A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA NIDRA ON BLOOD PRESSURE
AMONG HYPERTENSIVE PATIENTS IN SELECTED HOSPITAL, TIRUPATTUR
DISSERTATION SUBMITTED TO
THE TAMIL NADU Dr.M.G.R. MEDICAL UNIVERSITY CHENNAI
IN PARTIAL FULFILMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING
OCTOBER 2019
A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA NIDRA ON BLOOD PRESSURE
AMONG HYPERTENSIVE PATIENTS IN SELECTED HOSPITAL, TIRUPATTUR
Certified that this is the bonafide work of
Mrs. S. SMILLY JULIET, M.Sc., (N) II Year Student VIGNESH NURSING COLLEGE,
MANALURPET ROAD, KIZHANAIKARAI,
TIRUVANNAMALAI -606 603 TAMIL NADU.
COLLEGE SEAL
SIGNATURE:
Dr. (Mrs). S. VIJAYALAKSHMI
R.N., R.M., M.Sc. (N). M.A., Ph.D. (N)., PRINCIPAL & PROFESSOR IN NURSING, VIGNESH NURSING COLLEGE,
MANALURPET ROAD, KIZHANAIKARAI TIRUVANNAMALAI -606 603
TAMIL NADU.
Dissertation Submitted to
THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY CHENNAI
In partial fulfillment of requirement for the degree of MASTER OF SCIENCE IN NURSING
OCTOBER 2019
A STUDY TO ASSESS THE EFFECTIVENESS OF YOGA NIDRA ON BLOOD PRESSURE
AMONG HYPERTENSIVE PATIENTS IN SELECTED HOSPITAL, TIRUPATTUR
Approved by Dissertation Committee in July 2018 PROFESSOR IN NURSING RESEARCH
Dr. (Mrs).S.VIJAYALAKSHMI _________________________
R.N., R.M., M.Sc. (N), M.A., Ph.D (N), Principal & Professor in Nursing, Vignesh Nursing College,
Manalurpet Road, Kizhanaikarai, Tiruvannamalai - 606 603, Tamil Nadu.
CLINICAL SPECIALITY EXPERT
Mr.V.POOVARAGAVAN _________________________
R.N, M.Sc (N), Ph.D, Professor,
Medical Surgical Nursing, Vignesh Nursing College,
Manalurpet Road, Kizhanaikarai, Tiruvannamalai - 606 603, Tamil Nadu.
MEDICAL EXPERT
Dr. K.KARTHIKEYAN ___________________________
M.B.B.S, M.D., (General Medicine) Assistant Professor,
Government Medical College and Hospital Tiruvannamalai, Tiruvannamalai - 606603, Tamil Nadu.
Internal Examiner External Examiner
Dissertation submitted to
THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY CHENNAI
In partial fulfilment of requirement for the degree of MASTER OF SCIENCE IN NURSING
OCTOBER 2019
ACKNOWLEDGEMENT
Thanks be unto god for his unspeakable gift II corinthians 9: 15
First & Foremost, I am grateful to praise and thank the LORD ALMIGHTY for his abundant grace and providing me strength, wisdom and his presence throughout this Endeavour.
“Leadreship is the capacity to translate vision into reality” I express my heartfelt thanks to Mr.R.Kuppusamy, Chairman, Vignesh Group of Institutions, for giving me the sublime opportunity to pursue my study in this prestigious institution and enduring support by giving all the facilities for pursuing my study.
“Without Rain Nothing Grows” I take this opportunity to express my deep heartfelt sense of gratitude and sincere thanks to Dr. (Mrs) S.Vijayalakshmi, principal, Vignesh Nursing College, for her continuous showering of knowledge constant guidance, genuine, concern, continuous encouragement and expertise constructive suggestions throughout this study.
Her kind guidance throughout this study is truly immeasurable.
“No one can climb a tree with no branches” I would like to express my special appreciation and deep thanks to Dr.(Mrs).C.Uma, Vice Principal, Vignesh Nursing College for her trust, insightful discussion, offering valuable advice and constant support during the whole period of study and especially for her guidance during the writing process which helped me to step cautiously in the right direction.
“Great is the Master, Great is His Name’’ I owe my deep sense of gratitude to my co-ordinator Mr.V.Poovaragavan, Professor, Head of the Department, Medical and Surgical Nursing, Vignesh Nursing College, who helped me to grow in the process of doing this work, who has always been there to patiently listen and to give his valuable suggestions, showing me the right track to proceed in this work. His constant support and utmost consideration was felt at the most needed moments of this work which
invariably contributed his knowledge to unite the difficult knots of this research work.
“Talent wins games, but intelligence wins championships” I express my sincere thanks to Mrs.R.Jayalakshimi, Associate professor, Department of Community Health Nursing, Mrs.U.Udayasankari, Associate professor, Department of Child Health Nursing, Mrs.A.Padmavathi, Associate professor, Department of Medical Surgical Nursing, Mr.S.Rajesh, Associate professor, Department of Mental Health Nursing and all associate professors of Vignesh Nursing College for their guidance, support and encouragement, suggestions given throughout the study.
“Alone we can do so little, together we can do so much” I express my greatful thanks to Mrs.R.Suguna, Assistant professor, Department of Medical Surgical Nursing, Mrs.R.Tamilzhazhagi, Assistant professor, Department of Child Health Nursing, Mr.N. Baskaran Assistant professor, Department of Mental Health Nursing, Mrs. K. Nisamasoothini, Assistant professor, Department of Community Health Nursing and all M.Sc., Nursing faculties members of Vignesh Nursing College, for their guidance, support, and encouragement, suggestions given throughout the study.
I express my genuine gratitude and obligation to Vijaya hospital and Lakshmi Hospital Tirupattur, for granting approval to precede my
research study successfully.
I am greatly indebted to express my heartfelt thanks to all the Medical Surgical Nursing experts for their valuable suggestions in validating the tool for the study.
My immense thanks to the Librarian Mr. Suresh Babu and Mr.
P.Sukumar Computer Operator, Vignesh Nursing College, for their cooperation, immense help throughout the period of study.
A special bouquet to Mr.K.Govindaraj and Dr.N.Prabu for Editing appropriately in English and Tamil language respectively.
“Words cannot express the feelings in my heart. All that I am or ever hope to be, I owe to my angel parents.” A special Thanks to my beloved father and mother Mr. J. Savier and Mrs. S. Glory Vasantha, How Lucky I am to have you for their unending love, care, special prayers, encouragement and special support throughout my life.
“There is no substitute for a great love’’ I dedicate this work to my beloved hubby Mr.S. Pravin and my sweet daughter P.S. Miraclin Senorita.
My deepest and loving thanks for their guidance, cooperation, prayers and support for conducting this study.
“Brothers and sisters are natural friends gifted by God” I express my heartfelt love and gratitude to my only brother Dr. S. Kavin, for his everlasting love and support and also for the words of encouragement offered during the period of my study.
It’s my privilege to thank my father in-law and Mother in-law Mr.J. Selvanayagam and Mrs. S.Vijaya Selvanayagam to complete my
study successfully.
