“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING
AMONG CANCER PATIENTS IN CANCER CENTRE AT THULUKKAMPATTI, THANJAVUR”
BY
REGISTER NO: 301731751
DISSERTATION SUBMITTED TOTHE TAMILNADU DR. M.G.R MEDICAL UNIVERSITY CHENNAI, TAMILNADU.
IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SCIENCE
IN
MENTAL HEALTH NURSING
OCTOBER 2019
“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING AMONG CANCER PATIENTS IN CANCER CENTRE AT THULUKKAMPATTI, THANJAVUR”
BY
REG. NO: 301731751 M.SC. NURSING (2017-2019)
NANDHA COLLEGE OF NURSING ERODE-638052
AFFILIATED TO THE TAMILNADU DR.M.G.R MEDICAL
UNIVERSITY, CHENNAI.
“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING AMONG CANCER PATIENTS IN CANCER CENTRE AT THULUKKAMPATTI, THANJAVUR”
Approved by Nandha College Research committee.
Principal : ………
Prof.Mrs.R.Vasanthi, M.Sc., (N), (Ph.D) HOD of Paediatric Nursing,
Principal, Nandha College of Nursing, Erode-638052.
Research Guide : ……….
Mrs.B. Mercy Dora, M.Sc.,(N) Reader,
HOD of Mental Health Nursing, Nandha College of Nursing, Erode-638052.
Medical Guide : ………..
Dr. Anand., M.B.B.S., DPM Consultant Psychiatrist,
Government Head Quarters Hospital, Erode.
A Dissertation submitted to
The Tamil Nadu Dr. M.G.R Medical University, Chennai In partial fulfillment of the requirement for
Degree of Master of Science in Nursing
VIVAVOCE:
1. INTERNAL EXAMINER:
2. EXTERNAL EXAMINER:
ENDORSEMENT BY HEAD OF THE INSTITUTION
This is to certify that the dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING AMONG CANCER PATIENTS IN CANCER CENTRE AT THULUKKAMPPATI, THANJAVUR
”
is a bonafide research work by: 301731751, Nandha College of Nursing , Erode in partial fulfillment of the University rules and regulation for award of M.Sc (N) in Mental Health Nursing under my Guidance and supervision, during the academic year 2017-2019.Name and signature of the Guide and Head of the department
Mrs. B. Mercy Dora, M.Sc., (N) Reader,
Head of the department, Mental health Nursing, Nandha College of Nursing,
Erode – 638052.
Name and signature of the Principal
Prof. Mrs. R. Vasanthi, M.Sc. (N),PhD HOD of Pediatric Nursing,
Principal, Nandha College of Nursing, Erode – 638052.
ACKNOWLEDGEMENT
ACKNOWLEDGEMENT
“Optimism is the faith that leads to achievement. Nothing can be done without hope and confidence”
The success of my thesis would have been a dream without supports; help and coordination of my teacher take pleasure to mention their names that played a noteworthy part in this project work. First her, family member and most thank my “ALMIGHTY GOD” for his showers of blessing thought this venture.
God has a reason for allowing things to happen. We may never understand his wisdom but we simply have to trust his will. Thank you God for all your blessings to me and my family.
For the strength he had given me each day and for all the people around me who make my life more meaningful.
I acknowledge here with respect for the golden opportunity offered to me by
Thiru .N. Shanmugan, (B. Com) Chairman, Nandha Institution for giving me an opportunity to undertake my M.Sc Nursing program in this esteemed institution.
I expressed my sincere thanks to Thiru. k. Nandha Kumar Pradeep, M.B.A, Secretary of Nandha Educational Trust for awarding me opportunity to facilitate this course.
I wish to extend my sincere thanks to Thiru.. Krishnamoorthy, Administrative Officer, Nandha Paramedical Science for his support and inspiration during my study.
I express my deep sense of gratitude and indebtedness to Prof. R.Vasanthi, M.Sc. (N),PhD Principal, Nandha College of Nursing for her guidance, sustained presence, critical comments, constant availability and continuous inspiration right from the planning phase till the completion of the
study. Her patient listening, encouraging words and deep understanding indeed have been pillars of strength for me.
My sincere thanks to Mrs. R.Induhelen, M.Sc(N), Professor, HOD Department of Community Health Nursing, class coordinator for her consent encouragement, valuable guidance, supervision and timely help during the entire course of study.
It is pleasure and privilege to express my sincere thanks and deep gratitude to my esteemed subject guide to Mrs B.Mercy Dora, MSc (N), Reader, HOD Department of Mental Health Nursing for her valuable guidance during every step of my study. Her timely help and encouragement supported me a lot throughout my study, which is truly immeasurable.
I extend my thanks to the Entire Master of Nursing Faculty for their constructive criticisms and encouragement which led to the successful completion of the study.
I am grateful to Dr.Anand , M.B.B.S., DPM , Consultant psychiatrist, Government head quarters hospital ,Erode for his medical guidance.
I wish to extend my sincere thanks to Prof. K. Dhanapal (Biostatistician) Nanda College of Nursing.
Grateful acknowledgement is expressed by all the experts who spared their valuable time for content validity of the tools and their guidance.
I am grateful to the Cancer center , Thulukkampatti and Vishnu hospital for granting permission to conduct the study.
I extend my warm appreciation to the staffs facilitating the execution of this project.
Grateful acknowledgement is expressed to all the experts who spared their valuable time for content validity of the tools and their guidance.
My grateful thanks are extended to all the persons who participated in the study without whose active cooperation it would not have been possible to delve into the personal nature of this inquiry.
A special thanks to Mrs .S.R.Jeyachitra (M.A.B.Ed English Literature), Nandha matriculation school for English Language editing.
Special thanks to Mrs. Radhika, Library and Information Assistant for extending library facilities throughout the study.
I also owe my gratitude to my friends who shared the ups and downs of the past two years and were a constant source of fun and support.
My lovable thanks to my husband MR.A.Franklin Jude and my daughter F.Lenita Antoliya For their support, prayers, constant encouragement, valuable suggestions, timely help and inspiration which boosted up my morale during the course of this study.I express of deep sense of gratitude to my mother-in-Law Mrs. A.Josephine Mary, and my lovable parents Mr&Mrs.Ignacious Mariya Jaya and My sister Ms.I.sahaya Pradeepa and to all my family members for their constant support, prayers and encouragement.
Above all, I express my deep sense of gratitude to God Almighty for his ever abiding grace and blessing which gave me strength for the successful completion of this project.
