EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING TECHNIQUE ON MOTIVATION FOR A CHANGE AMONG
ALCOHOL DEPENDENCE CLIENTS OF SELECTED DE-ADDICTION CENTRE IN NAGERCOIL AT
KANYAKUMARI DISTRICT.
DISSERTATION SUBMITTED TO
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
APRIL 2012
EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING TECHNIQUE ON MOTIVATION FOR A CHANGE AMONG
ALCOHOL DEPENDENCE CLIENTS OF SELECTED DE-ADDICTION CENTRE IN NAGERCOIL AT
KANYAKUMARI DISTRICT.
BY
Miss. K.V.RUBIA LINZI
DISSERTATION SUBMITTED TO
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
APRIL 2012
SRI.K.RAMACHANDRAN NAIDU COLLEGE OF NURSING
Affiliated To The Tamilnadu Dr. M.G.R. Medical University, K.R. Naidu Nagar, Sankarankovil, Tirunelveli District-627 753
Tamilnadu.
CERTIFICATE
This is a bonafide work of Ms. K.V.RUBIA LINZI. M.Sc., NURSING (2010-2012 Batch) II year student of Sri. K.Ramachandran Naidu College of Nursing, Sankarankovil-627 753. Submitted in partial fulfillment for the Degree of Master of Science in Nursing, under The TamilNadu Dr.M.G.R.Medical university, Chennai.
SIGNATURE:
________________Prof. Mrs.N.Saraswathi,
M.Sc. (N)., Ph.D (N)., Principal,Head of the Department of Paediatric Nursing Sri K. Ramachandran Naidu College of Nursing Sankarankovil (Tk), Tirunelveli (Dist).
COLLEGE SEAL
A QUASI EXPERIMENTAL STUDY TO ASSES THE EFFECTIVENESS OF MOTIVATIONAL INTERVIEWING TECHNIQUE ON MOTIVATION FOR A CHANGE AMONG
ALCOHOL DEPENDENCE CLIENTS OF SELECTED DE-ADDICTION CENTRE IN NAGERCOIL AT
KANYAKUMARI DISTRICT.
APPROVED BY THE DISSERTATION COMMITTEE ON PROFESSOR IN NURSING RESEARCH
Prof. (Mrs). N. SARASWATHI, M.Sc.(N), Ph.D (N ) Principal,Head of the Department of Pediatric Nursing, Sri.K.Ramachandran Naidu College of Nursing,
Sankarankovil, Tirunelveli-627 753 TamilNadu.
CLINICAL SPECIALITY GUIDE
Associate Prof. Mr. S. ANAND, M.Sc. (N), HOD of Mental Health (Psychiatric) Nursing, Sri.K.Ramachandran Naidu College of Nursing, Sankarankovil, Tirunelveli-627 753
TamilNadu.
MEDICAL GUIDE
Dr. C. PANNEER SELVAN, M.B.B.S, M.D (Psychiatry), Sneka Mind Care Centre,
South Bye Pass Road, Tirunelveli-627 005 TamilNadu.
[
DISSERTATION SUBMITTED TO
THE TAMILNADU DR.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILLMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
APRIL 2012
ACKNOWLEDGEMENT
I thank God Almighty and my immense belief on him which helped me in each and every step for enabling me to undertake this programme and to complete my dissertation to my optimal satisfaction.
At the outset, I the researcher of this study express my heartfelt gratitude to Mr. R. Vivekanandan, Chairman and Mrs. G. Prem Santha, Managing Trustee of Sri.K. Ramachandran Naidu College of Nursing for the precious opportunity given for me to be a part of this esteemed institution.
I consider myself to be esteem fortunate to express my deepest gratitude to Professor. (Mrs). N. Saraswathi, Principal, Head of the Department of Pediatric Nursing, Sri. K. Ramachandran Naidu College of Nursing who taught the concept of research and her constant support, encouragement, enlightening ideas and expert guidance throughout my research.
I am indeed greatly indebted to Associate Prof. (Mrs). Subbalakshmi, Class Coordinator, M.Sc(N) 2nd year, for her constant supervision, patience and valuable suggestion which helped me in completion of my study successfully.
My deepest gratitude and immense thanks to Associate Prof.(Mr).S. Anand, Head of the Department of Mental Health (psychiatric) Nursing for his constant source of inspiration, guidance and encouragement, which was a key for the successful completion of the study.
I owe my profound gratitude and sincere thanks to the Medical expert Dr. C. Panneer Selvan, Psychiatrist, for his valuable guidance and expert opinion in
successful completion of the study.
I express my humble gratitude and sincere thanks to Mrs. A. Kavitha, Lecturer and Mr. C. Selgin Leons, Lecturer of mental health nursing department for their guidance and suggestions for the completion of the study.