“Give Light and people will find the way’’ I would like to offer my special thanks to Mr. N.Baskaran, for rendering his invaluable help illustrations, ideas and suggestions to make come out successful in all my efforts and endeavors.
“How Lucky I am to have something that makes saying goodbye to hard” I sincere in extending my loving gratitude to all of my friends Mr.G.
Anandharaji, Mrs. D. Radha and Ms. L. Vanapreethi,. Who were equally instrumental in enabling me to complete this task.
Above all, I thank “ALMIGHTY” for being with me and sustaining me in my entire Endeavour’s to complete and bring out the dissertation as a successful one.
LIST OF ABBREVATIONS
AHA - American Heart Association ACC - American College of Cardiology
BP - Blood Pressure
BMI - Body Mass Index
CAD - Coronary Artery Disease CHD - Coronary Heart Disease DBP - Diastolic Blood Pressure EEG - Electro Encephalogram GSR - Glutathione Reductase HC - Hip Circumference
HR - Heart Rate
MI - Myocardial Infarction
NH - Null Hypothesis
NS - Non Significant
PIH - Pregnancy Induced Hypertension PSQI - Pittsburg Sleep Quality Index RCTs - Randomized Control Trials r - Correlation
SBP - Systolic Blood Pressure
SD - Standard Deviation
S - Significant
WHO - World Health Organization WHR - Waist to Hip Ratio
WC - Waist Circumference
TABLE OF CONTENTS
CHAPTERS CONTENTS PAGE NO.
ABSTRACT
1 INTRODUCTION
1.1 Background of the Study 1
1.2 Need for the Study 3
1.3 Statement of the Problem 5
1.4 Objectives 5
1.5 Operational Definitions 5
1.6 Assumption 6
1.7 Null Hypothesis 6
1.8 Delimitations 7
1.9 Conceptual Framework 7
2 REVIEW OF LITERATURE
2.1 Reviews related to prevalence, incidence of blood pressure among hypertensive patients
11
2.2 Reviews related to effect of Yoga nidra 15
2.3 Reviews related to Yoga nidra on level of blood pressure among hypertensive patients
18
3 RESEARCH METHODOLOY
3.1 Research Approach 23
3.2 Research Design 23
3.3 Variables 24
3.4 Setting of the Study 24
CHAPTERS CONTENTS PAGE NO.
3.5 Population 24
3.6 Sample 25
3.7 Sample Size 25
3.8 Sampling Technique 25
3.9 Criteria for Sample Selections 25
3.10 Development and Description of the Tool 26
3.11 Content Validity 26
3.12 Ethical Consideration 27
3.13 Reliability of the Tool 28
3.14 Pilot Study 28
3.15 Procedure for Data Collection 29
3.16 Plan for Data Analysis 30
4 DATA ANALYSIS AND INTERPRETATION 32
5 DISCUSSION 57
6 SUMMARY, CONCLUSION, IMPLICATION, RECOMMENDATIONS AND LIMITATIONS
61
BIBLIOGRAPHY 69
APPENDICES
LIST OF TABLES
TABLE
NO.
TITLE
PAGENO.
1 Frequency and percentage distribution of demographic variables in respect to Age, Gender, Religion, Educational status and Occupation
33
2 Frequency and percentage distribution of demographic variables in respect to Marital status, Dietary pattern, Physical activity, Habit of smoking, Consumption of alcohol, Practicing regular exercise and Family history of hypertension.
36
3 Frequency and percentage distribution of demographic variables in respect to Area of residence, Duration of hypertension, Duration of treatment and Treatment for hypertension
39
4 Comparison of pre and post test level of blood pressure among hypertensive patients in Experimental group.
43
5 Comparison of pre and post test level of blood pressure among hypertensive patients in Control group.
45
6 Comparison of pre test level of blood pressure among hypertensive patients between Experimental and Control group.
47
7 Comparison of post test level of blood pressure among hypertensive patients between Experimental and Control group.
48 8 Association of pre and post test level of systolic blood pressure
among hypertensive patients with their selected demographic variables in Experimental group.
49
9 Association of pre and post test level of diastolic blood pressure among Hypertensive patients with their selected demographic variables in experimental group.
51
10 Association of pre and post test level of systolic blood pressure among hypertensive patients with their selected demographic variables in Control group.
53
11 Association of pre and post test level of diastolic blood pressure among hypertensive patients with their selected demographic variables in Control group.
55
LIST OF FIGURES
FIGURE
NO. TITLE PAGE
NO.
1. Conceptual framework based on Modified Weiden Bach’s Helping art of Clinical Nursing Theory (1964)
10
2. Schematic representation of research design 31 3.
Frequency and percentage distribution of pre and post test level of blood pressure among hypertensive patients
in Experimental group 41
4.
Frequency and percentage distribution of pre and post test level of blood pressure among hypertensive patients in Control group.
42
5. Comparison of pre and post test level of blood pressure among hypertensive patients in Experimental group.
44
6. Comparison of Pre and Post test level of blood pressure among hypertensive patients in Control group
46
LIST OF APPENDICES
APPENDIX TITLE PAGE NO.
A. Letter seeking permission for conducting the study i B. Letter granting permission for conducting the study ii
C.
Content validity
(i) Letter seeking experts opinion for content validity
(ii) List of experts for content validity
iii
D. Yoga Nidra Training Certificate vi
E. Certificate for English editing vii
F. Certificate for Tamil editing viii
G. Informed consent form– English ix
H. Informed consent form– Tamil x
I. Informed consent requisition form –English xi J. Informed consent requisition form –Tamil xii
K. Data Collection Tool xiii
L. Coding for Demographic Variables xvi
M. Plagiarism certificate xv
ABSTRACT
A study to assess the Effectiveness of Yoga Nidra on Blood pressure among Hypertensive patients in selected Hospital, Tirupattur.
INTRODUCTION
Hypertension is a medical term and other name for high blood pressure. This means that the blood gives too much pressure against the walls of the blood vessels, the pressure depends upon the work of the heart and resistant of the blood vessels. It increases the complications and risk of heart disease, stroke and death.
Hypertension and its complications are a leading cause of death in modern societies. Anti hypertensive drug therapy has been the only effective form of management. Unfortunately, the drug regimes available are by no means ideal. They cause major side effects in many patients.
Yoga nidra is an alternative therapy in reducing blood pressure levels of hypertensive patients has been validated in numerous clinical studies. The practice is now widely prescribed by doctors in several countries.
OBJECTIVE
To assess the Effectiveness of Yoga nidra on Blood pressure among Hypertensive patients in selected Hospital, Tirupattur
DESIGN
Non-equivalent control group pretest- posttest design which is comes under quasi experimental design.
SETTING
Vijaya hospital and Lakshmi hospital, at Tirupattur SAMPLING TECHNIQUE
Convenience sampling technique was used for selecting the hypertensive patients.
SAMPLES
30 in Experimental and 30 in control group, who fulfilled the sample selection criteria.
INTERVENTION
Yoga nidra is practiced 20 minutes per day in the morning between 6am to 8am for 15 days.