Researcher
CONTENTS
TABLE OF CONTENTS
S.NO CHAPTERS PAGE NO
I
INTRODUCTION 1-15
Introduction
1
Need for the Study
5
Statement of the Problem
8
Objectives
8
Operational definitions
8
Assumptions
10
Hypothesis
11
Delimitations
11
Conceptual Framework
12
II
REVIEW OF LITERATURE 16-32
Literature related to Progressive Muscle relaxation techniques
17
Literature related to stress and coping among cancer patients
23
Literature related to effectiveness of Progressive muscle relaxation techniques
26
METHODOLOGY 33-43
Research approach 33
Research design 33
Setting of the study 34
Population 35
Research Variables 35
Sample 36
Sample size 37
Sampling technique 37
III
Sampling criteria 37
Selection and development of tool 37
Data collection method 38
Description of the instrument 38
Scoring and interpretation 39
Testing of the tool 40
Content validity 40
Tool validity 41
Pilot study 41
Method of data collection 42
Data collection procedure 42
Plan for data analysis 43
IV
DATA ANALYSIS AND INTERPRETATION 45-80
Section-I: Distribution of samples in terms of demographic variables
47
Section II: Assessment of pre test level of stress and coping among cancer patients
51
Section III: Assessment of post test level of stress and coping among cancer patients
64
Section IV: Comparison of pre test and post test scores on effectiveness of Progressive muscle relaxation techniques and stress and coping among cancer patients
66
Section V: Association between pre-test scores and posttest scores of stress and coping among cancer patients with their selected demographic variables
73
V RESULTS AND DISCUSSION 81-88
SUMMARY, CONCLUSION, NURSING IMPLICATIONS AND RECOMMENDATION
89-99
Summary 89
Major findings of the study 91
VI Conclusion 96
Implication 97
Recommendations 99
References 100
Annexure 105
LIST OF TABLES
LIST OF TABLES
S.NO TABLES PAGE NO
3.1 Rating scale on assessment of stress 39
3.2 Rating scale on assessment of coping 39
4.1.1 Distribution of samples in terms of demographic variables 47
4.1.2 Distribution of samples in terms of Age 51
4.1.3 Distribution of samples in terms of Gender 52
4.1.4 Distribution of samples in terms of Religion 53
4.1.5 Distribution of samples in terms of Type of family 54
4.1.6 Distribution of samples in terms of Education 55
4.1.7 Distribution of samples in terms of Occupation 56
4.1.8 Distribution of samples in terms of Marital status 57
4.1.9 Distribution of samples in terms of Duration of illness 58 4.1.10 Distribution of samples in terms of Site of cancer 59 4.1.11 Distribution of samples in terms of Following any other relaxation
techniques
60
4.1.12 Distribution of samples in terms of Source of information 61 4.2.1 Assessment of level of stress before administration of Progressive
muscle relaxation techniques among cancer patients
62
4.2.2 Assessment of level of coping before administration of Progressive muscle relaxation techniques among cancer patients
63
4.3.1 Assessment of level of stress after administration of Progressive muscle relaxation techniques among cancer patients
64
4.3.2 Assessment of level of coping after administration of Progressive muscle relaxation techniques among cancer patients
65
4.4.1 Comparing the scores of component between the pre test and post test level of stress
66
4.4.2 Comparing the scores of component between the pre test and post test level of Coping
68
4.4.3 Comparison of mean and standard deviation of level of stress 69 4.4.4 Comparison of mean and standard deviation of level of coping 71 4.5.1 Association between pre test level of stress with their selected
demographic variables
73
4.5.2 Association between pre test level of coping with their selected demographic variables
77
LIST OF FIGURES
LIST OF FIGURES
S.NO FIGURES PAGE
NO 1.1 Conceptual framework based on J.W. Kenny’s open system model 15 3.1 Schematic representation of Research Design of the study 44
4.1.1 Distribution of samples in terms of Age 51
4.1.2 Distribution of samples in terms of Gender 52
4.1.3 Distribution of samples in terms of Religion 53
4.1.4 Distribution of samples in terms of Type of family 54
4.1.5 Distribution of samples in terms of Education 55
4.1.6 Distribution of samples in terms of Occupation 56
4.1.7 Distribution of samples in terms of Marital status 57
4.1.8 Distribution of samples in terms of Duration illness 58
4.1.9 Distribution of samples in terms of Site of cancer 59
4.1.10 Distribution of samples in terms of following any other relaxation technique 60 4.1.11 Distribution of samples in terms of Source of information 61
4.2.1 Pre test level of stress among cancer patients 62
4.2.2 Pre test level of coping among cancer patients 63
4.3.1 Post test level of stress among cancer patients 64
4.3.2 Post test level of coping among cancer patients 65
4.4.1 Comparison of the scores of pre test and post test level of stress 67 4.4.2 Comparison of the scores of pre test and post test level of coping 68 4.4.3 Comparison of mean and standard deviation of level of stress 70 4.4.4 Comparison of mean and standard deviation of level of coping 72
LIST OF ANNEXURE
LIST OF ANNEXURE ANNEXURE
NO
CONTENT
A. Letter requesting permission for conducting the final study B. Letter granting permission for conducting study
C. Letter seeking expert opinion for content validity of tools D. Editor’s certificates
E. Structured interview schedule questionnaire (English version) Part A :- Demographic variables
Part B :- Stress scale questionnaire Part C:- Coping scale questionnaire
F. Content on Progressive muscle relaxation technique G. Photographs taken during the study
ABSTRACT
ABSTRACT
The present research was “A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING AMONG CANCER PATIENTS IN CANCER CENTRE, AT THULUKKAMPATTI, THANJAVUR”. It was conducted by Mrs. LATHA.I in partial fulfillment of the requirement for the degree of Master of Science in Nursing at The Nandha College of Nursing, under The Tamil Nadu Dr.M.G.R. Medical University, Chennai during the year 2019.
OBJECTIVES OF THE STUDY
To assess the level of stress and coping before and after administration of progressive muscle relaxation techniques among cancer patients. To implement and evaluate the effectiveness of progressive muscle relaxation techniques among cancer patients.
To find out the association between the level of stress and coping among cancer patients with their selected demographic variables such as age, gender, religion, type of family, education, occupation, marital status, duration of illness, site of cancer, following any other relaxation techniques and source of information.