I extend my grateful thanks and honor to all the medical and nursing experts for giving their valuable guidance and suggestion towards modification of the tool for data collection.
I extend my deep gratitude to Dr. Najaar who has supported me with his patience and knowledge whilst allowing me the room to work in my own way.
I extend my sincere gratitude and thanks to Mr. Senthil Kumar, Statistician for his guidance in analysis and presentation of the data.
I extend my deep sense of gratitude and thanks to the clients and care givers for their cooperation and without whom the completion of the study could not be possible.
I owe my thanks to the librarians of Sri. K. Ramachandran Naidu College of Nursing for their help in procuring books whenever required.
My immense and deep gratitude to all my teachers who taught the concepts of nursing and to all my colleagues and friends for their love, concern, prayers and encouragement.
I extend my deep gratitude to Mr. Kumar for his constant help and support through out the study.
I am very much grateful to Mrs.VasanthaBai, for editing this manuscript in English patiently.
I am very much grateful to Mrs. T. Vimala Bai, for editing the contrivance in Tamil patiently.
Word cannot express my deep happiness, love, sincere appreciation and grateful thanks to my parents Mr. T. Kesari and Mrs. T. Vimala Bai, and my sister Ms. K.V. Kisholin Mercyba for their constant support throughout the study.
.
TABLE OF CONTENTS
CHAPTER No.
CONTENTS PAGE No.
I INTRODUCTION 1-14
Background of the study 1
Need for the study 4
Statement of the problem 9
Objectives 9
Hypotheses 10
Operational Definitions 10
Assumptions 11 Delimitations 11
Projected Outcome 12
Conceptual framework 13
II REVIEW OF LITERATURE 16-31
Review of related literature 16
III RESEARCH METHODOLOGY 32-40
Research approach 32
Research design 32
Variables 33
Setting of the study 33
Population 33 Sample 33
Sample size 33
Sampling technique 34
Criteria for the selection of samples 34 Development and description of the tool 34
Intervention 35
Content validity 36
Reliability 36
Pilot study 36
Data collection procedure 37
Plan for data analysis 38
Protection of human subjects 39
IV DATA ANALYSIS AND INTERPRETATION 41-64
Organization of data 41
Presentation of data 43
V DISCUSSION 65-69
VI SUMMARY, CONCLUSION, IMPLICATIONS, LIMITATIONS AND RECOMMENDATIONS.
70-76
BIBILIOGRAPHY APPENDICES
LIST OF TABLES
TABLE No.
TITLE PAGE No
. 1 Frequency and percentage distribution of demographicvariables of the alcohol dependence clients with respect to age, education, occupation, monthly income, marital status, type of family and duration of taking alcohol.
43
2 Frequency and percentage distribution of pre test level of motivation for a change among Experimental group and control group of alcohol dependence clients.
51
3 Frequency and percentage distribution of post test level of motivation for a change among experimental group and control group of alcohol dependence clients.
53
4 Mean and standard deviation of the pre test level of motivation for a change between experimental group and Control group.
55
5 Mean and standard deviation of the post test level of motivation for a change between experimental group and Control group.
57
6 Mean and standard deviation of pre and post test level motivation for a change among experimental group and control group.
59
7 Association of post test level of motivation for a change of experimental group with their selected demographic variables.
61
8 Association of Post test level of motivation for a change of control group with their selected demographic variables.
63
LIST OF FIGURES
FIGURE
No TITLE
PAGE No
1. Stages of Change 8
2. Conceptual Framework based on Imogene King’s Goal Attainment Theory
15
3. Schematic representation of research design 40 4. Percentage distribution of Age in years among experimental
group and control group.
47
5. Percentage distribution of Education among experimental group and control group.
47
6. Percentage distribution of Occupation among experimental group and control group.
48
7. Percentage distribution of Monthly Income among experimental group and control group.
48
8. Percentage distribution of Marital status among experimental group and control group
49
9. Percentage distribution of Type of Family among experimental group and control group.
49
10. Percentage distribution of Duration of Taking Alcohol among experimental group and control group.
50
11. Percentage distribution of Pre test level of motivation for a change among experimental group and control group.
52
12. Percentage distribution of post test level of motivation for a change among experimental group and control group
54
13. Mean of the pretest level of motivation for a change between experimental group and control group.
56
14. Mean of the post test level of motivation for a change between experimental group and control group.
58
15. Mean of the pre and post test level of motivation for a change among experimental group and control group.
60
LIST OF APPENDICES
APPENDIX TITLE
A Letter seeking and granting permission for conducting the study B Letter seeking experts opinion for content validity
C List of experts for content validity D Certificate of English editing.