MEASUREMENT AND TOOL
The level of blood pressure is measured by the classification of blood pressure according to American College of Cardiology/American Heart Association (ACC/AHA) 2017 by using Sphygmomanometer and Stethoscope
RESULTS
In a comparison of pre and post test level of systolic blood pressure among hypertensive patients in Experimental group, revealed that the calculated paired‘t’
value is t=12.882 which is found to be statistically significant at p<0.001 level. This clearly shows that the implementation of Yoga nidra has shown a significant reduction in the post-test level of systolic blood pressure among hypertensive patients in the Experimental group.
In a comparison of pre and post test level of diastolic blood pressure among hypertensive patients in Experimental group, revealed that the calculated paired ‘t’
value is t=17.461 which is found to be statistically significant at p<0.001 level. This clearly shows that the implementation of Yoga nidra has shown a significant reduction in the post-test level of diastolic blood pressure among hypertensive patients in the Experimental group.
In a comparison of the post-test level of systolic blood pressure among hypertensive patients between the control and Experimental group revealed that the calculated unpaired t value is t=9.598 which is found to be statistically significant at p<0.001 level. This indicates that there is a difference in the post-test level of systolic blood pressure between the groups. This clearly shows that yoga nidra has reduced the level of systolic blood pressure in Experimental group. The findings revealed that there is a highly significant difference in the level of diastolic blood pressure among hypertensive patients after implemented yoga nidra.
In a comparison of the post-test level of diastolic blood pressure among hypertensive patients between the control and Experimental group revealed that the calculated unpaired t value is t= 5.590 which is found to be statistically significant at p<0.001 level. This indicates that there is a difference in the post-test level of diastolic blood pressure between the groups. This clearly shows that Yoga nidra has reduced the level of diastolic blood pressure in Experimental group. The findings revealed that there is a highly significant difference in the level of diastolic blood pressure among people after implemented yoga nidra.
The majority of hypertensive patients were on stage I and stage II hypertension before providing Yoga nidra. After providing Yoga nidra, 54% of hypertensive patients had normal level of systolic blood pressure and 70% of hypertensive patients had normal level of diastolic blood pressure.
CONCLUSION
The present study is conducted to assess the effectiveness of Yoga nidra on level of blood pressure among hypertensive patients in selected hospital, Tirupattur.
The study findings concluded that there is a statistically significant difference in the level of blood pressure after proving Yoga nidra. This proved to be an effective alternative adjunct therapy and non-pharmacological therapy to reduce the level of blood pressure among hypertensive patients. Hence it can be concluded that Yoga nidra is a cost effective, non-invasive, non-pharmacological alternative in the management of hypertension. It is simple and easily learned technique on reducing blood pressure.
IMPLICATIONS FOR CLINICAL PRACTICE:
The significant improvement in the level of blood pressure among Hypertensive patients after implementation of Yoga nidra suggests that the Nurses play an important role in creating awareness on Yoga nidra in reducing the level of blood pressure. Further researchers have suggested determining the benefit to all age groups and also related studies could be conducted to assess the effectiveness of Yoga nidra on level of blood pressure among Hypertensive patients.
CHAPTER -I INTRODUCTION
“REST YOUR MIND AND HEART CALM WITH YOGA”
1.1 BACKGROUND OF THE STUDY
In this new mechanized and competitive era, man is passing through a very busy life and has got little time for physical and mental relaxation. The mental worries in association with sedentary habits have contributed to a lowering of vitality and causation of many diseases including hypertension. Hypertension has become a major cause of morbidity and mortality in worldwide and it is now ranked third as a cause of disability adjusted life years. It is called a ‘silent killer’ because people who have it are often symptom free.
Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure, putting them under increased stress. Each time the heart beats; it pumps blood into the vessels, which carry the blood throughout the body. The higher the blood pressures higher the risk of damage to the heart and blood vessels in major organs such as the brain and kidneys.
Hypertension is the most important preventable cause of heart disease and stroke in worldwide.
Hypertension is the most common non communicable disease and the leading cause of cardiovascular disease in the world. Many people with hypertension are unaware of their condition and among those with hypertension, treatment is infrequent and inadequate.
Globally, an estimated 26% of the world’s population (972 million people) has hypertension and the prevalence is expected to increase to 29% by 2025, driven largely by increases in economically developing countries. In 2015, an estimated 1.13 billion people worldwide have hypertension living in low and middle income countries. 1 in 4 men and 1 in 5 women had hypertension. Fewer than 1 in 5 people with hypertension have the problem under control. Hypertension is a major cause of premature death in worldwide. Complications from hypertension account for 9.4 million deaths worldwide every year. (WHO 2019)
S.Yadav, et al., (2018) India is a developing country going through a rapid demographic and epidemiological transition. In all such transitions, nutrition is the key ingredient and plays prime role. In India the prevalence of hypertension ranges from 20-40% in urban adults and 12-17% among rural adults. The number of people with hypertension is projected to increase from 118 million in 2000 to 214 million in 2025, with nearly equal numbers of men and women.
Prasad Ravindranath, (2016) Conducted a large-scale study was in high prevalence of hypertension, reported that 21.4 per cent prevalence in about 10,500 people studied (aged 25-64) in 11 villages. Prevalence was nearly the same in both sexes. The proportion of people (both males and females) whose hypertensive status was newly diagnosed decreased with age and awareness of the condition. In 24.5 percent of deaths in people aged 45-59 years in rural Tamil Nadu are caused by diseases of the circulatory system. The people who were on treatment were just 20 percent. Among this 6.6 percent have their blood pressure under control.
(AHA)"As one of the most common and dangerous risk factors for heart disease and stroke, this overwhelming presence of high blood pressure can't be dismissed from the equation in our fight against cardiovascular disease."
Wing, et al., (2014) stated that the incidence and complications of hypertension increase with prevalence rates of 70% in adults. Hypertension is extremely common among older men and women. Among older adults, hypertension is the most prevalent modifiable cardiovascular risk factor for coronary heart disease (CHD), cerebro vascular disease and peripheral arterial disease. More than 70% of older adults with incident myocardial infarction (MI), stroke, acute aortic syndromes and heart failure had pre existing hypertension.
Hypertension and its complications are a leading cause of death in modern societies. Anti-hypertensive drug therapy has been the only effective form of management for hypertension. The drug regimens available are by no means ideal.
Those medicines cause major side effects in many patients, risk of dangerous consequences and a shortened life span.
Hypertension is a significant and often asymptomatic chronic disease, which requires optimal control, persistent adherence to prescribed medications and lifestyle
modifications to reduce the risks of cardiovascular, cerebro-vascular and renal diseases. Anti-hypertensive is prescribed appropriately depending the degree of hypertension. But, many hypertensive patients require two or more drugs of different combinations to control blood pressure. This may lead to adverse drug interactions and side effects.
American Heart Association reported that 80 per cent of cardiovascular diseases can be prevented, through healthy lifestyle choices like diet, exercise, yoga, maintaining a healthy weight, not smoking and by controlling high blood pressure, diabetes and high cholesterol.
There are many different types of complementary and alternative treatments believed to be effective for treating hypertension. Scientific evidence indicates that following a diet, physical activity, mind-body practices, educational interventions and technology-based interventions and regular practice of relaxation techniques such as Yoga nidra, Tai-Chi or Qigong can lower higher blood pressure.