HYPOTHESIS
H1 – Progressive Muscle Relaxation techniques will be effective in reducing stress and improving coping among cancer patients
H2 - There will be a significant association between the level of stress and coping among cancer patients with their selected demographic variables such as age, gender, religion, type of family, education, occupation, marital status, duration of illness, site of cancer, following any other relaxation techniques and source of information.
METHODOLOGY
The conceptual framework of the study was based upon J.W. Kenny’s open system model. The research approach used for this study was Experimental approach and the research design was “Pre Experimental Design”. 60 cancer patients were selected for this study using purposive sampling technique. Data were collected with the help of 4 point rating scale on assessment of stress and modified Lazarus and Folkman coping inventories through interview method. The tool was given to five experts for content validity. This standardized scale’s reliability was 0.8. Pilot study was conducted to find the feasibility of the study and to plan for data analysis. Progressive muscle relaxation techniques were given to the patients dividing them into 2 groups. Each group containing 15 members were given Progressive muscle relaxation techniques for 15-20 minutes per day for 15 days. After 15 days post test was done using the same scale to assess the effectiveness of Progressive muscle relaxation techniques on stress and coping among cancer patients. Descriptive statistics (frequency, percentage, mean and standard deviation) and inferential statistics (paired ‘t’ test, unpaired ‘t’ test and chi square test) were used to analyze the data and test hypotheses.
MAJOR FINDINGS
According to Age, majority 27 (45%) of them belongs to the age group between 31-45 years, 19 (32%) of them belongs to the age group between 46-60 years and the remaining 14 (23%) of them comes under the age group between 19-30 years.
According to Gender, majority 38(63%) of them were female and the remaining 22 (37%) of them were male.
According to Religion, majority 37(62%) patients were Hindu, 22 (37%) of them were Christian and the remaining 1(2%) of them was Muslim.
According to Type of family, majority 50(83%) of patients belongs to nuclear family and the remaining 10(17%) of them were belongs to joint family.
According to Education, most of 45 (75%) patients were educated and the remaining 15 (25%) of them were uneducated.
According to Occupation, majority 49(82%) patients were employed and the remaining 11 (18%) of them were unemployed.
According to Marital status, most of 50(83%) patients got married and the remaining 10(17%) of them were unmarried.
Regarding Duration of illness, majority 45(75%) patients were below 1 year, remaining 15(25%) of them were in between 1- 2 years and none of them were above 2 years.
According to Site of cancer, most of 30(50%) patients had cancer on prostate/ uterus/
ovary/ breast, 19(32%) of them had cancer on other sites, 10 (16%) of them had cancer on stomach/ intestine/ colon/ rectum and remaining 1 (2%) of them had cancer on head / neck.
According to Following any other relaxation techniques, none of the patients had followed any other relaxation techniques.
Regarding Source of information, majority 55(92%) patients did not know about the information, 3(5%) of them knew the information through newspaper and the remaining 2(2%) of them knew the information through the television.
The Frequency and Percentage distribution of Pre test and Post test scores on the level of stress before and after administration of Progressive muscle relaxation techniques among cancer patients. In pre-test 44 (73%) of patients had severe level of stress, 14(23%) of them had moderate level of stress and the remaining 2(3%) of them had mild level of stress. In post test majority 52(87%) patients had mild level of stress, 8 (13%) of them had moderate level of stress and none of them had severe level of stress.
The frequency and percentage of scores of pre-test and post-test scores on the level of coping among cancer patients. In pre-test majority 45(75%) of them had inadequate coping, 15(25%) of them had moderately adequate coping and none of them had adequate coping. In post-test majority 50(83%) of them were adequate
coping and the remaining 10(17%) of them were moderately adequate coping. None of them had inadequate coping.
The comparison of mean of pre test and post test scores of effectiveness of Progressive muscle relaxation techniques on reducing stress among cancer patients.
The mean pre-test score was 64.16 and mean post-test score was 36. The paired “t”
test value was 44 when compared to the table value (2.0) it is high. The statistical paired “t” test indicates that the mean effectiveness found to be significant at P<0.05
revealing that the administration of Progressive muscle relaxation techniques was effective on reducing stress among cancer patients.
The comparison of mean of pre test and post test scores of effectiveness of Progressive muscle relaxation techniques on improving coping among cancer patients.
The mean pre-test score was 38 and mean post-test score was 66. The paired “t” test value was 15.48 when compared to the table value (2.0) it is high. The statistical paired “t” test indicates that the mean effectiveness found to be significant at P<0.05 revealing that the administration of Progressive muscle relaxation techniques was effective on improving coping among cancer patients.
There was significant Association found between pre-test score on the level of stress with their selected demographic variables namely age, type of family, education, marital status, duration of illness and site of cancer.
Regarding Age χ2=18.85 were as table value = 9.48 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of stress and age.
Regarding Type of family χ2=30.97 were as table value = 5.99 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of stress and type of family.
Regarding Education χ2=64.7 were as table value = 5.99 which is less than the calculated value at (P<0.05). It is evident that there is significant association between
the pre test level of stress and education.
Regarding Marital status χ2=17.6 were as table value = 5.99 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of stress and marital status.
Regarding Duration of illness χ2=29.83 were as table value = 9.48 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of stress and duration of illness.
Regarding Site of Cancer χ2=26.28 were as table value = 18.307 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of stress and Site of cancer.
Regarding Gender χ2 =0.18 were as table value =5.99 which is more than calculated value at (P>0.05) level .It is evident that there is no significant association between the pre test level of stress and gender.
Regarding Religion χ2 =2.56 were as table value =9.48 which is more than calculated value at (P>0.05) level .It is evident that there is no significant association between the pre test level of stress and religion.
Regarding Occupation χ2 =3.86 were as table value =5.99 which is more than calculated value at (P>0.05) level .It is evident that there is no significant association between the pre test level of stress and occupation.
Regarding Following any other relaxation techniques χ2 =0 were as table value =9.48 which is more than calculated value at (P>0.05) level .It is evident that there is no significant association between the pre test level of stress and following any other relaxation techniques.
Regarding Source of Information χ2 =3.88 were as table value =9.48 which is more than calculated value at (P>0.05) level .It is evident that there is no significant association between the pre test level of stress and source of information.
There was significant Association found between Pre-test scores on the level of coping with their selected Demographic Variables namely Education and Duration of illness.
Regarding Education χ2= 18.51 were as table value = 5.99 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of coping and education.
Regarding Duration of illness χ2=59.97 were as table value = 9.48 which is less than the calculated value at (P<0.05). It is evident that there is significant association between the pre test level of coping and duration of illness.
