A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
By
ELIZABETH JEBAKANI. C
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING APRIL - 2011
A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
ELIZABETH JEBAKANI .C By
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING APRIL - 2011
INTERNAL EXAMINER EXTERNAL EXAMINER
CERTIFICATE
Certified that this is the bonafide work of Mrs. Elizabeth Jebakani.C of K.G.
College of Nursing, Coimbatore, submitted in partial fulfillment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M.G.R Medical University under the Registration No: 30096442.
MRS.VAIJAYANTHI MOHANDAS, PROF.(MRS.) SONIA DAS,
Director of Education, Principal,
K.G.College of Health Sciences, K.G College of Nursing,
Coimbatore. Coimbatore.
A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
Approved by the Dissertation Committee on: 09-04-2010 ___________________________
Prof. (Mrs.) TAMILSELVI. , Head of the department,
Psychiatry Nursing, K.G.College of Nursing, K.G.Hospital,
Coimbatore- 641018.
___________________________
Dr.(Mrs.) V. PONNI MURALIDHARAN. , Psychiatrist,
K.G.Hospital,
Coimbatore- 641018.
___________________________
Prof. (Mr.) K.SUBRAMANIAN. , Biostatistics and Research,
K.G.College of Nursing, K.G.Hospital,
Coimbatore- 641018.
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai, in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING APRIL - 2011
ACKNOWLEDGEMENT
“I can do all things through him who strengthens me”
(Philippians 4:13)
I praise and thank the Almighty for the opportunity he gave me and the blessings bestowed on me throughout the course of my study.
The essence of all beautiful art, all great art, is gratitude. Gratitude can never be expressed in words but this is only deep perception, which makes the words to flow from ones inner heart
My heartfelt thanks to Padmashri. Dr. G. BAKTHAVATHSALAM,
Chairman, K.G. Hospital, Coimbatore, for giving me an opportunity to carry out this study successful.
“Changes are not made in this world until somebody brings them out”. I express my sincere, respectful and whole hearted gratitude to Mrs.VAIJAYANTHI MOHANDAS, Director of Education, K.G.College of Health Sciences, for her constant support, encouragement and guidance in all my endeavours.It is my great honor and privilege to have completed this study under her guidance.
“Greater achievements come from experiences and they stand as key to successes”. It is my privilege to express my sincere gratitude and heartfelt thanks to Prof. (Mrs.) SONIA DAS, Principal, K.G .College of Nursing for her encouragement, support and constant guidance to pursue this study.
My heartfelt thanks to Prof. (Ms.) RAJI. K, Vice-Principal, K.G College of Nursing for her support during this study.
“The dream begins with a teacher who believes in you, who tugs and pushes and leads you to the next plateau, called "truth.” I solicit my esteem gratitude to my research guide Prof.(Mrs.)TAMILSELVI , Head of the Department of Psychiatry Nursing, K.G.College of Nursing for her positive outlook,direction,valuable guidance and unwavering support which contributed towards the successful completion of this work.
I express my sincere gratitude towards Dr. V.PONNIMURALIDARAN, Psychiatrist, K.G.Hospital, for her constant support and guidance.
“There cannot be an excellent piece of architecture without an architect”. I am obliged to Prof. (Mr.) K.SUBRAMANIAN, Department of Biostatistics and Research for his critical statistical advice, his tremendous efforts to make figures meaningful.
I convey my sincere thanks to Prof. (Mrs.) SOFIA CHRISTOPHER, class coordinator and head of the Department of Community Health Nursing, for her patience, affectionate, moral support and guidance throughout my study.
I extend my heartfelt thanks to Prof. (Mrs.) VIJAYALAKSHMI.N, Head of the Department of Child Health Nursing and Prof. (Mrs.) SHEEBA. R, Head of the Department of Obstetrics and Gynecological Nursing, for their constant inspiration throughout the study.
I sincerely thank Mrs. NUZIBA BEGUM, Ms.SANTHAKUMARI, Lecturers, Department of Psychiatry Nursing, and K. G. College of Nursing for their essential motivation and inspiration throughout my study.
My sincere gratitude to all the experts Dr.(Mr.)MARIKANNAN, Dr.(Mrs.)PONNI MURALIDHARAN.V, Prof.(Mrs.)VIJAYALAKSHMI, Prof.(Mrs.)LALITHA VIJAY, Prof.(Mrs.)VANITHA, Prof.(Mrs.)MEERA SARAVANAN and Prof.(Mrs.)UTTRAMANI, who have given the content validity and given suggestions in the modification of the tool.