Yoga nidra can be a very beneficial therapy for controlling and lowering high blood pressure naturally. The gentle, soothing practice of yoga asana settles both mind and body and reduces stress a leading cause of hypertension.
1.2 NEED FOR THE STUDY
Hypertension is not a single disease, but a syndrome with multiple causes. In most of the cases the causes remain silent. Yoga nidra relaxes the autonomic nervous system and it reduces the whole physical, mental, muscular and neural activities and it slows down the metabolic rate of the body. The muscles become relaxed and the arteries become dilated. The cardiac output as well as cardiac work load reduces the systolic blood pressure (SBP) by an average of 15-20 mm Hg and diastolic blood pressure (DBP) by 10 mm Hg.
The practices of Yoga nidra draws in our attention inwards, and learn to surf between the states of wakefulness and sleep, where our body finds its natural state of equilibrium (homeostasis) – the breath balances and becomes quiet, unconscious and conscious aspects of the mind reveal themselves, and we fall into an innate state of deep, blissful awareness. As we rest here, we can turn our attention easily and
effortlessly to the very nature of awareness and consciousness. We start to experience the ‘deeper’ features of yogic teachings that previously we perhaps considered intangible, such as feeling our interconnected wholeness and becoming aware of our true, unified nature – expansive, inclusive, and deeply restful.
The effectiveness of Yoga nidra in lowering the blood pressure levels of hypertensive patients has been validated in numerous clinical studies. The practice is now widely prescribed by doctors in several countries.
Acharya Harish, (2011) Yoga nidra therapy adopted either alone or an adjunct therapy, has been found to reduce systolic readings (SBP) by an average of 15-20 mm Hg and diastolic readings (DBP) by 10 mm Hg. This will generally have happened after 3 week of daily guided practice of Yoga Nidra. Result shows that, newly diagnosed and asymptomatic hypertensive are now frequently capable of restoring their blood pressure to acceptable limit without having to resort to antihypertensive drugs and medications, whole side effects, such as sleep disturbance, depression and male impotency, can be severe and disabling enough to preclude their use. The majority of patients showed definite symptomatic improvement after 3 weeks of training. Headache, giddiness, nervousness, irritability and insomnia disappeared in almost everyone. The Significant decrease in blood pressure was obtained in 52% of patients.
Danilo, (2015) stated that Blood pressure increases by sustained activation of Flight and Fight response of the body. Yoga nidra effectively switches off the response and brings adrenaline levels down, thus reducing the blood pressure. It also relaxes the chronic stress induced sustained muscular contraction. This sustained muscular contraction sends hostile signals to the brain; it does secrete stress hormones associated with stress and high blood pressure. It is possibly reverted by constant yogic practices. Regular Yoga nidra will reduce the aldosterone and vasopressin which is a potent vasoconstrictor secreted from brain.
Saraswati Devi, (2018) conducted a randomized control trial study to assess the Impact of Yogic intervention on Mild Hypertensive patients. A total of 32 patients of age group between 30-60 years were randomly selected from the out-patient department Polyclinic in Hardwar. The Blood Pressure was measured in selected
subjects using mercury Sphygmomanometer in supine and sitting positions before starting Yogic Intervention. Result shows that Yogic Intervention significant decrease in the SBP values and DBP values of the Hypertension patients. The obtained t-value is 10.94, which is significant at p<0.01 level. Yogic Intervention decreases the level blood pressure among Hypertensive patients.
Hypertension is said to be a silent- killer and it does not shows any symptoms in earlier stage it makes the people to end up in other complications or diseases. In hypertensive patients the common problem is that they may not adhere to the drug regimen regularly. The emergence of Yoga nidra is a relaxation technique a safe, easy to practice, cost effective, inexpensive treatment for hypertensive patient.
The researchers concluded that this therapy opens a new avenue in the management of hypertension.
1.2 STATEMENT OF THE PROBLEM
A study to assess the Effectiveness of Yoga Nidra on Blood pressure among Hypertensive patients in selected Hospital, Tirupattur.
1.3 OBJECTIVES
➢ To assess the pre and post-test level of blood pressure among hypertensive patients in experimental and control group.
➢ To compare the pre and post-test level of blood pressure among hypertensive patients within experimental and control group.
➢ To compare the pre and post-test level of blood pressure among hypertensive patients between experimental and control group.
➢ To associate the pre and post-test mean difference level of blood pressure among hypertensive patients with their selected demographic variables in experimental and control group.
1.5 OPERATIONAL DEFINITIONS Effectiveness
It refers to the outcome of Yoga nidra on level of blood pressure among Hypertensive patients which is measured by using Sphygmomanometer.
Yoga Nidra
Yoga Nidra is a state of deep and conscious relaxation between waking and sleeping process and it has 8 stages, it starts with relaxation stage, affirmation, rotation of consciousness, respiration awareness, manifestations of opposites, creative visualization, affirmation and then ends with full awareness, once in a day for 20 minutes given by the researcher in the early morning between 6-8am.
Hypertension
Hypertension is refers to high blood pressure in which the pressure in the arteries is constantly increased of systolic blood pressure is >130mm of Hg and diastolic blood pressure is >80mm of Hg, which is measured by using Sphygmomanometer.
Patients
Person who are diagnosed as hypertensive and admitted in selected hospital for the treatment of Hypertension.
1.6 ASSUMPTIONS
➢ Hypertensive Patients will be suffering with many risk factors like age, sex, stress, family history, diet pattern, physical inactivity and obesity.
➢ Yoga nidra may help to reduce the level of blood pressure among hypertensive patients.
➢ Yoga nidra may help to relax the mind and body.
➢ Yoga nidra may reduce the cardiac risk factors and complication.
1.7 NULL HYPOTHESIS
➢ NH1-There is no significant difference in pre and post-test level of blood pressure among hypertensive patients within experimental and control group at p<0.05 level.
➢ NH2-There is no significant difference in pre and post-test level of blood pressure among hypertensive patients between experimental and control group at p<0.05 level.
➢ NH3-There is no significant association in pre and post-test mean difference level of blood pressure among hypertensive patients with their selected demographic variables in experimental and control group at p<0.05 level.
1.8 DELIMITATION
➢ The study is delimited to a period of 4 weeks only.
➢ The study is conducted in selected setting only.
1.9 CONCEPTUAL FRAMEWORK
The conceptual framework or a model is made up of concepts. It provides the guidelines to proceed to attain goals and objectives our study based on the theory. It is a schematic representation of the steps, activities and outcome of the study.
The investigator adopted WIEDENBACH’S HELPING ART OF CLINICAL NURSING THEORY as a base for developing the conceptual framework.
The study is based on the concept that administration of selected interventional package to client with Hypertension admitted at selected hospital.
Ernestin Wiedenbach proposes “Helping art of clinical nursing theory” for nursing, which describes a desired situation and the way to attain it. It directs action towards an explicit goal. The theory has three factors: Central Purpose, Prescription and Realties.