Regarding Age χ2 = 0.23 were as table value =9.48 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and age.
Regarding Gender χ2 =2.39 were as table value =5.99 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and gender.
Regarding Religion χ2 =5.328 were as table value =9.48 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and religion.
Regarding Type of family χ2 =3.96 were as table value =5.99 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and Type of family.
Regarding Occupation χ2 =1.817 were as table value =5.99 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and occupation.
Regarding Marital status χ2 =3.99 where as table value =5.99 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and marital status.
Regarding Site of cancer χ2 =4.02 were as table value =18.307 which is more than
calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and site of cancer.
Regarding Following any other relaxation techniques χ2 =4 where as table value
=9.48 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the pre test level of coping and practicing of other relaxation techniques.
Regarding Source of information χ2 =1.8 where as table value =9.48 which is more than calculated value (P>0.05) level .It is evident that there is no significant association between the post test level of coping and source of information.
RECOMMENTATIONS
Based on the findings of the study the following recommendations are made:
A Similar study can be conducted with a control group.
A comparative study can be conducted to evaluate the effectiveness psychological interventions and other coping strategies to reduce the level of stress among cancer patients.
A longitudinal study can be conducted for long term effects of coping strategies on stress.
Study can be done with randomization for better result.
A follow up study can be conducted to assess the effectiveness of the present intervention in reducing the stress and improving the coping among cancer patients.
KEY WORDS
Progressive relaxation technique, cancer patients, stress, coping.
Chapter I
Introduction
CHAPTER-I INTRODUCTION
“A clear vision, backed by definite plans, gives you a tremendous feeling of confidence and personal power”
According to World Health Organization (WHO) globally, Cancer is one of the top ten leading causes of death. It is estimated that 7.4 million people died of cancer in 2004 and if current trend continue, 83.2 million more will have died by 2020. Around 8,50,000 new cancer cases are diagnosed in India every year. Among them there are 4,41,405 female patients and 3,93,948 are male, affected with cancer. Lung cancer is the most common cause of cancer related death in men and the second most common illness among women after breast cancer, which is responsible for 1.3million deaths worldwide annually.
(World health Statistics 2008) Cancer has afflicted humans throughout the recorded history. From the dawn of history people have written about cancer. The origin of the word ‘Cancer’ was credited to the Greeks by the Father of Medicine-Physician Hippocrates 460B.C-370B.C. Since then, Physicians and scientists have come up with many theories. But the discovery of DNA structure by James Watson Crick has paved the way for the modern cancer science.
(National accounts 2000) Cancer burden in India has more than doubled over the last 26 years. The highest increase among all therapy areas, with breast cancer being the most common among Indian women, according to a recent report. As per the Indian Council of Medical Research (ICMR) data, India had 14 lakh cancer patients in 2016 and this number is expected to increase.
The government has laid down four priority cancers -- breast cancer, cervical cancer, oral cancer, and lung cancer which together constitute 41 per cent of cancer burden, the report mentioned.
Oral Cancer is among the top three cancers in India, number one among all cancers in men and number three among female cancers.
"Breast cancer is currently the most common cancer among Indian women, both in terms of incidence as well as mortality, with proportional prevalence in younger age- groups being higher than the global average."
"The age standardized rate is approximately 25.8 per one lakh women and is expected to rise to 35 per one lakh women in 2026," the report stated.
(India Today) Stress is a major public health concern as of recent decade. An imbalance between excessive demands and a person’s ability to cope with them, ultimately leads to stress. Stress has harmful consequences on the physical, psychosocial and mental health thus causing deleterious effect on the individual, organization and the society.
There are various methods recommended to control or reduce the stress. Stress coping skills have a comprehensive concept and multiple cognitive-behavioral components. Generally, coping has been described as efforts to comply the individual with the environment or efforts for preventing from the negative consequences of stressful situation. Two main methods for preventing from stress are deal with problem-focused directly on the issue which includes direct activities on the environment in order to change or correction of the situation which is threatening and also emotion-focused practices which include thoughts or activities in order to control the unpleasant feelings which have been created from stressful conditions.
Evidence suggests that stress relaxation techniques are one of the most effective training programs to enhance psychological resources and reduce psychological distress. Majority of stress relaxation techniques are considered safe in healthy adults and there have been no severe adverse effects reported. Hence, health education in the form of individual-focused Jacobson Progressive Muscle Relaxation (PMR) therapy is essential in coping with stress.
There are several types of relaxation therapies such as stretch release relaxation (SRR), Progressive muscle relaxation (PMR), cognitive imagery relaxation (COG), and some types of
meditations. Here, the PMR technique is used because of its better reported results, its simplicity in performance and easy independent practice at home. The main idea of initiating the relaxation response in this way is to take control of the voluntary muscles through creation of tension in them, followed by forcing them into a state of relaxation. A number of possibilities for the implementation of complementary therapies in an evidence-based medicine environment.
Victor Emanuvel,(2013) Jacobson who conducted the first psycho physiological study of relaxation, he found that when subjects deeply relaxed their skeletal muscles, they would not show a normal startle response to a loud noise. Later Jacobson developed a technique called ‘Progressive Muscle Relaxation’ which was designed to bring about a deep state of muscle relaxation. He believed that such a state could reduce arousal in both the central nervous system and the autonomic nervous system and as a result could restore or promote psychological and physical well-being.
Jacobson (1930) Considering that all the living organisms experience the stress, the aim of nursing is not removing the whole stress completely, because stress is part of the life. Response to stress can be in an unhealthy way, and the role of the nurse at this time is helping to promote the health.
Health promotion includes strategies for reduction and management of the stress, the nurse also can use nursing process in order to manage the stress. Stress management practices include, yoga relaxation, progressive muscle relaxation, breathing exercises, meditation and mental imagery.
NEED FOR THE STUDY
Cancer is a generic term for large group of diseases that can affect any part of the body.
One defining feature of cancer is the rapid creation of abnormal cells that grow beyond their usual boundaries. Cancer is leading cause of death worldwide, accounting for estimated 9.6 million deaths in 2018.
World Health Organization
Cancer has a major impact on society in the United States and across the world. Cancer statistics describe what happens in large groups of people and provide a picture in time of the burden of cancer on society. Statistics tell us things such as how many people are diagnosed with and die from cancer each year, the number of people who are currently living after a cancer diagnosis, the average age at diagnosis, and the numbers of people who are still alive at a
given time after diagnosis. They also tell us about differences among groups defined by age, sex, racial/ethnic group, geographic location, and other categories.