I acknowledge the timely help of all the FACULTY MEMBERS of K.G.College of Nursing for their kind support during the course of the study.
My whole hearted thanks to the DIRECTOR of Sheela Senior Citizen Home, Coimbatore for her valuable permission and constant support throughout my study.
A word of appreciation to Mrs. JOSEPHINE PRINCEY, English Lecturer, K.G. College of Nursing, for her valuable editorial support.
I have immense pleasure in thanking Prof.(Mr.)A.SUBRAMANIAN, Tamil Lecturer, J.J.Teacher Institute, Trichy, for his valuable editorial support.
I acknowledge my sincere thanks to Mr.KADTHIRVADIVELU.M, Librarian, K.G.College of Health Sciences for rendering his help and support in procuring the literature related to the study.
I express my sincere thanks to all the PARTICIPANTS for their kind co- operation throughout the study, without them it would have been impossible to conduct the study.
I dedicate this work to my PARENTS and HUSBAND for their unconditional love, care, supporting prayers and encouragement to complete this task.
It gives me great pleasure to thank with deep sense of gratitude to Mr.ABRAHAM MESHAK, for his painstaking efforts in preparing the reminiscence therapy album for my study.
I am extremely thankful to Mr.RANGARAJ, Xerox, Saravanampatty, who spent hours to prepare the script of this thesis.
I would also like to render a word of appreciation to all my FRIENDS and CLASSMATES for their timely help and support throughout the study.
I thank one and all who directly and indirectly helped in the successful completion of this dissertation.
INDEX
CHAPTER CONTENT PAGE NO
I
II
III
IV V VI
INTRODUCTION Need for the study
Statement of the problem Objectives
Operational definitions Assumptions
Hypothesis Limitations
Projected outcomes Conceptual framework
REVIEW OF LITEATURE Literature studies related to stress.
Literature studies related to reminiscence therapy.
Literature studies related to coping.
METHODOLOGY Introduction
Research approach Research design Setting of the study Variables
Population Sample size
Sampling technique
Criteria for sample selection Description of the tool Content validity
Pilot study Reliability
Method of data collection Plan for data analysis
DATA ANALYSIS AND INTERPRETATION RESULTS AND DISCUSSION
SUMMARY,RECOMMENDATIONS AND NURSING IMPLICATIONS OF THE STUDY BIBLIOGRAPHY
APPENDICES
1-3 4-6 7 7 7-8
8 8 8 9 9-12 13-21 13-16 17-20 20-21 22-32
22 22 22-24
24 25-26
27 27 28 28 28-30
30 30-31
31 31 32 33-57 58-62 63-67
LIST OF TABLES
Fig No TABLES
1. Distribution of demographic variables among elderly in experimental group and control group.
2. Distribution of pre test stress and coping score among elderly in experimental group and control group.
3. Distribution of post test stress and coping score among elderly in experimental group and control group.
4. Comparisons of scores on pre test and post test stress among elderly in experimental group.
5. Comparisons of scores on pre test and post test coping among elderly in experimental group.
6. Comparisons of scores on stress among elderly in experimental and control group.
7. Comparisons of scores on coping among elderly in experimental and control group.
8. Correlation coefficient between stress and coping among elderly in experimental group.
9. Correlation coefficient between stress and coping among elderly in control group.
10. Association on stress score with selected demographic variables in experimental group.
11. Association on coping score with selected demographic variables in experimental group.
LIST OF FIGURES
Fig No FIGURES
1. Conceptual Framework.
2. Schematic Representation of Study Design.
3. Relationship of Variables.
4. Diagram showing the demographic variables with regard to age of the elderly in the experimental and control group.
5. Diagram showing the demographic variables with regard to stay of the elderly in the experimental and control group.
6. Diagram showing the demographic variables with regard to marital status in the experimental and control group.
7. Diagram showing the comparisons of scores on pre test and post test stress among elderly in the experimental group.
8. Diagram showing the comparisons of scores on pre test and post test coping among elderly in the experimental group.
9. Diagram showing the comparisons of scores on stress among elderly in the experimental and control group.
10. Diagram showing the comparisons of scores on coping among elderly in the experimental and control group.
LIST OF APPENDICES
APPENDIX TITLE
A B C D E F G H
I
Letter seeking permission for conducting the study.
Letter granting permission for conducting the study.
Letter seeking experts opinion for content validity of the tool.
Format for content validity.
List of experts for content validity.
Certificate of English editing.
