionnaire
based on parent on parent report and a separation Reunion procedure that was
coded using the procedure that was coded using the preschool assessment at
Attachment. Indiscriminately behavior was examined using parent’s responses to 5
questions about this children’s behavior with new adults. Although Ro children’s
did not score differently from either CB or EA children on the attachment security
measure based on parent report, they did display significantly more insecure
attachment patterns than did children in the other 2 groups, In addition, Ro
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children displayed significantly more indiscriminately friendly behavior than both
CB &EA children, who did not direr in terms of indiscriminate friendliness Ro
children insecure attachment patterns were not associated with any aspect of this
institution environment, but were related to particular child and family
characteristics, specifically, insecure Ro children had more behavior problems
scored lower on the Stanford. Binet Intelligence scale, and had parents who
reported significantly more parenting stress than Ro children classified as secure.8
A study conducted on impact of institutionalization on child development
during the past 10 yrs Romanian orphanages have had the opportunity to revisit
developmental questions regarding the impact of curly deprivation are examined by
reviewing both the early and more recent literature on studies of children who spent
the 1st few years of life in institutions special attention is given to the Canadian
study of Romania’s adoptee. Findings across time and studies are consistent in
showing the negative impact of institutionalization on all aspects of children’s
development (intellectual, physical, behavioral, & social emotional) the impact of
institutionalization is greatest when coupled c risk factors in the post institutional
environment.9
4) Studies related to intellectual problem of orphanage children.
Children at the Jimma community orphanage between the ages of 5 and 14
years were given a battery of tests to assess their intellectual, social, and nutritional
well-being relative to a group of family-reared controls. On two tests of intellectual
ability, the Ravens Progressive Matrices and the Conservation test, the orphanage
children performed as well as the family children. Children who entered the
orphanage at an early age scored higher than those who entered later. On social-
emotional measures of self-esteem, the orphanage children scored higher than or
similar to the controls. However, in terms of their relationships with adults, the
orphanage children reported fewer interactions and weaker attachments to adults.
This was largely determined by the higher child: adult ratio in the orphanage than
in family homes. Also, the orphanage children were more likely to be stunted but
not more likely to be wasted than the family children. The former was attributed to
the malnutrition experienced by children before they entered the orphanage, which
in many cases was during the 1984 famine. Stunting was associated with lower
Ravens scores. The generally favorable status of the orphanage children can largely
be attributed to the no institutional orphanage rather than to their preorphanage
family life. This raises disturbing questions about family life under conditions of
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economic stress.10
A study was undertaken to assess the health, nutrition and psychosocial
profile of Institutionalized children in four States--Uttar Pradesh, Andhra Pradesh,
Karnataka and West Bengal. A sample of 3,822 children from 70 institutions in 6-
18 years age group formed the subjects of the study. It was observed that the
destitute children were mainly taken care of in three types of institutions, viz;
Voluntary, Government Aided and Government run institutions. Calorie deficiency
and deficiency of Vitamins and minerals characterized the diets of these children.
In general, there was no deficit of protein in their diets. Growth wise, these children
were retarded both in height and weight compared to standards. However, they
fared better in comparison to their age and sex counterparts in the rural and urban
poor. Psychosocial profile of these children indicated that the prevailing
environment in the institutions is less conducive for intellectual stimulation but not
so for the development of skills of self-help, locomotion, socialization and
imagery.11
6.3. STATEMENT OF THE PROBLEM
A study to determine effectiveness of structured teaching programme on
psycho-social problem among orphanage children in selected homes in Bangalore.
6.4. OBJECTIVES OF THE STUDY:
1. To assess the psycho social problem among orphanage children.
2. To assess the effectiveness of STP among orphanage children.
3. To find association between psychosocial problem demographic
Variable.
6.5. OPERATIONAL DEFINITIONS:
1. Assess: - Measurement of Knowledge of orphanage children to minimize
the psychosocial problems on pretest and posttest.
2. Effectiveness :-Refers to significant gain in knowledge as determined by
significant change is free and post test scores
3. Structured teaching programme – Refers to systematically prepared
teaching programme for orphanage children to impart then knowledge using
relevant teaching methods and a.v. aids which provides information
regarding psychosocial problems.
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4. Psycho-social:-It refers to the mental and social environment of an
Individual
5. Orphan :-A child who has lost both parents, though death or less
Commonly, are parent.
6. Orphanage :- As institution for the housing and care of orphan
6.6. HYPOTHESES:
H1-re will be significant difference in the post test and pre test scores
of psychosocial problems of orphanage children.
6.7. ASSUMPTIONS:
It is assumed that:
1.Care givers of orphanage children will be willing to express
psychosocial cope up with psychosocial problems.
2. Subjects will be able to cope up with psychosocial problems.
6.8. DELIMITATIONS:
1. The study is delimited to orphanage children who are attending selected
orphanage.