E Certificate of tool editing in Tamil F Certificate for informed consent
G Copy of tool for data collection-English H Description of Tool and Scoring Key
I Copy of Tool for Data collection-Tamil J Content Validity Certificate
ABSTRACT
A quasi experimental study to assess the effectiveness of motivational interviewing technique on motivation for a change among alcohol dependence clients of selected de-addiction center in Nagercoil at Kanyakumari district was conducted by Ms.K.V. Rubia Linzi in partial fulfillment of the requirement for the degree of Master of Science in nursing at the Sri.K.Ramachandran Naidu College of nursing, under the Tamil Nadu Dr.M.G.R. Medical University, Chennai in 2012.
The objectives of the study were:
1) To assess the pre test level of motivation for a change among alcohol dependence clients in experimental group and control group.
2) To find out the effectiveness of motivational interviewing technique on motivation for a change among experimental group and control group of alcohol dependence clients.
3) To compare the pre test and post test level of motivation for a change among alcohol dependence clients in experimental group.
4) To associate the post test level of motivation for a change among alcohol dependence clients in experimental group and control group with their selected demographic variables.
The following hypotheses were set for the study:
All hypotheses were tested at 0.05 levels.
H1: The mean post test level of motivation for a change among alcohol dependence clients in experimental group was higher than their mean post test level of motivation for a change in Control group.
H2: The mean post test level of motivation for a change among alcohol dependence clients was higher than their mean pre test level of motivation for a change in experimental group.
H3: There was a significant association between the post test level of motivation for a change in experimental group and control group with their selected demographic variables.
The study was based on Imogene King’s Goal Attainment Model. The quantitative approach was used. The study was conducted in Madhu Adimaigal Maruvaalvu Maiyam in Nagercoil. The designs adopted for the study were quasi experimental with pre and post test control group design to evaluate the effect of motivational interviewing technique on motivation for a change. Convenient sampling was used to select 60 alcohol dependence clients for experimental and control group.
The data collection tools developed for generating the necessary data by using a likerts scale to assess the effectiveness on motivation for a change. The content validity of the tools was established by five clinical experts. The motivational interviewing technique on motivation for a change was validated by clinical experts.
Pilot study was conducted to find out the feasibility of the study and to plan for data analysis.
Data collection was done and the data obtained were analyses in terms of both descriptive and inferential statistics.
The significant findings of the study were:
1. The mean post test level of motivation for a change among alcohol dependence clients in experimental group was higher than their mean post test level of motivation for a change in control group at p<0.05 level (t=2.91).
2. The mean post test level of motivation for a change among alcohol dependence clients was higher than their mean pre test level of motivation for a change in experimental group at p<0.05 level (t=3.64).
3. There was no significant association between the post test level of motivation for a change in experimental group and control group with their selected demographic variables at p< 0.05levels.
On the basis of the findings of the study it is recommended that, 1. A similar study can be conducted by increasing the sample size.
2. A study can be conducted on other problems of alcohol dependence clients.
3. A study can be performed by developing a self-instructional module which enables the care givers to become aware of motivational interviewing technique and its benefits.
4. A further study can be conducted to assess the knowledge, attitude and practice of nursing personnel in motivational interviewing technique among alcohol dependence clients.
Recommendation based on the suggestions of the study subjects:
1. The nursing person should develop in-depth knowledge about the motivational problems of alcohol dependence clients.
2. Certification programs for training in motivational interviewing technique for health personnel should be started in hospitals.
3. Staff development programs for imparting education and training regarding motivational interviewing technique.
Conclusion:
From this study it was evident that motivational interviewing technique was effective on motivating the alcohol dependence clients for a change.
1
CHAPTER 1
INTRODUCTION
“When someone is telling you that you can't do something, don’t quit, just smile and say I'll show you."
-...Sir Anthony GyanOsign
BACKGROUND OF THE STUDY
In this modern world people drink because they are happy, sad, bored. They drink without reason or simply because drinking has become a lifestyle. Advertising banners or TV commercials are invaded by messages that spur to alcohol consumption followed by hypocritical warning that "alcohol consumption might cause severe harm". However, nobody can tell where the problem starts, so people continue to drink.
Alcohol dependence is a chronic disease that is often progressive and fatal.
Alcohol dependence has no one single cause and not directly passed from one generation to another genetically. Rather, it is the result of a complex group of genetic, psychological, and environmental factors. Signs that indicate a person is intoxicated include the smell of alcohol on their breath or skin, glazed or bloodshot eyes, the person being unusually passive or argumentative, and/or deterioration in the person's appearance or hygiene. Other physical symptoms of the state of being drunk include flushed skin, slurring words, vomiting etc. Cognitively, the person may experience decreased ability to pay attention and a propensity toward memory loss.