Certificate of Tamil editing.
Tool I: Demographic Variables
Tool II: Modified Sheldon Cohen’s Perceived Stress Scale.
Tool III: Modified Lazarus Coping Scale.
Procedure of reminiscence therapy.
APPENDIX – A
LETTER SEEKING PERMISSION FOR CONDUCTING THE STUDY
To,
The Director,
Sheela Senior Citizen Home, 26, Annai Amirthanandha Nagar, Thadagam Road,
Velandipalayam, Coimbatore.
Respected Madam,
This is to bring your kind notice that Mrs. Elizabeth jebakani.C, student of K.
G. College of Nursing is conducting a research on “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE, COIMBATORE.” For the purpose of submission to the TamilNadu Dr.M.G.R Medical University, Chennai, as a partial fulfillment of the requirement for the award of M. Sc (N) Degree.
I kindly request you to grant her permission to conduct this study in your old age home. Further details of the proposed project, if required will be furnished by the student personally. Kindly do the needful.
Thanking you Yours truly, Prof. Sonia Das PRINCIPAL
APPENDIX-B
LETTER GRANTING PERMISSION FOR CONDUCTING THE STUDY
To
The Principal,
K.G.College of Nursing, Coimbatore.
Respected Madam,
Sub: Granting permission for conducting the study.
With reference to your letter, Mrs. Elizabeth jebakani. C of
M.Sc (N)-II year is permitted to conduct the research on “A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE HOME, COIMBATORE.” for the purpose of submission to the Tamil Nadu Dr. M.G.R Medical University, Chennai, as a partial fulfillment of the requirement for the award of
M. Sc (N) Degree.
Thanking you, Regards,
Dr.Christy Ganapathy DIRECTOR
APPENDIX – C
LETTER SEEKING EXPERTS OPINION FOR CONTENT VALIDITY From,
Mrs. Elizabeth jebakani.C II year M. Sc Nursing,
K. G. College of Nursing, Coimbatore.
To,
Through Principal of K. G. College of Nursing, Respected Madam / Sir,
Sub: Requisition for expert opinion and suggestions for content validity of the tool.
I am a student of M.Sc Nursing II year, of K. G. College of Nursing, Coimbatore affiliated to the Dr. M.G. R. Medical University, Chennai. As a partial fulfillment of M.Sc, Nursing Programme, I am conducting a study on “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE, COIMBATORE.”
Here with I am sending the developed tool for content validity and for your expert opinion and possible suggestion. It will be very kind of you to return the same to the undersigned at the earliest possible.
Thanking you Date
Place: Coimbatore
Yours faithfully,
(Mrs. Elizabeth jebakani.C)
APPENDIX – D
FORMAT FOR CONTENT VALIDITY
Name of the expert :
Address :
Total content for the tool : Adequate / Not Adequate Kindly validate each tool and (√) if it is applicable.
S. No No. of Tool / Section
Strongly
Agree Agree Need
Modification Remarks
Signature of the expert with date
APPENDIX-E
LIST OF EXPERTS FOR CONTENT VALIDITY
1. Dr. (Mr.) MARIKANNAN, Psychiatrist,
Government Hospital, Coimbatore - 641018.
2. Dr. (Mrs.) PONNI MURALIDHARAN. V, Psychiatrist,
K.G.College of Nursing, Coimbatore - 641018.
3. Prof. (Mrs.) VIJAYALAKSHMI. R, Head of Psychiatry Nursing Department, Chettinad College of Nursing,
Chennai - 600044.
4. Prof. (Mrs.) LALITHA VIJAY, Head of Psychiatry Nursing Department, Sri Gokulam College of Nursing,
Salem - 636412.
5. Prof. (Mrs.) VANITHA,
Head of Psychiatry Nursing Department, Ramakrishna College of Nursing,
Coimbatore - 641044.
6. Prof. (Mrs.) MEERA SARAVANAN, Head of Psychiatry Nursing Department, P.S.G College of Nursing,
Coimbatore - 641004.
7. Prof. (Mrs.) UTTRAMANI,
Head of Psychiatry Nursing Department, Rabindharanath Tagore College of Nursing, Salem - 637303.
APPENDIX - F
CERTIFICATE FOR ENGLISH EDITING
TO WHOMSOEVER IT MAY CONCERN
This is to certify that the tool developed by Mrs. Elizabeth Jebakani.C II year M.Sc Nursing Student of K.G. College of Nursing for dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE HOME ,COIMBATORE.” edited for English language appropriateness by Mrs. JOSEPHINE PRINCY M.A, M.