CENTRAL PURPOSE
It refers to what the nurse has to accomplish. In this study, the investigator identified the central purpose as effectiveness Yoga nidra in changing the blood pressure among Hypertensive patients.
PRESCRIPTION
It refers to plan of care for the Hypertensive patients. It will specify the nature of action that fulfils the nurse central purpose. In this study the investigator adopted effectiveness of Yoga nidra on level of blood pressure among Hypertensive patients.
REALITIES
It refers to the physical, physiological, emotional, spiritual factors that come into play in situation involving nursing action. The realities identified by Wiedenbach’s are agent, recipient, goal, means and framework.
Agent:
The practicing nurse researcher or investigator delegate characterized by personal attributes problems, capacities, commitment and competence in Nursing. In this research the agent was investigator.
Recipient:
Is the patient is characterized by personal attributes, problems, capacities, aspiration and ability to cope with the concern or problems being experienced. In this study, Hypertensive patients admitted at Vijaya hospital and Lakshmi hospital at Tirupattur.
Goal:
In this study, goal is to achieve the outcome of yoga nidra on level of blood pressure among Hypertensive patients.
Means:
Comprise the activities and devices through which the practitioners to attain the goal. The mean include skills, techniques, procedures and devices that may be used to facilitate nursing practice. In this study, means is the Yoga nidra.
Framework:
Consist of the human, environmental, professional, organizational facilities that not only make up the context which nursing practice but also constitute the currently existing limits. In this study, the framework was the Vijaya hospital and Lakshmi hospital at Tirupattur.
The conceptualization of nursing practice-according to this theory consists of three Steps:
Step 1: Identifying the need for help.
Step 2: Ministering the need for help.
Step 3: Validating the need for help was met.
Step 1: Identifying the need for help
The determination of need for help was made by the process of selecting Hypertensive patients based on sample selection criteria which is followed by pre- assessment. Convenience sampling techniques were used to assign the Hypertensive patients in experimental group and control group to assess the level of blood pressure in both groups.
Step 2: Ministering the need for help
After the assessment of pre test, Yoga nidra practice by experimental group and routine activity by control group.
Step 3: Validating the need for help was met
This is accomplishing by means of post test level of blood pressure in experimental group and control group. It is followed by analysis of the interpretation ofresults.
FIGURE: 1 CONCEPTUAL FRAME WORK ON MODIFIED WEIDEN BACH’S HELPING ART OF CLINICAL NURSING THEORY (1964) CENTRAL PURPOSE:
To assess the effectiveness of yoga nidra on level of blood pressure among hypertensive patients
Step-1 Identifying the need for help
Step 2 Ministering the need for help
Step 3 Validating the need for help
DEMOGRAPHIC VARIABLES:
Age, Gender, Religion, Educational status, Occupation, Marital status, Dietary pattern, Physical activities, Habit of smoking, Consumption of alcohol, Practicing regular exercise, Family history of hypertension, Area of residence, Duration of hypertension, Duration of treatment and Treatment for hypertension
EXPERIMENTAL GROUP:
Agent: Investigator
Recipient: Hypertensive patients Goal: Reduce the level of blood pressure
Means: Yoga nidra, 20 minutes per day for 15 days
CONTROL GROUP:
Agent: Investigator
Recipient: Hypertensive patients Goal: Reduce the level of blood pressure
Means: Routine treatment
POST TEST:
Measure the level of blood pressure by using sphygmomanometer and stethoscope
PRE TEST
Measure the level of blood pressure by using sphygmomanometer and stethoscope.
Level of blood pressure was
reduced.
Level of blood pressure was not
reduced
Enhancement REASSESSMENT
CHAPTER -II
REVIEW OF LITERATURE
The review of literature is defined as a broad comprehensive in depth systematic and critical review of scholarly publications, unpublished scholarly print materials, and personal communication. (S.K. Sharma, 2005)
Literature is an essential component of the investigator for a greater understanding of the research problem and its major aspects. It provides an opportunity to evaluate many different approaches to the problems. First it is necessary to obtain the most current facts relevant to the problem, and secondly a thorough literature review will assist the selection or development of the theoretical and methodological approaches to the problem. The purpose of review of literature is to obtain comprehensive knowledge and in depth information in about the effectiveness of Yoga nidra on level of blood pressure among hypertensive patients.
Review of literature is a systematic study of a number of previous studies which helps to support the research work done. It includes all types of studies. It gives an idea of how the study can be conducted and what is to be done for it. It is helpful for the researcher.
The review of literature is organized under the following sections:
SECTION 2.1: Review of literature related to prevalence, incidence of blood pressure among hypertensive patients.
SECTION 2.2: Review of literature related to effect of Yoga nidra
SECTION 2.3: Review of literature related to Yoga nidra on level of blood pressure among hypertensive patients.
SECTION 2.1: Review of Literature Related to Prevalence, Incidence of Blood Pressure among Hypertensive Patients:
Likhita Bhavani P, et al., (2018) conducted a cross-sectional study on pre- hypertension and its association with anthropometric indices among undergraduate medical students in Andhra Pradesh, India. In this study 210 students were selected and three students were excluded based on exclusion criteria. The mean (±standard
deviation) age of the participants was 18.53±0.84 (range: 17-21 yr). The prevalence of pre-HTN was 15.9 per cent (33/207, males: 29.3% and females: 5.2%). Prevalence of overweight and obesity was 43 per cent (n=89) and underweight was 12.6 per cent (n=26). The study result shows that, pre-hypertensive students had significantly higher values of anthropometric indices [BMI (22.3±0.29 vs. 26.6±1.05 kg/m2), WC (78.3±0.75 vs. 88.9±2.66 cm), HC (94.1±0.65 vs. 103.4±2.09 cm) and WHR (0.82±0.003 vs. 0.85±0.01)] as compared to their counterparts.
Shikha Singh, et al., (2017) conducted a community based cross sectional study to assess the prevalence of hypertension and its associated factors and to estimate the awareness, treatment, and adequacy of control of hypertension among urban population of Varanasi. In this study multistage sampling design was used, 640 samples of male and female aged with 25–64 years was taken. Out of these, 301 (47%) were male subjects and 339 (53%) were female. The results shows that among both groups (male and female), prevalence was higher among the eldest age group. The prevalence of isolated diastolic BP was higher among male subjects (28.1) against female subjects (12.2%). It was the highest among the second oldest age group among male and oldest age group in female subjects. The systolic blood pressure, age was associated with hypertension status among both genders, whereas diastolic blood pressure was associated with age in male subjects only. There was no association between age and diastolic BP in female subjects.
Sebastian NM, et al., (2016) conducted a cross sectional community based study to reveal the prevalence, proportion of hypertension cases treated and controlled, and the knowledge and practice among hypertensive patients in the municipal town of Perinthalmanna, Kerala, India. 1154 adults blood pressure were recorded at their homes along with their personal details, history of earlier diagnosis, treatment and dietary and lifestyle modification. The prevalence of hypertension was 32.3%. Among them 55% were already diagnosed and 45% newly diagnosed.