Globally it is estimated that 100 million people across world had any of the forms of cancer in 2017. This number has more than doubled since 1990 when an estimated 45 million had cancer.
In 2017, an estimated 15,270 children and adolescents ages 0 to 19 were diagnosed with cancer and 1,790 died of the disease.
In 2018, an estimated 1,735,350 new cases of cancer will be diagnosed in the United States and 609,640 people will die from the disease.
The link between stress and cancer is complex. There is a possible link between the chronic stress response, which may predispose patients to depression, and the risk of mortality from cancer. A diagnosis of cancer and the typical treatment regimes and uncertainty associated with cancer are, naturally, very stressful psychologically and this has an effect on the soma or body.
Cancer pervades many dimensions of an individual's life – demanding a holistic treatment approach. However, studies with combined medical and psychological interventions (MPIs) are sparse. High-level stress and poor quality of life (QoL) can hinder patients' prognosis. The study thus aimed to analyze the impact of Jacobson progressive muscle relaxation technique on reducing stress and improving coping among cancer patients.
Stress is considered a major precipitating psychological issue in cancer patients from diagnosis, through treatment and prognosis, even after the disease is long gone. Cancer patients are often stressed with the uncertainty, disease severity, physical difficulties, medical treatments, psychological state, and family issues. The various negative impact of stress in cancer patients – either in compounding to psychiatric co-morbidity such as anxiety, depression, posttraumatic stress disorder, etc. or in deteriorating their quality of life (QoL), indicates the need for a holistic approach.
People who have cancer may find the physical, emotional, and social effects of the disease to be stressful. Those who attempt to manage their stress with risky behaviors such as smoking
or drinking alcohol or who become more sedentary may have a poorer quality of life after cancer treatment. In contrast, people who are able to use effective coping strategies to deal with stress, such as relaxation and stress management techniques, have been shown to have lower levels of stress, depression, anxiety, and symptoms related to the cancer and its treatment.
Progressive muscle relaxation (PMR) is a deep relaxation technique that has been effectively used to control stress. Researchers report that relaxation training methods, including Jacobson Progressive muscle relaxation work best if a person is trained before cancer treatment starts.
The researchers also said that after 2 hours of training from an expert, patients are usually experienced enough to successfully practice the techniques on their own.
In studies of people with breast cancer Jacobson progressive muscle relaxation training has been shown to help reduce stress, nausea, vomiting, anxiety, and depression.
In a study published in 2002, 38 breast cancer patients used Jacobson progressive muscle relaxation technique 1 hour before they received chemotherapy, followed by daily Progressive muscle relaxation technique for an additional 5 days. Each Jacobson progressive muscle relaxation technique session lasted 25 minutes. The 38 patients were compared with a group of 33 patients undergoing chemotherapy without Jacobson progressive muscle relaxation technique. In the Jacobson progressive muscle relaxation techniques group, the stress level was significantly reduced.
Keeping the above facts the researcher felt the need to take up the following study to evaluate the effectiveness of Progressive muscle relaxation techniques on stress and coping of cancer patients at cancer center.
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUES ON STRESS AND COPING AMONG CANCER PATIENTS IN CANCER CENTRE AT THULUKKAMPATTI, THANJAVUR”
OBJECTIVES
To assess the level of stress and coping before and after administration of progressive muscle relaxation techniques among cancer patients. To implement and evaluate the effectiveness of progressive muscle relaxation techniques among cancer patients.
To find out the association between the level of stress and coping among cancer patients with their selected demographic variables such as age, gender, religion, type of family, education, occupation, marital status, duration of illness, site of cancer, following any other relaxation techniques and source of information.
OPERATIONAL DEFINITIONS Effectiveness
It is the capability of producing a desired result. When something is deemed effective, it means it has an intended or expected outcome or produces a deep, vivid impression.
In this study, effectiveness refers to the intended change in the level of stress and coping after administration of Progressive muscle relaxation techniques as measured by standard 4 point rating scale on assessment of stress and modified Lazarus and Folkman coping scale.
Progressive muscle relaxation technique
Progressive muscle relaxation is an effective technique for reducing overall body tension as well as psychological stress. It is also known as progressive relaxation therapy. It focuses on tightening and relaxing specific muscle groups in sequence, for 15-20 minutes per day.
In this study Progressive muscle relaxation techniques triggers the Central nervous system and autonomic nervous system and promotes psychological and physical well being in which a person first tenses and relaxes major muscle groups of the body in a prefixed and systematic order, tensing for 5 seconds and relaxation for 10 seconds. It is usually beginning from head and progressing downwards toes about 15-20 minutes every day in 15 consecutive days.
Stress
Stress is the arousal of mind and body in response to demands made upon them.
(Schafer-2000) In this study stress refers to emotional pressure experienced by cancer patients due to adverse circumstances highlighted by difficulty in relaxing, nervous arousal and being easily upset/agitated, irritable/over-reactive and inpatient as measured by standard 4 point rating scale on assessment of stress.
Coping
Coping is constantly changing cognitive and behavioral efforts to manage specific external and/ or internal demands that are appraised as taxing or exceeding the resources of the person.
(Lazarus &Folkman, 1984) In this study, it refers to the coping ability of the cancer patients, which will be measured by using modified Lazarus and Folkman coping scale.
Cancer
Cancer is defined by the collection of diseases in which abnormal cells can divide and spread to nearby tissue. Cancers can arise in many parts of the body and in some cases spread to other parts of the body through the blood and lymph systems.
In this study cancer refers to male or female individual who are clinically diagnosed to have cancer and receiving treatment in hospital as inpatient.
ASSUMPTIONS
Cancer patients may experiences severe stress and inadequate coping abilities. Practice of progressive muscle relaxation techniques will reduce stress and improve coping among cancer patients.
HYPOTHESIS
H1 –Progressive Muscle Relaxation techniques will be effective in reducing stress and improving coping among cancer patients
H2 - There will be a significant association between the level of stress and coping among cancer patients with their selected demographic variables such as age, gender, religion, type of family, education, occupation, marital status, duration of illness, site of cancer, following any other relaxation techniques and source of information.
DELIMITATIONS
The study was restricted to cancer patients who were admitted in Oncology ward at cancer center.
Study period was limited to four weeks only.
The sample size was 60 only.
CONCEPTUAL FRAMEWORK
Conceptual frameworks are inter-related framework that assembled together in some rational scheme by virtue of their relevance to a common theme. Conceptual framework helps to stimulate research and the extension of knowledge by proving both direction and input.