Phil.
Signature
APPENDIX - G
CERTIFICATE FOR TAMIL EDITING
TO WHOMSOEVER IT MAY CONCERN
This is to certify that the tool developed by Mrs. Elizabeth Jebakani.C II year M.Sc Nursing Student of K.G. College of Nursing for dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN SELECTED OLD AGE HOME , COIMBATORE.” is edited for Tamil language appropriateness by Mr. A. SUBRAMANIAN, M.A, M.Ed.
Signature
APPENDIX-H TOOL-I SECTION:A SECTION:A
DEMOGRAPHIC VARIABLES:
1. AGE years
2. GENDER
a. Male
b. Female
3. EDUCATIONAL QUALIFICATION
a. Illiterate
b. Primary
c. High school
d. Higher secondary
e. College level
4. MARITAL STATUS
a. Unmarried
b. Married
c. Widow/Widower
d. Separated
5. PAST OCCUPATION
a. Unemployed
b. Coolie
c. Professional
d. Others 6. MONTHLY INCOME
a. < Rs.1000
b. Rs.1001-2000 c. >Rs.2000
7. SOURCE OF INCOME
a. Pension
b. Deposit c. Family members
d. Institution 8. DURATION OF STAY
a. <one year b. One year
c. 2-5years
d. more than 5 years
9. FREQUENCY OF VISIT BY FAMILY MEMBERS
a. Once in a week
b. Twice in a week
c. Thrice in a week
d. Never 10. NUMBER OF CHILDREN
a. One
b. Two
c. Three
d. None.
11. STAY OF THE ELDERLY
a. Staying together with spouse
b. Staying alone.
12. PHYSICAL ILLNESS
a. Diabetes Mellitus b. Hypertension c. Respiratory problems
d. Others
13. SOCIAL SUPPORT
a. Friends b. Family members c. Relatives d. None.
TOOL-II SECTION:B
MODIFIED SHELDON COHENS PERCIEVED STRESS SCALE
The Perceived stress scale [PSS] is the most widely used psychological instrument for measuring the perception of stress. It is a measure of the degree to which situations in one’s life are appraised as stressful.
The questions in this scale ask about your feelings and thoughts during the lifetime. In each case, you will be asked to indicate by tick mark how often you felt or thought in a certain way. Perceived stress scale scores are obtained by reversing responses (eg:0=4,1=3,2=2,3=1 &4=0)to the four positively stated items(4,5,7,&8)and summing across all scale items.
KEY:
[0=Never; 1=Almost never; 2=Sometimes; 3=Fairly often; 4=Very often]
S.NO CONTENTS 0 1 2 3 4 1 How often have you been upset
because of something that happened unexpectedly?
2 How often have you felt That you were unable to control the
important things in your life?
3 How often have you felt nervous and stressed?
4 How often have you felt confident about your ability to handle your personal problems?
5 How often have you felt that things were going your way?
6 How often have you found that you could not cope with all the things that you had to do?
7 How often have you been able to control irritations in your life?
8 How often have you felt that you were on top of things?
9 How often have you been angered because of things that were outside of your control?
10 How often have you felt difficulties were piling up so high that you could not overcome them?
SCORE:
0-10: No Stress, 11-20: Mild Stress,
21-30: Moderate Stress, 31-40: Severe Stress.
TOOL-III SECTION:C
MODIFIED LAZARUS COPING SCALE:
The coping strategy instrument which is made by Lazarus in 1991 to assess the coping methods used by the family members. The instrument is classified into problem oriented method and affective oriented method.
This method consists of 15 items and the responses as always, sometimes, never and undecided. The questions in this scale ask about your feelings and thoughts regarding coping strategies. In each case, you will be asked to indicate by tick mark in the following.
KEY: Never=1; Sometimes=2; Always=3; Undecided=0.
SCORE:<50= Inadequate coping ; 51-70= Moderate coping ; >70= Adequate coping.
Coping methods Never Sometimes Always Undecided S.no Problem Oriented
Methods No % No % No % No %
1. Try to maintain some control over the situation.
2. Look at the problem objectively.
3. Accept the situation as it is.
4. Think through different ways to handle the situation.
5. Try out different ways of solving the
problem.
6. Try to find meaning in the situation.
7.
Find out more about the situation so that you can handle in better.
8. Break the problem down in to “Smaller Pieces”.
9. Set specific goals to help solve the
problem.
10. Settle for the next best thing.
11.