An individual who is dependent upon alcohol typically uses it to avoid personal and social factors in his or her life. The four symptoms of alcohol dependence include:
2
craving for alcohol, inability to reduce or stop alcohol consumption, experience withdrawal symptoms when stopping alcohol consumption and increased tolerance of alcohol.
Health-care practitioners diagnose alcohol abuse or dependence by gathering comprehensive medical, family, and mental-health information. The practitioner will also either perform a physical examination or request that the individual's primary- care doctor perform one. The medical examination will usually include lab tests to evaluate the person's general health and to explore whether or not the individual has a medical condition that might have mental-health symptoms.
There are numerous individual treatments for alcoholism. Individualized drug counseling specifically emphasizes short-term behavioral goals in an attempt to help the individual reduce or stop the use of alcohol altogether. Cognitive-therapy techniques, helping the individual with alcohol dependence recognize what tends to precede and follow their episodes of alcohol use, are often used to address alcohol abuse. Some treatment programs include drug testing, twelve-step recovery programs like Alcoholics Anonymous and individualized drug-counseling methods.
Motivational enhancement therapy encourages the person suffering from alcoholism to increase their desire to participate in therapy. Stimulus control refers to a treatment method that teaches the alcohol-dependent person to stay away from situations that are associated with alcohol use and to replace those situations with activities that are contrary to using alcohol. Urge control is an approach to changing patterns that lead to drug or alcohol use.
3
The line between problematic and non problematic alcohol use is different for each individual, but some common criteria for problem drinking include repeated binge drinking episodes, driving while under the influence of alcohol or drugs, drinking negatively impacts works, health or important relationships. David Prescott (2011).
People with certain variations in a gene called GABRA2 are at a higher risk for alcoholism. Genetic factors, externalizing personality traits such as impulsivity and brains processing of salient stimuli can all effect individual risk for alcoholism.
Indra Cidampi (2011).
Australians drink a large volume of alcohol and drink it frequently. In 2007 the per capita consumption of alcohol for Australians over 15 years was nearly 10 liters. This is high by world standards. 90% Australians over 14 years had consumed alcohol in their lifetime (an estimated 14.2 million people), 40% drank alcohol weekly, and 8% drank daily. While many young Australians drink frequently, the highest proportions of daily drinkers in 2007 were those over 60 year’s old. The proportion of Australians over 14 years of age who had never consumed alcohol increased by a small degree between 2004 and 2007, and the proportion who drank daily declined by a small degree in that period. Australian Medical Association (AMA) (2009).
Alcoholics Anonymous (AA) is an international organization of recovering alcoholics that offers emotional support through self-help groups and a model of abstinence for people recovering from alcohol dependence, using a 12-step approach.
AA may help patients to accept treatment and keep patients in treatment more than alternative treatments. Ferri M, Amato L, Davoli M (2006).
4
NEED FOR THE STUDY
It is estimated that 1 in 10 people worldwide are either alcoholic or border line alcoholic. Addiction is an obsession which is scented in the mind. Physical craving can only occur when alcohol is in the body. For an alcoholic who has not drank for a while, it is the mind that will convince him that he needs to drink, and the moment he does the physical craving kicks in and keeps telling him to pour more in regardless of the consequences. The mind and the body work very well together with addictive personality types. Alcoholism adversely affects people from every religious affiliation, race, gender, income group, occupation, political party, and nationality.
The younger the person when begin drinking, more likely they are to develop a problem with alcohol. Girls who drink heavily said they have attempted suicide compared to girls who do not drink. More people die in car crashes each year in which under age drinking is involved. Alcohol is involved in nearly half of all violent deaths involving teens. Teen who drink are more likely to engage in sexual activity, have unprotected sex, have sex with a stranger, or be the victim or perpetrator of a sexual assault. Excess alcohol use can cause or mask other emotional problems, like anxiety or depression.
People seeking help for their alcohol or other drug problems enter treatment with very different levels of motivation for a change. Differences in motivation appear to make a critical difference in which patients seek, comply with, and complete treatment. There are a number of different ways to talk about motivation in the form of stages of Change. The model conceptualizes motivation as a level of readiness to change and self-efficacy as a combination of temptation to drink alcohol and confidence to abstain from drinking. Researchers need to focus their research and
5
clinical work on tailoring treatment approaches to patients based upon the stage of their disease, the patient's stage or level of motivation, their self-efficacy, and biological responsiveness to medications.
Alcohol has been linked to more than 60 different medical conditions including cirrhosis of the liver, inflammation of the gut and pancreas, heart and circulatory problems and sleep disorders.
Consumption of alcohol affects concentration, coordination, judgment, and slows response time to unexpected situations. Alcohol alters brain receptors and can result in an increased likelihood of risk-taking with impaired problem-solving in conflict situations and increasing the risk of aggressive behavior. Alcohol consumption also increases the risk of mental illness, such as depression, in people who are prone to these conditions. A range of individual, social and economic factors can contribute to the excess or harmful use of alcohol. Australian Medical Association (AMA) (2009).