Prevalence of pre hypertension was 43.7%. Among those treated, only 33.9% had their BP controlled. The percentage of those who were aware of dietary restriction was 79.4% and 76% were practicing. The percentage of subjects aware of a need for regular BP check was 83.6% but 69% were doing so. Only 42.6% were aware of a need for other lifestyle changes and 34.4% were practicing. Age, family history, and
sedentary lifestyle were identified as correlates of hypertension. The prevalence of hypertension and pre hypertension is high and the control of hypertension among those treated is low.
Lacruz, Maria, et al., (2015) conducted a cohort study was to assess the Prevalence and Incidence of Hypertension in the general adult Population at German.
The sample included 967 men and 812 women aged 45 to 83 years at baseline, 1436 subjects completed first follow-up after 4 years and 1079 completed second follow-up after 9 years. BP was measured according to a standardized protocol with oscillometric devices and hypertension was defined as mean systolic BP (SBP) ≥140 mmHg and/or diastolic BP (DBP) ≥90 mmHg and/or use of antihypertensive medications if hypertension was known. The age-standardized prevalence of hypertension at baseline was 74.3% for men and 70.2% for women. The age- standardized annual incidence rate of hypertension for men was 8.6 (95% CI 4.3–
12.9) for first follow-up period and 5.4 (95% CI 2.8-10.6) for second follow-up period and for women 8.2 (95% CI 3.6–12.8) for first follow-up period and 5.6 (95% CI 2.7- 11.4) for second follow-up period. A result concludes decrease in SBP and DBP between baseline and follow-up1 and follow-up2 was seen and accompanied by an increase in anti-hypertensive medication consumption and a higher awareness of the condition.
Raghupathy Anchala, et al., (2014) conducted a systematic review and metaanalysis study was to assess the prevalence, awareness, and control of hypertension in India. Medline, Web of Science, and Scopus databases from 1950 to 30 April 2013 were searched for ‘prevalence, burden, awareness, and control of blood pressure (BP) or hypertension (≥140 SBP and or ≥90 DBP) among Indian adults’ (≥18 years) of the total 3047 articles, 142 were included. The result shows that overall prevalence for hypertension in India was 29.8% (95% confidence interval: 26.7–33.0).
Significant differences in hypertension prevalence were noted between rural and urban parts [27.6% (23.2–32.0) and 33.8% (29.7–37.8); P = 0.05]. Regional estimates for the prevalence of hypertension were as follows: 14.5% (13.3–15.7), 31.7% (30.2–33.3), 18.1% (16.9–19.2), and 21.1% (20.1–22.0) for rural north, east, west, and south India and 28.8% (26.9–30.8), 34.5% (32.6–36.5), 35.8% (35.2–36.5) and 31.8% (30.4–33.1) for urban north, east, west and south India, respectively.
Overall estimates for the prevalence of awareness, treatment, and control of BP were 25.3% (21.4–29.3), 25.1% (17.0–33.1), and 10.7% (6.5–15.0) for rural Indians; and 42.0% (35.2–48.9), 37.6% (24.0–51.2), and 20.2% (11.6–28.7) for urban Indians.
One-tenth of rural and one-fifth of urban Indian hypertensive population have their BP under control.
Rizwan S A, et al., (2014) conducted observational study on prevalence of primary hypertension among adult tribal populations of India. Twenty studies or 53 subpopulations with 4674 subjects were included. The pooled estimate of hypertension prevalence was 16.1% (95% CI: 13.5, 19.2). There was significant heterogeneity among the studies (I2 = 99% and Q = 4624.0, df = 53, p<0.001). Subgroup analyses showed that acculturation status, special features and BP measurement techniques significantly influenced prevalence, but after meta-regression analyses,
‘decade of study’ remained the only covariate that significantly and independently influenced prevalence (R2 = 0.57, Q= 119.2, df = 49, p value at p <0.001).
Chythra R Rao, et al., (2013) conducted a cross-sectional community-based study to estimate the prevalence and the socio-demographic correlates of hypertension among 1239 adults aged ≥30 years. Data was collected by personal interviews, followed by anthropometric and blood pressure measurements. The prevalence of hypertension was 43.3%, with the prevalence being more among males (51.6%) as compared to females (38.9%). The total prevalence 23.1% (287) were known cases and 20.2% (250) were newly detected cases. Based on the seventh report of the Joint National Committee (JNC VII) on high blood pressure, pre-hypertension was noted among 38.7%. The prevalence of hypertension was 43.3% of which 20.2%
were previously undiagnosed cases. A higher prevalence was noted among males (51.6%) as compared to females (38.9%), which was statistically significant (chi- square = 18.61, p<0.001).
Srinivasan and Balamurugan, (2013) conducted a cross-sectional study on prevalence of diabetes and hypertension among geriatric population in at Attayampatti village, Salem district rural community of Tamil Nadu. The study was conducted on 400 geriatric populations by using a pre-tested, semi-structured questionnaire. House to house visit was done on simple random basis. Their height and weight was
measured and body mass index was calculated. The diabetic status was confirmed by using random blood sugar estimation and hypertension was assessed by using a standard sphygmomanometer. The overall prevalence of diabetes and hypertension among study population was 36% and 59% respectively. Among diabetes the prevalence in males and females was 22% and 15% respectively. Among hypertensive the prevalence in males and females was 33.3% and 26.2% respectively. Their mean blood pressure was 140/100mm of Hg and the mean random blood sugar was 180mgs/dl. Factors like age, body mass index and smoking shows that statistical significant association towards diabetes and hypertension.
Jaddo, et al., (2012) conducted a systematic review and meta-analysis study on Population-Based Studies on Hypertension in Ghana from 1990 to 1997. The sample size for individual studies ranged from 287 to 6900 with a response rate between 53% and 97%. The mean SBP ranged between 122.0 and 139.4 mmHg in women and 123.8 mmHg and 132.9 mmHg in men, while mean DBP ranged between 68.8 and 86.4 mmHg in women and 69.2 and 78.4 mmHg in men. Result showed that the mean SBP and DBP were higher in the urban compared to rural populations.
SECTION 2.2: Review of Literature Related effect of Yoga Nidra:
Sang-Dolkim (2016) conducted a Meta-Analyses study to identify randomized controlled trials (RCTs) in the psychological effects of Yoga-Nidra in women with menstrual disorders. Two potential trials were identified and both were included in the review. A significant difference was observed between experimental and control groups in that anxiety and depression were significantly decreased in the experimental group than control group. The study result shows that, the calculated t value t = 6.271 is statistically significant at p<0.001 level. There is evidence from two RCTs that Yoga-Nidra may have favourable effects in terms of reducing psychological problems in women with menstrual disorders.
Bajpai, et al., (2015) conducted a study to assess the effect of Bhramari Pranayama and Yoga-Nidra on cardiovascular hyper-reactivity to cold pressor test was done on each student before and after yoga. There was 79% reduction in hyper- reactivity to cold pressor test as number of hyper-reactors reduced from 32 before the
study to 7 after 3 months of yoga. Systolic rise of blood pressure to cold 17 pressor test reduced from 20.1 ± 3.5 mm Hg to 15.2 ± 3.7 mm Hg (P < 0.001) and diastolic rise reduced from 13.81±3.4mmHg to 10.37±2.62 mmHg (P < 0.001) in hyper-reactors. Mean systolic blood pressure in all the 94 subjects reduced from 119.87±12.01 mm Hg to 117.68±11.89 mm Hg whereas mean diastolic blood pressure reduced from 77.08 ± 9.3 mm Hg to 75.11 ± 9.07 mm Hg (P<0.001). The result showed that, Bhramari Pranayama and Yoga nidra together can significantly alleviate stress.