Talk the Problem over with someone who has been in the same type of situation.
12. Draw on past
experience to help you handle the situation.
13. Actively try to change the situation.
14. Do anything just to do something.
15. Let someone else solve the problem.
Coping Methods Never Sometimes Always Undecided S. no Affective- Oriented
Methods No % No % No % No %
1 Hope that things will get better.
2 Pray.
3 Worry.
4 Try to put the problem out of your mind.
5
Laugh out off, figuring that things could be worse.
6 Get nervous.
7 Seek comfort or help from family or friends.
8 Over eat.
9 Smoke.
10 Drink.
11
Go to sleep, figuring that things will look better in the morning.
12 Work off tension with physical activity.
13 Get prepared to expect the worst.
14
Don’t worry about it;
everything will probably work out fine.
15 Get mad, curse, swear.
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my;yJ rkhspf;Fk; cj;jpfs; gw;wp c';fspd; czh;t[fs; gw;wpa[k; epidt[fs;
gw;wpa[k; rhh;e;jjhf cs;sd. fPH;f;fz;l xt;bthU mk;rj;jpYk; eP';fs; of;
khh;f; bra;a[k; go Twg;gLfpwPh;fs;.
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2.
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4.
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7.
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13.
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czh;t[fisj; jGtpa Kiwfs;
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19.
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23. mjpfkhf rhg;gpLjy;
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26.
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29.
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rpwg;ghf Koa[k;
30. igj;jpak;, rgpj;jy;, rj;jpak; bra;jy;
APPENDIX-I
PROCEDURE OF REMINISCENCE THERAPY REMINISCENCE THERAPY:
Measures to stimulate long term elderly patients with memorabilia, films and songs meaningful to their generation used in conjunction with or as a prelude to reality orientation therapy. Reminiscing is a universal activity in old person. In the past two decades there has been a change in our understanding of the psychological role played by reminiscing theoreticians and clinicians to-day view it as an adaptive mechanism for the aging person. [LEWIS, 19752]
So it as come up as a therapeutic measure to enhance psychological well being in elderly.
PURPOSE:
To learn about and appreciate life of individual.
To gather valuable information concerning psychological factors underlying health beliefs, coping skills and cultural perspective.
To help in better adjustment to the situations.
To energize and increase self-esteem in demented individual.
To describe what was better in past, to describe self and recall life’s spirit.
To plan for future, to cope or deal with loss or problem.
Many benefits of individual reminiscence revealed by review of literature have improved mood, elevated self esteem, and expression of life satisfaction and maintenance of cognitive function when compared to group reminiscing. The model used for the interaction was SOL COS reminiscence model.
The model consists of 3 components: The process, items and outcome.
THE PROCESS:
involves primary skills [interviewer’s behavior]. Primary influencing factors and focus, which is the environment to which reminiscence is related.ITEMS:
This includes stimuli and response. Stimuli are the items used in the therapeutic process to focus, recollection of events or memories.RESPONSE
: Are concrete recording of the interview that occur as a result of sensory stimulation, intense verbalization that focus on community, family and life role.OUTCOME:
This includes two things, client outcome and interviewer’s outcome. The client’s outcome is grouped into the areas of perspective, closure, gratification and resolution. All focuses on client’s sense of identity, self-esteem, communication skills and energizing, validating and continuing experiences.COMMUNICATION TECHNIQUES USED IN SESSIONS:
a.
LISTENING
: An active process of receiving information and examining reaction to the message received. Maintenance of eye-eye contact, communicating interests and acceptance are must.b.
BROAD OPENING:
Encourage the patient to select topics for discussion, show acceptance and encourage patient’s initiative.c.
RESTATING:
Repeating the main thoughts the patient expressed, which help to indicate listening, validate, reinforces and calls attention to something important that has been said.d.
CLARIFICATION:
Attempting to put into words vague ideas or clear thoughts of the patient to enhance understanding.e.
REFLECTION:
Directing back the patient’s ideas, feeling, question and content.f.
FOCUUSING:
Questions or a statement that help the patient’s to expand on topics of importance.g.
SILENCE:
Lack of verbal communication for therapy session.h.
HUMOUR:
The discharge of energy through the comic enjoyment of the imperfect.PROTOCOL
.1. Determine appropriateness of reminiscence therapy.
2. Collect available data of client to plan reminiscence therapy.
3. Plan how to introduce therapy promptly.
4. Select a suitable environment or room where the subject will be comfortable, with minimum external stimuli and distractions.