2. Orphanage children who have available during the period of study.
3. Study if delimited 6-12 years only
Student who can understand read and write Kannada.
6.9. PROJECTED OUTCOME:
1. The study will help to find out psychosocial problems
STP will help cope up the psychosocial problem of orphanage children.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA Orphanage children in selected orphanage
homes Bangalore.
7.2 METHOD OF COLLECTION OF DATA
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7.2.1. SAMPLING CRITERIA
INCLUSION CRITERIA
1. Orphanage children age of 6-12 yrs.
2. Those willing to participate in the
study.
3. Those who can read and understand
Kannada.
4. Those orphanage children present
during the study.
EXCLUSION CRITERIA 1. Those who are absent in part counseling
study.
2. Those who are absent during the study.
7.2.2. RESEARCH DESIGN Pre-experimental design (one group pre test-
post design).
7.2.3 VARIABLES UNDER STUDY:
1. INDEPENDENT VARIABLE
2. DEPENDENT VARIABLE
3. DEMOGRAPHIC
VARIABLE
Structured teaching programme
Knowledge of orphanage children.
Age, socioeconomic status and education.
7.2.4. SETTING Study will be conducted in the selected
orphanage home.
7.2.5. SAMPLING TECHNIQUE Study will be conducted in the selected
orphanage home
7.2.6. SAMPLE SIZE 40 Orphanage children
7.2.7. TOOL OF RESEARCH Socio demographic question are will be used
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to collect data.
Structured questionnaire will be developed
by researcher to assess psychosocial
problem.
7.2.8. COLLECTION OF DATA A prior formal permission will be obtained
from orphanage home. Informal permission
will be obtained from the subjects after
explaining the purpose of study. A structured
questionnaire will be administer to assess the
demographic data and pre test knowledge
related to psychosocial problems of
orphanage A structured teaching
programme will be given to orphanage
children . Post-test conducted after 7 days.
Duration of data collection will be 30 days.
7.2.9. METHOD OF DATA
ANALYSIS AND
PRESENTATION
1. Descriptive and inferential statistics
will be used for data analysis.
2. The analyzed data will be presented
in the form of tables, diagrams and
graphs.
3. Paired‘t’ test will be used to test
significance difference in the
knowledge score between pre test
and post test knowledge scores.
4. Chi-square(χ2) test to determine the
Association between demographic
variables
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
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Yes, the study requires administration of structured questionnaire and
administration of STP to the children in selected orphanage home, Bangalore.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
Yes, informed consent will be obtained from the institution authorities and
subjects. Privacy, confidentiality and anonymity will be guarded. Scientific
objectivity of the study will be maintained with honesty and impartiality.
8. LIST OF REFERENCES:
1. My orphanage.Wikipedia the free encyclopedia. 2007 Sep.Available from URL:
http://www.google.com.
2. Sengendo J, Nambi J.The psychological effect of orphan hood:a study of orphans
in Rakai district. Health transition review 1997;7:105-124.
3. Thabet, Lamia, Thabat M, Aziz A, Hussein A, Sajida. Mental health problems
among orphanage children in the Gaza strip. Adaptation and fostering journal
2007;31(7):54-62.
4. Ford JA, Milosky LM. Inferring emotional reactions in social situation,
differences in children with language impairment. J speech Lang Hear Res 2003
Feb;46(1):21-30.
5. Buchanan A, Ten Brinke J, Flouri E. Parental background, social disadvantage,
public “care,” and psychological problems in adolescence and adulthood. J Am
Acad Chid Adolesc Psychiatry 2000 Nov;39(11):1415-23.
6. Makame V, Ani C, Grantham-McGregor S. Psychological wellbeing of orphans
in Dar El Salaam, Tanzania. Acta Paediatr 2002;91(4):459-65.
7.Wolff PH, Fesseha G. The orphans of Eritrea:are orphanages part of problem or
part of solution. Am J Psychiatry 1998 Oct;155(10):1307-8.
8. Chisholm K. A three year follow up attachment and indiscriminate friendliness
in children adopted Romanian orphanages. Child Dev 1998 Aug;69(4):1092-106.
9. Maclean K. The impact of institutionalization on child development. Dev
Psychopathal 2003;15(4):853-84.
10. Aboud F, Samuel M, Hadera A, Addus A. Intellectual, social and nutritional
status of children in an Ethiopian orphanage McGill University, Montreal, Canada
Soc Sci Med. 1991;33(11):1275-80.
11.Sarma KV, Vazir S, Rao DH, Sastry JG, Rao NP. Nutrition, health and
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psychosocial profile of institutionalized children Indian pediatr. 1991 jul;
28(7):767-78.
12. Webster’s Encyclopedic unabridged Dictionary of the English language
Newyork: Granercy books;1996.p.1017.
13. Basavanthappa BT. Nursing Research.1sted. New Delhi: Jaypee brothers
medical publisher; 1998.p.109-112.
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