Alcoholism can increase the risk for certain cancers, especially those of the throat, voice box (larynx), liver, colon, kidneys, rectum, and the esophagus. Excessive drinking can also cause immune system problems, brain damage, harm to the fetus during pregnancy, and cirrhosis of the liver. Approximately 43% of American adults have had a child, parent, sibling or spouse who is or was an alcoholic. Around 6.6 million American children under the age of 18 live in homes with at least one alcoholic parent. More than one-half of American adults have a close family member who has or has had alcohol addiction. More than seven percent of the population aged 18 years and older has problems with drinking. 50% of high school seniors reported that they drank alcohol in the past 30 days, with 32% of them
6
reporting that they were drunk at least once. According to one U.S. survey, almost 20% of 8th-graders, and 41% of 10th-graders have been drunk at least once.
The average U.S. 18-year-old has seen 100,000 television commercials encouraging him or her to drink. In 2002, U.S. alcoholism statistics reported that 2.6 million binge drinkers were between the ages of 12 and 17. Jeff Gardere et al (2010)
In a nation with a big population of 1 billion individuals, 7.5 crore Indians are drug addicts. Drug and alcohol abuse is becoming an area of interest in the Indian community. The actual preponderance values inside the age group of 12-18 age was Alcoholic Drink (preceding21), Cannabis (3), Opiates (0.7) and other illicit drugs (3.6 per cent). According to the survey a high concentration of drug addiction goes in certain friendly sections and high-risk groups, much as, commercialized sex workers, transportation workers and street kids. Among full the provinces, usage is higher in North Eastern states/border areas and opium development areas of the nation. The National Survey in India(2007).
A study by NIMHANS has shown that the average age of initiation has reduced from 28 years during the 1980s to 20 years in the recent times. The National Survey (study sponsored by the Ministry of Social Justice and Empowerment and the United Nations Office on Drugs and Crime, 2004) revealed that among adult men, about 21% were current drinkers and about 17% were regular user of alcohol, and among those seeking treatment about 44% were alcohol users. Our nation traditionally has a dry or abstaining culture yet now it has one of the largest alcoholic beverage industries in the world. We are the dominant producer of alcohol in the South East Asia region (65%) and contribute to about 7% of the total alcohol beverage imports into the region. The increasing production, distribution, promotion and easy
7
availability of alcohol coupled with the changing value of society and Illiteracy have resulted in a big challenge for the country in the absence of advocacy, research documentation and a National Policy on Alcohol. The Indian Alcohol Policy Alliance (IAPA) (2007).
Motivational interviewing technique recognizes and accepts the fact that clients who need to make changes in their lives approach counseling at different levels of readiness to change their behavior. If counseling is mandated they may never have thought of changing the behavior in question some may have thought about it but not taken steps to change it. Others especially those voluntarily seeking counseling may be actively trying to change their behavior and may have been doing so unsuccessfully.CM Murphy (2009).
Motivational interviewing technique is a therapeutic approach for helping the people to make changes in their lives. This has been applied effectively to the treatment of addictions. The sprit of motivational interviewing is based on three concepts, collaboration between the therapist and the person with the addiction, rather than confrontation by the therapist, drawing out the individual’s ideas, rather the therapist imposing their ideas and autonomy of the person with the addiction rather than the therapist having authority over them. Elizabeth Hartney (2008).
There are five primary stages that people move through as they seek to make changes in their lives. These stages have been named precontemplation, contemplation, preparation, action and maintenance.
co co re p th
d ab ch en in m
Durin onsider mak onfidence, a eady to con erson may h he drawback
The p etermined to bout change hanges. Afte ntered the ac n the prepar moves into th
ng the pre-co king a chan and sometim nsider chang have mixed f ks to change
preparation s o change. A e, then he is
er an individ ction stage.
ration stage.
he maintenan
Fig 1:
ontemplation nge in his mes he may a
ge, he enters feelings abo
and sometim
stage occurs After he has s prepared to dual has beg
During this After these nce stage. T
Stages of c
n stage, a p life. Somet actually be r s the contem
ut making a mes seeing th
s when an in s resolved h
o make plan gun to take th stage, a pers e new habit This final sta
change
person is no times a per
resistant to c mplation sta a change in h he benefits.
ndividual ha his conflictin ns and to ta he necessary son enacts th s become e age of the ch
ot yet ready son lacks m change. Afte age. During his life, som
as become r ng thoughts ake action to
y steps for ch he plans or g stablished, t hange proces
y to seriousl motivation o
er a person this stage, metimes seein
ready for an and feeling oward desire hange, he ha goals outline then a perso ss can last fo 8
ly or is a ng
nd gs ed as ed on or
9
an indefinite period of time, but individuals may experience periodic relapses into pre-change behavior. James Prochaska, John Norcross and Carlo DiClemente (2001).