5. Seating arrangements should be taken care of, preferable face-face with 3-4 feet apart.
6. Introduce yourself, explain purpose of interview and explain plan of therapy.
7. Assess the client for anxiety, confusion, cognitive function, hearing, vision, comprehension etc.
8. Use indirect questioning rather than direct. Eg: Tell more about..
9. Probe only for information needed to complete reminiscence session.
10. Refocus on these areas in which data are most needed.
11. Incorporate knowledge about simple reminiscence.
12. CLOSURE: Briefly summarize the session; clear the subject’s doubts and plan for next session.
PHASES OF SESSION:
INTRODUCTORY:
Lasted for about 5-10 minutes and includes wishing the subject, providing comfortable position, enquiring about general condition, giving a brief description of last session and introducing new theme.WORKING:
Providing 10 minutes for the subjects to think and recollect the memories according top the present day’s theme followed by retrieving and sharing memories using on communication techniques. Various stimuli will be used to provide memories according to the theme of sessions. The therapist will ask appropriate questions or statements according to the situation.CONCLUDING PHASE:
Lasts for about 5 minute and includes clarifying doubts, restating main themes and memories of session, sharing the experiences about session by both subject and therapist and plan for next session. Special assignment to maintain a diary will be given to the subjects.CHARACTERISTICS:
Includes only bits and pieces of life and focus on happy and fun memories.
The listeners need not be a professional.
Reminiscence is a psychosocial intervention.
Focus may not be on the meaning of life but it can be on a subject or variety of subjects.
Reminiscence can be free flowing or structures.
Reminiscence can be painful, depends upon level of trust and rapport the elderly had with the therapist.
ACTIVITIES TO STIMULATE REMINISCENCE:
1. Family reunion.
2. Writing peer stories.
3. Story telling.
4. Taped sounds, exercise.
5. Family studies, photographs, scrap books.
6. Reminiscence diaries.
7. Structured interview.
8. Old newspaper reading.
9. Music of golden era.
10. Historical documental films.
11. Advertisements catalogue and touch.
CRITICAL POINTS IN USING REMINISCENCE INCLUDE:
1. There must be a verbal interaction between the nurse and one or more persons.
2. The interaction that involves recalling or telling of previous experience as a memorable experience.
3. Recall must not be of recent events or experience.
PRE-REQUISITE FOR THE NURSE IN REMINISCENCE PROCESS:
1. Ability to listen to verbalized memories.
2. Ability to identify the reminiscing process in another person.
3. Ability to respond to the need for reminiscence.
PRE-REQUISITE FOR THE CLIENT:
1. Ability to retrieve long-term memories.
2. Ability to verbalize memories.
PRACTICAL GUIDE TO REMINISCENCE:
¾ Have aim and objective.
¾ Plan the sessions clearly.
¾ Select appropriate stimuli according to objective, age of elderly, cultural background, exposure of client etc.
¾ Encourage sharing memories, watch for non-verbal communication.
¾ Select appropriate time and encourage sharing memories.
¾ Prompt listening in sessions.
¾ Plan for next session.
REMINISCENCE THERAPY AS THERAPEUTIC INTERVENTION:
SESSION NO
TIME
FOCUS
STIMULI USED
I 45-1hr Pre-assessment of stress and coping and explanation about study.
Tool.
II 45-1hr Focus on subjects, family of origin.
Photos, pictures,cinema,music and Handi-craft.
III 45-1hr Focus on education life of the individual.
Photos, pictures of different events, happy times in school, craft items, prayer song.
IV 45-1hr Focus on the
occupational life of the individual.
Photos, pictures of people employed in different types of work.
V 45-1hr Focus on family procreation.
Photos, pictures of different events, lullaby
Song, craft items.
VI 45-1hr Focus on social life of the individual.
Photos, pictures, stamp album, craft items.
VI 45-1hr Evaluation of therapy, feedback by both persons and post assessment.
Tool.
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PRE ASS ESSMENT OF STRESS AND COPING ADMINISTERING REMINIS CENCE THERAPY
POS T ASS ESSMENT OF STRESS AND COPING
PRE ASSESSMENT OF STRESS AND COPING
ADMINISTERING REMINISCENCE THERAPY
POST ASSESSMENT OF STRESS AND COPING
A STUDY TO EVALUATE THE EFFECTIVENESS OF REMINISCENCE THERAPY ON STRESS AND COPING STRATEGIES AMONG ELDERLY IN
SELECTED OLD AGE HOME , COIMBATORE .