(Polit and Hungler., 1999) Conceptual framework is the precursor of the theory. It provides broad prospective for nursing practice, research and education. Conceptual framework plays several interrelated roles in the progress of science. Their overall purpose is to make scientific and meaning findings and also to generalize the finding.
(Polit and Hungler., 1999)
The present study is focused on the effectiveness of Progressive muscle relaxation techniques on reducing stress and improving coping among cancer patients. The study is based upon J.W. Kenny’s open system model. The systems theory concerned with changes due to inter relation between various factors in a situation. All living systems are open in which, there is a continual exchange of matter, energy and information. Open system have degrees of input and gives back output in form of matter, energy and information.
The concepts of Kenny’s open system model are input, throughput, output and feedback.
Input refers to matters and information which are continuously, processed through the system and released as output. After processing the input, the system returns output (matter and information) to the environment in as altered state, affecting the environment for information to guide its operation. This feedback information of environment responses to the systems output is used by the system adjustment correlation with the environment. Feedback may be possible, negative or neutral .In this study the concepts have been modified as follows,
Input
According to J.W.Kenny’S input can be matter, energy and information from the environment. In this study input is assessing the level of stress and coping among cancer patients before administering Progressive muscle relaxation techniques. It was assessed by standardized questionnaire.
Throughput
In this model throughput refers to the procedure by which matter, energy and information that is modified or transform within the system. In this study Progressive muscle relaxation techniques were administered for reducing stress and improving coping among cancer patients. Progressive muscle relaxation techniques were administered in the following sequence right hand and fore arm, right upper arm, left hand and fore arm, fore head, eyes and cheeks, mouth and jaw, neck, shoulders, shoulder blade/ Back, Chest and stomach, hips and buttocks, right upper leg, right lower leg, right foot, left upper leg, left lower leg and left foot.
Progressive muscle relaxation techniques were given to the major muscle groups of the body in
2 steps, tightening and relaxing the muscle groups. Progressive relaxation techniques were given to the group members dividing them into 2 groups. Each group containing 15 members were given intervention for 15-20 minutes per day for 15 days. After 15 days of Progressive relaxation techniques the level of stress and coping was assessed for the samples.
Output
Output refers to matter, energy and information that are released from the interaction of the system into the environment. In this study it involves the Progressive muscle relaxation techniques were administered to the cancer patients. The Output is considered in terms of improvement in the level of stress and coping after Progressive muscle relaxation techniques which was measured by using standardized questionnaire.
Feedback
Differences in pre and post test scores were observed from the level of stress and coping of the sample. In the present study, the feedback considered as a process of maintaining the effectiveness of Progressive muscle relaxation techniques. Feedback was based on the analysis of post test scores, the intervention strategy can be modified if necessary and same pattern can be followed once again.
Chapter II
Review of Literature
CHAPTER II
REVIEW OF LITERATURE
A literature review is an evaluative report of information found in the literature related to the selected area of study. The review should describe, summarize, evaluate and clarify this literature. It should give a theoretical base for the research and help you (the author) determine the nature of the research.
(libguides.library.cqu.edu.au) A literature review involves the systematic identification, location, scrutiny, and summary of written materials that contain information on the research problem
(Polit and Hungler2007) A review of related research and non research literature was done to broaden the understanding and develop an insight into the related problem under study.
Reviews were categorized under following headings,
Literature related to Progressive muscle relaxation techniques.
Literature related to stress and coping among cancer patients.
Literature related to Effectiveness of Progressive muscle relaxation techniques on stress and coping among cancer patients.
Literature Related To Progressive muscle relaxation techniques
B. Batra, Dolly John Shiju (2019), conducted pre experimental study to assess the effectiveness of Progressive muscle relaxation techniques on reduction of stress among post menopausal women in selected hospital in Bhopal, Madhya Pradesh. 60 postmenopausal women were selected by convenient sampling technique. Pre- and post-test assessment was done using Dr. M. Singh Stress Scale Assessment Scale. The study found that 75% of the postmenopausal women had moderate level of stress. 16.7% of postmenopausal women had low level of stress and 8.3%% of postmenopausal women had high level of stress. The overall mean of post-test of the stress level is decreased from 29.02% to 19.62% after administering Progressive muscle relaxation techniques. This study shows Progressive muscle relaxation techniques is an effective way in reducing stress among postmenopausal women.
Dedy Arisjulyanto S Kep (2018), conducted quasi experimental study to assess the effectiveness of Progressive muscle relaxation techniques to reduce the blood pressure among hypertensive patients in selected hospital in Mataram at Indonesia. 27 patients were selected by purposive sampling techniques. The results of this study indicates that the T-test calculation using Quasi Experiment Design shows the difference of average of hypertension rate before and after given progressive muscle relaxation technique. It is 10,306 mmHg in intervention group and 1,425 mmHg in control group. The p-value in the intervention group is 0.000 that is smaller than α=0.05 and the p-value of control group is 0.431 that is greater than α=0.05.
From this study, we can conclude that , progressive muscle relaxation technique can be used as an appropriate alternative or complementing treatment to control Hypertension rate.
Rashina reetu, Navneet Kaur (2018), conducted pre experimental study to assess the effectiveness of progressive muscle relaxation technique on level of anxiety among patients with hypertension in selected areas of District Ludhiana, Punjab. 40 patients were selected by the convenience sampling technique was used to select the sample. Pre and post-interventional level of anxiety was assessed and compared by using Beck anxiety inventory Scale (1993). In pre-interventional assessment, 60% patients were having low level of anxiety followed by moderate (37.5%) and high (2.5%) level of anxiety whereas in post interventional assessment,
97.5% patients were having low level of anxiety followed by only moderate (2.5%) level of anxiety at p=0.000. There was a significant decrease in pre and post-interventional mean anxiety scores (17.75±9.35 vs 9.13±5.598, p=0.000) respectively. It reflects that there was a significant decrease in level of anxiety after administration of progressive muscle relaxation technique.
A.Rajeswari (2018), conducted Quasi experimental study to assess the effectiveness of progressive muscle relaxation technique on pain among mothers underwent the caesarean section in New life Hospital at Cuddalore. Thirty mothers selected based on the convenient sampling techniques. The pretest was conducted for both the groups and intervention on progressive muscle relaxation technique was taught to the experimental group. The collected data were analyzed by using descriptive and inferential statistics. In control group uncomfortable pain was noticed among mothers on 1st day was 33.3% increases in to 93.3%. In Experimental group the uncomfortable pain was noticed on 1st day was 60% and it was gradually decreases on 2nd day and 3rd day it was none. The unpaired “t” test to assess the effectiveness of progressive muscle relaxation technique on post test level of pain among mothers underwent the caesarean section on 1st day the “t” value is 9.2 and p value is p < 0.000.