Anand, et al., (2015) conducted a study to assess the effectiveness of yoga nidra on quality of sleep among cancer patients. A survey was used in phase I (n=25) to assess the quality of sleep using Pittsburgh Sleep Quality Index. In phase II, an evaluative approach was used through one group pre-test post-test design (n=19). The participants with poor quality of sleep were given yoga-nidra intervention. Among the study participants, most of them (24%) suffered from breast cancer; 40% each were in stage I and stage II cancer. Majority (75%) of the participants were receiving chemotherapy along with radiation therapy. Results showed that there is significant difference between pre-test and post-test mean scores on PSQI (t=3.720) at (p=0.002).
Santaella, et al., (2014) conducted a randomized controlled trial study on Yoga relaxation (Savasana) decreases cardiac sympathovagal balance in hypertensive patients, in Hemodynamic Laboratory in Physical Education at Sao Paulo University, Brazil. Sixteen women and 14 normotensive patients (6-women) non-obese subjects participated in 2 random sessions: savasana relaxation and control. Patients remained supine for 55 minutes after interventions. Electrocardiogram, beat-to-beat blood pressure and respiration were acquired during and after interventions for posterior autoregressive spectral analysis of the R-R interval and blood pressure variability.
Savasana relaxation decreases cardiac sympathetic autonomic modulation after its performance in hypertensive patients; this reduction lasts at least 35 minutes and is not blunted in hypertensive patients when compared to normo-tensive controls. The result showed that, savasana relaxation has positive effects on cardiac autonomic modulation of hypertensive patients and may be included as a strategy for the non- drug treatment of hypertension.
Jie Wang, et al., (2013) conducted a systematic review and meta-analysis study and it included randomized clinical trials testing yoga against conventional therapy, yoga versus no treatment, yoga combined with conventional therapy versus conventional therapy or conventional therapy combined with breath awareness. Study selection, data extraction, quality assessment, and data analyses were conducted according to the Cochrane standards. A total of 6 studies (involving 386 patients) were included. The methodological quality of the included trials was evaluated as generally low. A total of 6 RCTs met all the inclusion criteria. 4 of them compared yoga plus conventional therapy with conventional therapy. 1 RCT described yoga combined with conventional therapy versus conventional therapy combined with breath awareness. 2 RCT tested the effect of yoga versus conventional therapy alone.
1 RCT described yoga compared to no treatment. Only one trial reported adverse events without details, the safety of yoga is still uncertain.
Monika, et al., (2012) conducted a study to assess the effectiveness of yoga- nidra on physiological variables in patients with menstrual disturbances in department of Obstetrics and Gynaecology, UP, Lucknow. 150 females were divided randomly in to two group intervention and in control 75 in each group. The yogic intervention consisted of 35-40 minutes per day for five days in a week till six months. An autonomic function testing was done in both the groups at zero time and after six months. A significant positive effect was observed when yoga therapy was used as an adjunct in the patients of menstrual disturbances. The result shows there was significant reducing in the blood pressure, postural hypotension and sustained hand grip, heart rate expiration, inspiration ratio and 30:15 beat ratios of the subjects after yogic practice.
Khushbu Rani, et al., (2011) conducted a randomized controlled trial study to assess Impact of Yoga-Nidra on psychological general wellbeing in patients with menstrual irregularities. A total of 150 female subjects were randomly divided into two groups with experimental and control group, yogic intervention and without yogic intervention. The psychological general wellbeing tool was used for all the subjects.
This assessment was done twice first time in the beginning (baseline) and then after six months. The result showed that Anxiety decreased significantly (P<0.003) and depression decreased significantly (P<0.01) in the Yoga group. Positive wellbeing
and general health improved significantly (P<0.02) and vitality improved significantly (P<0.01) after six months Yoga group compared with the control group.
Kumar K, (2006) conducted a study to assess the effectiveness of Yoga-Nidra on improvement of physical and mental health at Dev Sanskriti Vishwavidyalaya.
Yoga-Nidra was Practiced 30 minutes in a day for 6 months. The sample consisted of 80 students which includes forty males and forty females. A control group of 30
students (fifteen males and fifteen female) was taken up in the study. The result shows a significant change as Yoga-Nidra positively increases the Alpha E.E.G. and G.S.R.
of the subjects. This indicates that the improvement of physical and mental health as a result of practicing Yoga-Nidra.
Sivasankaran, et al., (2006) conducted a study to assess effects of yoga and meditation on hemodynamic and laboratory parameters as well as on endothelial function in a 6-week pilot study. Systolic and diastolic blood pressures, heart rate, body mass index, fasting glucose, lipids, C reactive protein, and endothelial function (as assessed by brachial artery reactivity) were all studied at baseline and after 6 weeks of yoga practice. A course in yoga and meditation was given to the subjects for 1.5 hours three times weekly for 6 weeks and subjects were instructed to continue their efforts at home. This prospective cohort study included 33 subjects (mean age 55
± 11 years) both with (30%) and without (70%) established coronary artery disease (CAD). Result shows that there were significant reductions in blood pressure, heart rate, and body mass index in the total cohort with yoga. None of the laboratory parameters changed significantly with yoga. For the total cohort there was no significant improvement in endothelial dependent vasodilatation with yoga training and meditation compared with baseline (16.7% relative improvement from 7.28.4%;
p=0.3). In the group with CAD, endothelial-dependent vasodilatation improved 69%
with yoga training (6.38-10.78%; p<0.09). Yoga and meditation appear to improve endothelial function in subjects with CAD.
SECTION 2.3: Review of literature related to Yoga Nidra on level of blood pressure among hypertensive patients
Raja Ram Dhungana, et al., (2018) conducted a experimental study to assess the effectiveness of structured yoga practice on blood pressure reduction among
hypertensive patients in seven District Ayurveda Health Centers in Nepal, It will be a randomized, two-armed, non-blinded, pragmatic trial. The intervention consists of three components: a) five days of yoga training (two hours per day); b) two hours health education session on healthy lifestyles; and c) home based self-practice of yoga daily for 90 days (with daily session lasting for 30 min). The treatment arm participants will receive all the intervention components whereas the control group will only be given the two-hour health education program and standard clinic care.
The primary outcome of this trial will be the change in systolic blood pressure. It will be measured before, on each month interval and after completion of the intervention (at 90 days) at outpatient clinical settings with an aneroid sphygmomanometer (BP set). The secondary outcome will be the body mass index (BMI) and heart rate (HR).
Both will be assessed at baseline and after the intervention. Both models will include baseline assessments as covariates. All tests will be two-tailed and p<0.05 will be considered statistically significant.