By
ELIZABETH JEBAKANI. C
A Dissertation submitted to The Tamil Nadu Dr.M.G.R Medical University, Chennai in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING APRIL - 2011
CHAPTER-I INTRODUCTION
The twentieth century has seen a triumphant increase in life expectancy. 60 years is usually considered has the dividing line between middle and old ages. It is a period of rest from physical stress and mental strain. They have reached great heights of excellence and achievements and enriched with abundance in their living. Their moments are treasured with pleasant memories of the past with a fulfillment at all aspects.
The early parts of life changes are evolutionary, in that, they lead to maturity of structure and functioning. In later part of life, by contrast, changes are mainly involutions, involving a regression to earlier stages. These changes are the natural accomplishment of what is commonly known as “aging”. They affect physical as well as mental structures and functioning. Individual differences in the effect of aging have been recognized and it makes people difficult to get adapt to them.
Currently, elderly people represent around 20% of the total population and will represent 25% by 2020.The ‘oldest’ old country by 2020 will be Japan [30%]
followed by Italy, Greece and Switzerland [above 28%]. By 2020, of the ten countries with the largest number of elderly population in the world, five will be in the developing world. China [230million], India 142million], Indonesia, [29 million], Brazil [27 million] and Pakistan [18 million] (Williams.E.Larry).
The aging population has a looming public health challenges, as currently 355/380 million people, aged 60 years and older live in developing countries. In
2020,the number of old age people is projected to reach more than 1000 million, with 70% living in developing countries, especially in India, China, Brazil, Indonesia and Pakistan (Who Report, 2009).
Living arrangement of old people are influenced by several factors as gender, health status and presence of disability, socio-economic status and societal traditions. However, the traditional families are fast disappearing in rural areas, with urbanization families are becoming nuclear, smaller and are not always capable of caring, for older relatives. Allowing parents to live in old age homes draws criticism from the family network and society at large. There are altogether 356 old age homes in India. Among the major states in India, Kerala ranks first with about 22% of aged persons living in old aged homes. The states of Kerala and TamilNadu have together 57% of all old age homes in India. The general observations are that people are now more affluent but have no one to care for them (Jayaprakash, 2008).
“The act or habit of thinking about or relating past experience especially those considered personally most significant”. Reminiscence provides a basis to recollect past thoughts, memories and experiences. It stands as an entrance to open the people’s happiness about life on past. It makes one to express their own views and feelings on a broader concept. People are motivated to retrieve the excessive storage of experiences either joys or sorrows and live in harmony with mankind. So it can be useful, in monitoring the imbalanced state of stress and suffering present among elderly and help them to lead a healthy psychological adaptation, in later years of life. Health care providers should develop reminiscence programs to enhance the psychological well-being of elders.
An experimental study was conducted to examine the effects of reminiscence therapy on psychological well-being, depression, and loneliness among institutionalized elderly people at Taiwan. 92 institutionalized elderly people aged 65 years and over were recruited and randomly assigned to two groups. Those participants in the experimental group received reminiscence therapy for 1 month in six sessions, to examine the effects of this therapy on their psychological well-being. The results showed that the elderly in the experimental group, a significant positive effect, on depression, psychological well-being, and loneliness.
(Shabeen, 2008)
Many psychosocial interventions are available to help the elderly, as stress as such has become a part and parcel of everyone’s life, which makes living in the world much difficult in nature. The many disappointments in one’s life put down their coping abilities and make them face great challenges in life.
Henceforth, reminiscence therapy is one of the cost-effective, therapeutic modalities, which a nurse can implement, to promote and enhance the mental health, of the elderly.
NEED FOR THE STUDY
In India there were 1.5million people aged years and over at the turn of the century, while the present number is 6.5million.By the year 2020, India will have 80,000 – 1,000,000 more dependent elderly people. As evident from the statistics
from the beginning of this century, the world as been experiencing a dramatic shift in proportion of people who are aged 60 years or older. By the year 2025, India is expected to reach 12.6%.
Longevity has been a spectacular achievement of our country. The age structure of Indian population shows an increasing proportion of the elderly. The population of India in the age group of 60 years and above is increasing more rapidly than the population as whole. The population of India was 844.3 million as per 2004 census and by the year 2008, the Indian population reached 986.1 million. The population of those aged 60 years and above in India, has increased from 24.71 million to 55.3 million. By the year 2020, life expectancy at birth in India will be close to 70 years (Vijayauni, 2008).