Comparatively on the 3rd day the “t” value is 11.3 and p value is p < 0.000. Hence it is interpreted the p value is highly significant and the progressive muscle relaxation technique was more effective on pain among mothers underwent the caesarian section.
Sultan ayaz alkaya (2018), conducted randomized controlled trial study to determine
the effectiveness of progressive muscle relaxation (PMR) on the quality of life of women during postpartum period in obstetric department of selected hospital at Ankara, Turkey. Thirty women in the intervention group and 30 women in the control group were included. Data were collected using the Maternal Postpartum Quality of Life Questionnaire (MAPP-QoL).
Progressive Muscle Relaxation was applied to the intervention group. PMR was performed as contracting a muscle group and then relaxing it, moving (or progressing) from one muscle group to another. The mean pretest and posttest scores of the MAPP-QoL in the intervention
group were 24.43 ± 4.58 and 26.07 ± 4.58, respectively (t = −2.73, p < .05). The mean pretest and posttest scores of the MAPP-QoL in the control group were 23.29 ± 4.37 and 21.99 ± 5.58, respectively (t = 2.23, p < .05). The difference between the mean scores of the women in the intervention and control groups before PMR was not statistically significant (t = 0.99, p > .05), whereas the difference between the groups after PMR was found to be statistically significant (t = 3.09, p < .05).Postpartum quality of life of women was increased after PMR. It is recommended that Progressive Muscle Relaxation was effective.
Arun.M (2017), conducted experimental study to assess the effectiveness progressive muscle relaxation techniques on stress among computer professionals working in selected private companies at Ernakulum District.60 samples selected by consecutive sampling technique. The results shows that the mean pretest stress score was 49.72 which was reduced to 26.72 in the posttest. This difference was found to be significant with at ‘t’ value of 12.645(p = 0.001). This explains that the progressive muscle relaxation technique is effective in reducing work-related stress
Donit John (2017), conducted experimental study to evaluate the effectiveness of Progressive Muscle Relaxation Technique on level of anxiety among first year graduate students in selected Training college of Nursing at Aurangabad, Maharashtra. 30 samples were selected by non-probability purposive sampling technique. The research design used was one group Pre-test Post-test design. Data was collected using State and Trait anxiety scale, analyzed and interpreted by using descriptive and inferential statistics. Mean value at pre-test was 108.7 which decreased to 58.4 in post-test. This study depicted that Progressive Muscle Relaxation Technique is very effective in anxiety reduction among first year graduate students in selected training college of nursing. It is suggested that Progressive Muscle Relaxation Technique should be practiced as an integral part of the nursing profession by the nurses working in college, community and hospital.
Diana S L, Nagarajaiah (2017) conducted quasi experimental study to assess the effectiveness of progressive muscle relaxation on the level of stress and anxiety among the
elderly in selected old age homes at Kanyakumari district. 200 elderly persons were selected by convenience sampling technique. The pre-test and post-test level of stress and anxiety were assessed using a modified Perceived Stress Scale and Zung self-rating anxiety scale. The study findings revealed, the mean stress score before the administration of progressive muscle relaxation was 76.6 ± 5.2 and the same after relaxation was 67.8 ± 4.7. The reduction of stress was 8.8 ± 5.2, and the same was statistically highly significant (P<0.001). The mean anxiety before the administration of progressive muscle relaxation was 57.2 ± 5.6, and the same, reduced to 46.3 ± 4.1 after Progressive Muscle Relaxation techniques. The mean reduction was 10.9 ± 5.8, and was statistically very highly significant (P<0.001). The result revealed that Progressive muscle relaxation was effective in reducing the level of stress and anxiety in elderly.
Cholina Trisa Siregar, Rizki Annisa Nasution (2017), conducted pre experimental study to assess the effectiveness of progressive muscle relaxation techniques on fatigue level among patients undergoing hemodialysis in selected hospitals in Medan at Indonesia.20 samples were selected by purposive sampling technique. The level of fatigue patients before given the Progressive muscle relaxation techniques that is mild fatigue as much as 4 respondents (20%), moderate as much as 6 respondents (30%) and severe as much as 10 respondents (50%). Fatigue levels after the patient given progressive muscle relaxation technique that is not fatigue as much as 4 respondents (20%), mild as much as 6 respondents (30%) and moderate as much as 10 respondents (50%). There is significant difference between the mean fatigue level before and after given progressive muscle relaxation technique (p <
0.000). The results shows progressive muscle relaxation techniques can reduce fatigue level among hemodialysis patients.
Ms.Palak Patel (2014), conducted pre experimental study to assess the effectiveness Of Progressive Muscle Relaxation techniques on stress among staff nurses working in selected hospitals at Vadodara City, Gujarat. 30 staff nurses were selected by non probability convenient samplingtechnique.The findings of the study revealed that in pre test most of the nurses 53.3%
had moderate stress, 40.0% had mild stress and 6.7% had severe stress. In post test most of the nurses had mild stress 73.3 % and no stress 26.7 % . It is concluded that Progressive Muscle Relaxation Therapy is effective in reducing the stress level of the staff nurses.
Kumutha.V, Dr.Aruna S, Poongodi.R (2014), conducted experimental study to assess the effectiveness of Progressive Muscle Relaxation techniques on stress and hypertension among elderly people with hypertension in selected village, Vayalanallur at Thiruvallur. Sixty elderly with hypertension were selected by Lottery method of sampling Stress level was assessed by perceived stress scale (PSS) and blood pressure was measured by sphygmomanometer. The study group (n=30) demonstrated the progressive muscle relaxation technique for 20 minutes for 21 days. Control group followed routine activities. The data were collected at four phases: The survey (pretest), demonstration of PMR, practice of PMR for 21 days, posttest on the 22ndday after intervention. During posttest the stress and blood pressure were measured. There were considerable variations in level of stress and blood pressure in the posttests as viewed with the pretest score of the study group at P<0.001. The outcome showed substantial variations in the study group which when compared with the control group at p<0.001 on stress, systolic blood pressure and p<0.05 on diastolic blood pressure. The result highlighted Progressive Muscle Relaxation technique to be an effective method to decrease the stress and blood pressure among elderly with hypertension.