Chauhan, (2017) conducted a study on evaluate the effect of Yoga-Nidra on reducing hypertension. 60 participants were selected by simple random sampling technique. Samples were 30 in experimental and 30 in control group. The result shows that, the calculated‘t’ value (for systolic blood pressure = 5.19 and diastolic blood pressure = 6.98) was greater than the table value at p< 0.001 level of significance. The study suggested that Yoga Nidra is one the effective non- pharmacological method for reducing blood pressure.
Dhivya Bharathi A, (2016) a quasi-experimental study was conducted to assess the effectiveness of Yoga-Nidra on blood pressure among elderly with hypertension residing at selected old age homes, Coimbatore. The elderly people was assigned to experimental (n=20) and control group (n=15) by Convenient sampling technique. The study results showed that a significant reduction of mean systolic blood pressure from 154.5 to 130.4 mm of Hg and the mean diastolic blood pressure from 92.2 to 82.8 mm of Hg. The calculated‘t’ value (for systolic blood pressure = 4.19 and diastolic blood pressure = 3.98) was greater than the table value at 0.001 level of significance. The study concluded that Yoga-Nidra is an effective measure to reduce the level of blood pressure among elderly with hypertension residing at old age homes.
Dhivya mohanan, et al., (2016), conducted a study to assess the effectiveness of yoga on patients with high blood pressure. Patient attending the outpatient department of cardiology of Narayana medical college and hospital, Nellore, 100 subjects were recruited into the study, Yoga session was conducted for a period of 12 weeks. The same number of age/sex matched control group with high blood pressure were also enrolled and kept without yoga techniques. During the period of treatment the symptom relief in the subjects is assessed periodically by a sphygmomanometer.
The study result showed that yoga is effective non pharmacological method for reducing blood pressure among hypertension patients.
Jeenath justin, (2016) conducted a quasi experimental study to assess the effectiveness of yoga (alternate nostril breathing) on blood pressure among hypertensive clients Unicare Hospital, Rajkot. The conceptual framework for this study was based on modified Ludwig Von Bertalanffys General System Theory. The samples were selected by purposive sampling method. The sample size was 40 (20 under Experimental group and 20 under Control group). As an intervention of 15 days alternate nostril breathing exercise was practiced for experimental group. Results shows that SBP was 31.2 and for DBP was 29.8 which is greater than 15 tabulated t value 3.8 which were highly significant at p<0.001. The finding of the study reveals that the alternate nostril breathing helps in reducing in high blood pressure among hypertensive clients.
Devi and Kala, (2015) conducted a study on role of Yoga-Nidra and shirodhara on hypertensive patients. This study samples were randomly selected (32 hypertensive patients) from various Polyclinics. Pre- post single group design was used in this study. There was significant reduction of mean values in systolic and diastolic blood pressure. The study findings revealed that a significant reduction in the systolic and diastolic blood pressure practicing Yoga-Nidra and shirodhara (p<0.001).
Marshall Hagins et al., (2013) a systematic meta - analysis study was conducted to assess the effectiveness of Yoga-Nidra for reducing blood pressure in adults with hypertension and to assess the modifying influences of type and length of yoga intervention and type of comparison group.17 studies included in the review had unclear or high risk of bias. Yoga-Nidra had a modest but significant effect on
systolic blood pressure (SBP) (−4.17 [−6.35, −1.99], P = 0.0002) and diastolic blood pressure (DBP) (−3.62 [−4.92, −1.60], P = 0.0001). Subgroup analyses demonstrated significant reductions in blood pressure for (1) interventions incorporating 3 basic elements of yoga practice (postures, meditation, and breathing) (SBP: −8.17 mmHg [−12.45, −3.89]; DBP: − 6.14 mmHg [−9.39, −2.89]) but not for more limited Yoga- Nidra; (2) yoga compared to no treatment (SBP: −7.96 mmHg [−10.65, −5.27]).
Sharma et al., (2013) conducted a study on the effect of yoga training on hypertension. The study was conducted on 50 hypertensive patients aged 40-50 years, who are on salt reduction and antihypertensive drugs. They were randomized into two groups: control group and study group. The study group practiced yoga for 45 mines, 5 day/week for 3 months. The control group did not participate the yoga session. After 12 weeks of yogic practice in study group as compared to control group in mean values of the systolic blood pressure (121.12+8.18), diastolic blood pressure (94.24+12.32). This study concludes that yoga can be reduce the blood pressure level.
Deepa et al., (2012) conducted a study to assess the effectiveness of yoga and meditation on mild to moderate essential hypertensive patients. The patients were divided into two groups: 15 patients treated with antihypertensive drugs along with Yoga Nidra, 15 patients on antihypertensive drugs alone. Yoga Nidra practiced for 45 min daily in the morning and evening. Parameters were recorded at the beginning and again at the end of 3 months. The study results showed that a significant reduction of mean blood pressure after 3 months of Yoga Nidra (P<0.01 significant). The study suggested that Yoga Nidra can be used as adjunctive treatment with drug therapy on mild and moderate essential hypertensive patients.
Bindya Viswambharan, (2012) a quasi-experimental study was conducted to assess the Effectiveness of Shavasana on Blood Pressure among Hypertensive Clients at selected Community, Salem. 60 samples were selected by convenience sampling technique. 30 samples from Poolavari and Veerapandi community were assigned to experimental group and 30 samples from Karip natti community were assigned to the control group. The calculated‘t’ value of 4.92 shows that shavasana was effective in
reducing blood pressure at p<0.05 level. Therefore shavasana is a very safe and easy method for reducing blood pressure among hypertensive patients.
Kumar K, (2005) conducted a study to find out the effectiveness of yoga- nidra on hypertension and other psychological co-relates at Patliputra Seva Sansthan, Patna. 40 samples (30 males and 10 females) were taken for this study by purposive sampling technique. The means of pre and post values of systolic blood pressure was 155 and 125mm of Hg and the ‘t’ value was t=10.13, whereas for diastolic pressure was 98 and 76 mm of Hg. The result showed that a significant change as Yoga Nidra positively decrease the blood pressure (both systolic and diastolic) as well as pulse rate, respiration rate, stress, anger and fear. Whereas no significant change shown at the depression level.
CHAPTER-III
RESEARCH METHODOLOGY
Research methodology is a way to systematically solve the research problem.
It is a science of studying how research is done scientifically. Methodology is a significant part of the research under which the researcher is able to project a blue print of the research undertaken.
This study includes Research approach, Research design, Variables, Setting, Population, Sample, Sample size, Sampling technique, Criteria for Sample selection, Development and Description of tool, Scoring procedure, Content validity, Pilot study, Reliability of the tool, Procedure for data collection and Plan for data analysis.
3.1 RESEARCH APPROACH:
The research approach used in this study was Quantitative research approach.
3.2 RESEARCH DESIGN:
The research design is the researcher's overall plan for obtaining answers to the research question. (Polit, 2017)
The research design used for the present study is Non-equivalent control group pretest- posttest design which is comes under quasi experimental design.
GROUP PRE-TEST INTERVENTION POST-TEST
Experimental E1 X E2
Control C1 -- C2
E- Experimental 1- Pre test C- Control 2- Post test X- Yoga nidra