Society tends to venerate youth and deplore old age. Many elderly persons are experiencing multiple stresses and it burdens families and institutions providing care for the elderly. In India about, 4 million older people are reported to have psychological problems related to lack of family support and social support, absence of physical disabilities, lack of income and dissatisfaction with life achievements, changes in usual lifestyle, the thoughts of approaching death, society’s attitude and other social problems. During this period their ability to adapt is compromised by the alterations in the physiologic and psychological functions of living.
So these mental health issues among elderly are not addressed adequately. The existing health system is not geared up to meet the needs, of large groups of
elderly. The health care of the elderly is essential as that of younger age group.
Reminiscence has been shown to be a valuable intervention for elderly clients. A review of the reminiscence related literatures, suggest that reminiscence therapy is effective in preventing or reducing stress, increasing life satisfaction, improving coping and helping older adults adapt alternative coping strategies. Reminiscence therapy has the advantage of being a cost effective, therapeutic, social and recreational intervention for institutionalized older adults.
So, it has been proposed that reminiscence interventions can be successfully practiced in a variety of settings, including acute care, senior care centers, adult day care centers, long term care facilities and the client’s home. Research in the fields of nursing, psychology and sociology has explored the meaning, interpretation, types and clinical usefulness of reminiscence therapy.
A study was conducted to examine the effectiveness of group reminiscence therapy on stress among elderly people attending a day centre in Shiraz, Islamic Republic of Iran. A sample of 49 people aged 60+ years participated in 6 reminiscence sessions were held weekly for a 4 week period. The results showed mean scores decreased significantly from 8.18 (SD 1.20) before the intervention to 6.73 (SD 1.20) immediately after the intervention. The researcher concluded that reminiscence therapy had effectiveness on elderly with stressful living (Hurlock, 2009).
In the current era, the elderly population constitutes a significant proportion of total world population and their health care needs, deserve much importance. Research in the area of geriatrics has explored various physical and psychological health problems but there are only a few interventions of the aged.
A survey of those aged 60 years and above, in a population of 15,668 using a designed interview schedule, was done at Madurai. Overall, prevalence of
psychiatric illness was found to be 89/1000.The prevalence of psychiatric illness in those aged 60 - 70 was 71.5/1000, in those aged 70 - 80 was 24/1000 and in those above 85 the rate was 155/2000. Stress disorders alone constituted 67% of total psychiatric morbidity. This acts as a root cause of psychological disturbances, and hence the study becomes relevant. There are few nursing research studies, done to identify the problems of elderly persons, their concept of well-being, their state of wellbeing, their needs and level of satisfaction.
Besides, only few studies on reminiscence therapy had been carried out in India. The investigator felt that a study on the effectiveness of reminiscence therapy, which is cost-effective, will help the individuals to recollect all pleasurable memories, thereby helping them to overcome stress and enhance their coping strategies.
STATEMENT OF THE PROBLEM:
A Study To Evaluate The Effectiveness Of Reminiscence Therapy On Stress and Coping Strategies Among Elderly in Selected Old age Home, Coimbatore.
OBJECTIVES:
To assess the level of stress and coping among elderly in experimental and control group. To administer reminiscence therapy among elderly in experimental group.
To reassess the level of stress and coping among elderly in both the groups.
To compare the effectiveness of reminiscence therapy among elderly in experimental and control group.
To associate the findings with the selected demographic variables in the experimental group.
OPERATIONAL DEFINITIONS:
EFFECTIVENESS:
It refers to the outcome of reminiscence therapy in terms of reduced stress and increased coping strategy.
STRESS:
It refers to any change in an individual life that causes alteration in the physical, mental or emotional states that can be assessed using Perceived Stress scale.
COPING STRATEGY:
It is the measures followed by the elderly to deal with the existing reality and assessed using Lazarus coping scale.
ELDERLY:
People who are above 60 years of age.
REMINISCENCE THERAPY:
Thinking about the past experiences by means of visual collection and reflecting on it to promote a better mental health in old age.
ASSUMPTIONS:
There is a reduced stress and increased coping level among the elderly after reminiscence therapy.
HYPOTHESIS:
There is a significant difference in the levels of stress and coping strategies among elderly in experimental group than the control group.
LIMITATIONS:
Elderly residing in the old age home.
Elderly who are above 60 years.
Elderly who are willing to participate in the study.
The duration of data collection is only for 4 weeks.
PROJECTED OUTCOMES:
The findings of the study will identify the need and effectiveness of reminiscence therapy for the elderly at a reduced level of stress and coping strategies.
The study will help to provide a positive attitude towards reminiscence therapy.