Sheetal Barde (2013), was conducted experimental study to assess the effectiveness of progressive muscle relaxation technique on generalized anxiety of elderly orthopedic patient in selected hospitals of Pune City. 40 elderly orthopaedics patients from selected hospitals of Pune City, were selected by random assignment technique. A Modified state trait Anxiety Inventory Scale was used to collect data from the subjects. In the pre intervention stage, the anxiety level in elderly orthopaedic patients in experimental and control groups revealed that anxiety tended to differ from the mean by ± 5.16 in control group and ±8.15 in experimental group, whereas in post intervention stage, there was a significant mean anxiety reduction that tended to differ from the mean by ± 4.938 in control group and ± 4.426 in experimental group.
Findings indicated that the Jacobson Progressive muscle relaxation technique was effective for anxiety reduction among elderly orthopaedic patients.
Literature Related To stress and coping among cancer patients
N.Subhashini (2015), conducted cross sectional descriptive study to assess the coping strategies among breast cancer patients in medical oncology ward, SVMIS at Tirupati. 100 breast cancer patients were selected by non probability convenient sampling technique.
Modified folk man and Lazarus ways of coping scale was used to assess the coping strategies.
Findings revealed that, 52% had moderate level of coping, 28% had adequate level of coping and 20% had low level of coping. There was an association between the escape avoidance and residence with the chi square value of 9.619,and positive reappraisal and second stage of breast cancer with the chi square value of 17.67 significant at P<0.05 level. The study suggest that, a majority of breast cancer patients were having moderate level of coping.
Vaishali R Mohite , Prabhuswami Hiremath , Prakash Naregal (2014), conducted descriptive study to assess the level of stress and its coping strategies among cancer patients in selected hospital of Punjab. 200 cancer patients were selected by convenience sampling technique. Findings of the study has shown that profound level 73% of stress present in cancer patients and 90% cancer patients use poor coping strategies.
S.Lavanya, Dr. Nalini Jayavandha Sandha, Dr. Gowri sethu (2014), conducted cross sectional
descriptive study to assess the level of stress among women with selected type of cancer in Erode cancer center at Erode. 50 women with cancer were selected by purposive sampling technique. All participants were interviewed a questionnaire to complete; questions were related to Baseline Proforma of women and Rating scale on The Impact of Event Scale (IES) and participants were given 20 minutes to complete the questionnaire. The findings revealed that the stress among women with breast cancer shows that, majority (70%) of the samples had severe stress, and 30% of them had moderate stress, whereas women with cervical cancer 10 % were had mild stress, 30 % were had moderate stress and 60 % were had severe stress. It shows that breast cancer patients had more stress compared to cervical cancer patients.
Simin Bemana (2011), conducted quantitative study to examine the effects of coping skills on stress between women diagnosed with cancer in Shiraz Amir oncology Hospital at Iran. The sample consisted of 105 cancer patient selected by convenience sampling technique.
We evaluated in 105 women's cancer patients their stress levels using the Hospital Anxiety and stress Scale and their coping strategies using the Ways of Coping Checklist. Results showed that 16 (15%) of cancer patients had severe level of stress and low level of coping strategies.
Skaali, (2010) Conducted a descriptive study on psychological distress among men with testicular cancer associated with their neuropsychological test performance in The Norwegian Radium Hospital, Norway. 135 Testicular cancer patients were selected by purposive sampling technique. They completed the Impact of Event Scale (IES) as a measure of Cancer Related Distress at a median of 37 days after diagnosis. They also completed the Hospital Anxiety and Depression Scale (HADS) and the Positive and Negative Affect Schedule (PANAS). Among 135 Testicular Cancer Patients, 131 were interviewed and 129 were also tested with a neuropsychological battery. The results showed that 24 % of the patients are experiencing cancer related distress.
Parameswara. J (2009) conducted a descriptive study on Psychosocial problems of cancer patients in selected hospitals Kidwai at Bangalore. 2402 cancer patients were selected by purposive sampling technique. It shows that patient perceived high stress by worrying on the side effects of treatment like loosing organ (61%), breast and other organs, hair loss as a result of surgery, chemotherapy and radiotherapy. The result was revealed that out of 2402 cancer patients, 1078 (45.8%) had stress.
Bevearnes, (2000) conducted a descriptive study to evaluate stress among cancer patients in selected hospital at Germany. 127 breast cancer patients selected by convenience sampling technique. Patients with breast cancer (n = 127) were assessed for PTSD (Post traumatic stress disorder) immediately after cancer diagnosis and 6 months after the first assessment. The assessments included screening instruments, such as the Impact of Event Scale-Revised (IES-R) and the PTSD Checklist-Civilian (PCL-C). The first assessment also
included a semi structured interview (questionnaire). On the basis of the questionnaire 3.4% of participants met the criteria for mild-to-moderate cancer-related PTSD. However, the screening instruments IESR and PCL-C identified PTSD in 18.5% of participants at the first assessment and 16.3% of participants at the second assessment. Authors of the study suggest that cancer patients tend to have more stress which affected their quality of life
Literature related to effectiveness of Progressive muscle relaxation techniques on Stress and coping among cancer patients
Masoomeh Noruzi, Behnam, Simazaheidi (2019), conducted experimental double group study to assess the effectiveness of progressive muscle relaxation techniques among cancer patients at Ayatollah Khansari hospital in Iran. This study was a clinical trial in which 80 patients suffering from cancer were randomly assigned to two groups of experimental and control. Data collection instruments consisted of demographic information and Strategies Used by People to Promote Health questionnaires. In the experimental group, the patients performed relaxation techniques once a day for 30 min over two months. In the control group, the patients received the routine care. The mean score of the patients' self-efficacy in the experimental group was 107.05±9.46 before the intervention that reached 115.85±8.98 after it. In addition, the means of this index in the control group were 106.35±11.67 and 100.35±12.46 before and after the intervention, respectively. Based on the results of ANOVA test, there was a statistically significant difference between the mean self-efficacy indices in the experimental group (p=0.001). However, the difference was not significant for the control group (p=0.3).
Furthermore, the results of the ANOVA test revealed that there was a statistically significant difference between the means of self-efficacy test in both experimental and control groups after the intervention (p=0.001). A statistically significant difference was observed between the mean self-efficacy indices in the experimental group (p=0.001). There was no significant difference in the control group (p=0.3). Progressive muscle relaxation can enhance self-efficacy of cancer patients. Therefore, it can be used as an alternative method for patients who are willing to use this technique.