Hence the investigator selected motivational interviewing technique as an intervention to improve the motivational readiness of the alcohol dependence clients.
STATEMENT OF PROBLEM
A quasi experimental study to assess the effectiveness of motivational interviewing technique on motivation for a change among alcohol dependence clients of selected de-addiction centre in Nagercoil at Kanyakumari district.
OBJECTIVES
1. To assess the pre test level of motivation for a change among alcohol dependence clients in experimental group and control group.
2. To find out the effectiveness of motivational interviewing technique on motivation for a change among experimental group and control group of alcohol dependence clients.
3. To compare the pre test and post test level of motivation for a change among alcohol dependence clients in experimental group.
4. To associate the post test level of motivation for a change among alcohol dependence clients in experimental group and control group with their selected demographic variables.
10
HYPHOTHESES
H1: The mean post test level of motivation for a change among alcohol dependence clients in experimental group will be higher than their mean post test level of motivation for a change in Control group.
H2: The mean post test level of motivation for a change among alcohol dependence clients will be higher than their mean pre test level of motivation for a change in experimental group.
H3: There will be a significant association between the post test level of motivation for a change in experimental group and control group with their selected demographic variables.
OPERATIONAL DEFINITIONS
Assess:
It is the process of systematically collecting and interpreting the client’s level of motivation for a change in pre test and post test.
Effectiveness:
It refers to improving the level of motivation for a change among alcohol dependence clients by motivational interviewing technique measured by Prochaska and DiClemente’s readiness to change questionnaire.
Motivational interviewing technique:
A client centered communication style that helps the alcohol dependence clients to clarify and resolve ambivalence about stages of change.
11
Motivation for a change:
It refers to the driving force which causes the alcohol dependence clients to move through stages of change.
Alcohol dependence clients:
The persons who are taking treatment for alcohol addictionin the selected de-addiction centre.
De-addiction centre:
It refers to Madhu Adimaigal Maruvalvu Maiyam in which alcohol dependence clients get treatment and move themselves towards a path of permanent detoxification.
ASSUMPTIONS
1. Alcohol clients admitted in the de-addiction centre may have low level of motivation for a change.
2. Motivational interviewing technique enhances the level of motivation for a change.
3. Alcohol clients level of motivation for a change may vary depending
upon
their demographic variables.
DELIMITATIONS
1.
The study is delimited to the clients who are in de-addiction centre.2.
The study is delimited to 4 weeks.12
PROJECTEDOUTCOME
1. Administration of Motivational Interviewing Technique will improve the clients level of motivation for a change.
2. The findings of the study will help the nurse to administer Motivational Interviewing Technique to improve the level of motivation for a change among alcohol dependence clients.
13
CONCEPTUAL FRAMEWORK
The conceptual framework provides the perspective from which the investigator views the problems. The study bases the concept that the administration of selected nursing measures i.e. Motivational Interviewing Technique to alcohol dependence clients will enhance their motivation for a change.
The investigator adopted the Imogene King’s Goal Attainment Theory as a base for developing the theoretical framework. Imogene King’s Goal Attainment Theory was proposed by Imogene King in 1890. The Goal Attainment theory was based on the personal and interpersonal systems, which includes the following:
¾ Interaction
¾ Perception
¾ Communication
¾ Transaction
¾ Stress
¾ Growth and development
¾ Time and action
Perception
It refers to person’s representation of reality. It is universal yet highly subjective and unique to each person. Here the investigator perceives that the alcohol dependence clients may have low level of motivation for a change. They too perceive that there was low level of motivation for a change among them.
14
Judgement
The investigator judged that motivational interviewing technique improves the level of motivation for a change among alcohol dependence clients. Alcohol dependence clients judged the need to improve their level of motivation for a change.
Action
The investigator implements the motivational interviewing technique. Alcohol dependence clients set willingness to participate in the study.
Reaction
The investigator and the alcohol dependence clients set mutual goals.
Interaction
It refers to the verbal and non verbal behavior of individual and the environment and between two or more individuals with a purpose to achieve goal.
Here the investigator provided motivational interviewing technique to improve the level of motivation for a change.
Transaction
It refers to the behavior of individual interaction with their environment to achieve desired goal. At this stage the investigator analyze the level of motivation for a change among alcohol dependence clients in order to implement action. If positive outcome is achieved then the intervention is said to be effective, if there is a negative outcome reassessment to be done.
15
BIBLIOGRAPHY
BOOKS
1. Ahuja. (1999). A Short Text Book of Psychiatry, (3rd Ed). New Delhi: Jaypee Brother’s medical Publications.
2. Basavanthappa, B.T. (1998). Nursing Research, (1st Ed).Bangalore: Jaypee Brother’s medical Publications.
3. Basavanthappa, B.T.(2007).Psychiatric MentalHealth Nursing,(3rd Ed) Bangalore:
Jaypee Brother’s medical Publications.
4. Bhatia, M. S. (2004). Essentials of psychiatry, (4th Ed). Mumbai: CBS Publishers and Distributors.
5. Bimla Kapoor. (1994). Psychiatric Nursing, (1st Ed). Bangalore: Kumar Publishing House.
6. Colin R. Martin. (2001). Identification and treatment of alcohol Dependency, (9th Ed). Newyork: Guilford Publications.
7. Daniel. (2007). Biostatistics: A Foundation for analysis in the Health Sciences,(2nd Ed). Philadelphia: John Wiley & Sons Publications.
8. Diclemente, Carlo (2004). Stages of change and addiction: clinician's manual, (4th Ed). Minnesotta : Hazelden Publications.
9. Gelder, Gath, Mayou, & Cowen. (2000). Oxford Text Book of psychiatry,(5th Ed). London: Oxford University Press.
10. Gerard Joseph Connors, Dennis Michael Don.(2001). Substance abuse treatment and the stages of change, (5th Ed). Newyork: Guilford Publications.
11. Mahajan, B. K (1997). Methods in Biostatistics, (6th Ed). Bangalore: Jaypee Brother’s Publications.
12. Mceven, & Wills, (2007). Theoretical Basis for Nursing. (7th Ed). Philadelphia:
Lippincott William & Wilkins Publications.
13. Meleis. (2006). Theoretical Nursing. Development and Progress, (2ndEd) Philadelphia: Lippincott William & Wilkins Publications.
14. Miller, R.William & Rollnick, Stephen (2002). Motivational interviewing.
preparing people for change, (1st Ed). Newyork: Guilford Publications.
15. Neeb. (2008). Fundamentals of Mental Health Nursing, New Delhi: Jaypee Brother’s Publications.
16. Neeraja, K . P. (2008). Essentials of Mental Health and Psychiatric Nursing, (Vols 1- 2). Bangalore: Jaypee Brothers Publications.
17. Nieswiadomy. (2008). Foundations of Nursing Research,(4th Ed). Manipal:
Pearson Education Publications.
18. Polit, F., & Beck. (2008). Nursing Research ,(9th Ed). New Delhi: Lippincott William &Wilkin’s Publications.
19. Rebraca. (2008). Basic concepts of Psychiatric – Mental Health Nursing, (3rd Ed). New York: Lippincott William & Wilkins Publications.
20. Smith, Jane Ellen & Meyers, J.Robert (2004). Motivating Substance Abuses to Enter Treatment,(5th Ed). Newyork: Guilford Publications.
21. Sreevani, R. A. (2007). Guide to Mental Health and Psychiatric Nursing,(2nd Ed). Bangalore: Jaypee Brothers Publications.
22. Stuart, W., & Laraia. (2005). Principles and Practice of Psychiatric Nursing. (9th Ed). New York: Elsevier Publications.
23. Sundar Roa, P. S. S (1999). An introduction to biostatistics. A manual for students in health sciences, (1st Ed).Vellore: C.M.C
24. Townsend, C. Mary. (2008). Text book of Psychiatric Mental Health Nursing. (4th Ed). New delhi: Jaypee Brothers Publications.
25. Zae, H. J errold. (1990). Biostatistica l Analysis . (3rd Ed). London: Pearson Education Publications.
JOURNALS
26. Alicia Rodríguez-Martos1, Yolanda Castellano (2007). Simple advice for injured hazardous drinkers. Oxford Journal of Alcohol and Alcoholism, 55(5), 11-14.
27. Bager, P., & Vilstrup, H. (2010). Post - Discharge Brief Intervention Increases the Frequency of Alcohol Abstinence-a Randomized Trial. Journal of addictions nursing. 23(2), 37-41.
28. Bill Saunders, Celia Wilkinson, Mike Phillips. (1995). The impact of a brief motivational intervention with opiate users attending a methadone programme. Journal of Addiction, 5610I), 415-424.
29. Brad W. Lundahl, Chelsea Kunz, Cynthia Brownell. (2010). A Meta- Analysis of Motivational Interviewing. University of Utah journal on Social Work Practice, 79(21), 137-160.
30. Brown, Janice M., Miller, William R. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. Journal of Psychology of Addictive Behavior, 65(11), 211-218.
31. Burke, Brian L,Arkowitz, Hal, Menchola, Marisa. (2003). The efficacy of motivational interviewing. Journal of Consulting and Clinical Psychology, 33(7), 843-861.
32. Burke, Brian L, Dunn, Christopher W. (2004). The Emerging Evidence Base for Motivational Interviewing. Journal of Cognitive Psychotherapy, 99(39), 309- 322.
33. Carolyn J Heckman, Brian L Egleston, Makary T Hofmann. (2010). Efficacy of motivational interviewing for smoking cessation: a systematic review and meta-analysis. Oxford Journal of Tobacco contro.,21(6), 410-416.
34. Christine Barrowclough, Ph.D., Gillian Haddock, Ph.D., Nicholas Tarrier, F.B.Ps.S. (2005). Randomized Controlled Trial of Motivational Interviewing, Cognitive Behavior Therapy, and Family Intervention for Patients With Comorbid Schizophrenia and Substance Use Disorders. The American Journal of psychiatry, 43(30), 1706-1713.
35. George W., Joe D., Dwayne Simpson, Kirk M. Broome. (2002). Effects of readiness for drug abuse treatment on client retention and assessment of process. Journal of addiction, 47(23), 77-90.
36. Eirini I. Vasilaki, Steven G. Hosier and W. miles Cox. (2006). the efficacy of motivational interviewing as a brief intervention for excessive drinking.
Journal of Motivational Interviewing and Psychiatry: Use in Addiction Treatment, Risky Drinking and Routine Practice, 51(12), 42-54.
37. Emily Gray, Jim Mc Cambridge and John Strang. (2005). The effectiveness of motivational interviewing delivered by youth workers in reducing drinking, cigarette and cannabis smoking among young people: quasi- experimental pilot study. Oxford Journals of Alcohol and Alcoholism, 22(11), 535-539.
38. Jacques Gaume, Gerhard Gmel, Jean-Bernard Daeppen. (2007). Brief alcohol interventions: Do counselors’ and patients' communication characteristics predict change. Oxford Journals of Alcohol and Alcoholism, 71(9), 62-69.
39. Jacqueline M. J. Withers. (1995). Motivational Interviewing: A Special Ethical
Dilemma. Journal of Behavioral and Cognitive Psychotherapy, 33(7), 335- 344.
40. Janine Oleski, B.A., Natalie Mota, M.A., Brian J. Cox, Ph.D. (2010). Perceived Need for Care, Help Seeking, and Perceived Barriers to Care for Alcohol Use Disorders in a National Sample. American Journal of Psychiatric Association, 43(9), 77-93.
WEBSITES
41. California association of alcoholism. (2005). Assessment in alcoholism treatment. (2nd ed.). California: Allen, J. P, Columbus, M, Fertig, J. http://
alcoholism. treatment. org/ drinking.
42. National association on alcoholism. (1993). Impact of motivational interviewing on participation and outcome in residential alcoholism treatment. (4th ed.).
Newyork: Brown, J. M, Miller,W. R. http:// impact: motivation. Goggle.com.
43. Columbia alumni association. (2011). Motivational interviewing practice for drug use and problem drinking. (1st ed.). Newyork: Cindy Levin.
http://psychorg.com/problem: drinking.
44. British association of social workers. (2009). to motivate addiction clients toward a healthy recovery. (3rd ed.). Northem Ireland: Daniel, D. Squires, M. S.
http://psydelic.com:healthy-recovery
45. American psychological association. (2009). Using motivational interviewing to address college client alcohol abuse.(1st ed). Boston: Scholl, Mark B.
Schmitt, Dorothy M. http:// alcohol. Org/abuse.
46. Cindy Levin, M. (May 17, 2011). Motivational interviewing practice for drug andproblemdrinking.retrievedfromhttp://alcohol.addictionblog.org/motivatio nal-interviewing-practice-for-drug-use-and- problem-drinking/.
47. Brown, Janice, M. ,Miller,William, R. (April 11, 2010). Impact of motivational interviewing among alcohol dependence clients. Available from http://psycnet.apa.org/journals/adb/7/4/211/
48. Miller, W. R., Rollnick, S. (January 3, 2011). Motivational Interviewing:
PreparingPeopletoChange.availablefromhttp://books.google.com/books/abo ut/Motivational_interviewing.html?id=r_CuyHwdz7EC
49. Stephen Rollnick and William R. Millera. (June 18,2011). Behavioral and CognitivePsychotherapy.retrivedfromhttp://scholar.google.co.in/scholar?q=
Miller,+W.R.+and+Rollnick,+S.+Motivational+Interviewing:+Preparing+Pe ople+to+Change&hl=en&as_sdt=0&as_vis=1&oi=scholart
50. Motivational Interviewing abstracts. (May3 2010). http://motivational interview.net/library/abstracts.html
