PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Mr. SHANKARGOUDA PATIL

I YEAR M. Sc NURSING

PSYCHIATRIC NURSING

YEAR 2011-2012

TULZA BHAVANI COLLEGE OF NURSING

NO, 899/3, NEAR HAJRAT JUNEEDI DARGA, GYANG BAWADI,

BIJAPUR-586101.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS

MR. SHANKARGOUDA PATIL I YEAR M.Sc. (NURSING),TULZA BHAVANI COLLEGE OFNURSINGNEAR HAJRAT JUNEEDI DARGA,GYANG BAWADI, BIJAPUR-586101.

2.NAME OF THE INSTITUTE

TULZA BHAVANI COLLEGE OF

NURSING,

NO, 899/3, NEAR HAJRAT JUNEEDI

DARGA, GYANG BAWADI,

BIJAPUR-586101.

3. COURSE OF THE STUDY AND SUBJECT

I YEAR M.SC. (NURSING),PSYCHIATRIC NURSING

4. DATE OF ADMISSION TO THE COURSE

11th MAY, 2011

5. TITLE OF THE STUDY“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE REGARDING STRESS MANAGEMENT AND COPING STRATEGIES AMONG THE PATIENTS UNDERGOING HAEMODIALYSIS IN SELECTED HOSPITALS AT BIJAPUR.”

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6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION“Liberty is to the collective body, what health is to every individual body, Without

health no pleasure can be tasted by man; without liberty, no happiness can be enjoyed

by society”.

- Henry St. John

Health is the level of functional or metabolic efficiency of a living being.

In humans, it is the general condition of a person's mind, body and spirit, usually

meaning to be free from illness, injury or pain (as in “Good health” or “Healthy”).

The World Health Organization (WHO) defined health in its broader sense in 1946 as

"A state of complete physical, mental, and social well-being and not merely the

absence of disease or infirmity." Although this definition has been subject to

controversy, in particular as having a lack of operational value and the problem

created by use of the word "Complete", it remains the most enduring. Classification

systems such as the WHO Family of International Classifications, including

the International Classification of Functioning, Disability and Health (ICF) and

the International Classification of Diseases (ICD), are commonly used to define and

measure the components of health. The maintenance and promotion of health is

achieved through different combination of physical, mental, and social well-being,

together sometimes referred to as the “Health triangle.” The WHO's 1986 Ottawa

Charter for Health Promotion furthered that health is not just a state, but also "A

resource for everyday life, not the objective of living. Health is a positive concept

emphasizing social and personal resources, as well as physical capacities."1

Most people who require hemodialysis have a variety of serious health

problems. Hem dialysis prolongs life for many people, but life expectancy for people

who need hemodialysis is still much less than that for the general population.

Complications can stem from haemodialysis or the underlying kidney disease. They

includes: low blood pressure (hypotension), muscle cramps, itching, sleep problems, 

anaemia,bone diseases, high blood pressure (hypertension), fluid overload,

inflammation of the membrane surrounding the heart, high potassium levels

(hyperkalemia), infection, depression.2

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End Stage Renal Disease (ESRD) is a slow progressive, irreversible

destruction of functional units of kidneys caused by inherited disorders, prolonged

medical condition such as diabetes (DM) and hypertension (HTN) or the long term

use of certain medications. Transplantation and dialysis are the only choice of

treatment to sustain the life of these patients. Though the transplantation if success

can relive the patient of the entire problem with ESRD but transplantation is not

possible for every patient due to shortage of suitable donors, increased incidence of

organ transplant rejection, age and ill health of the many ESRD patients.3

When pharmacological and dietary management strategies are no longer

effective to maintain fluid and electrolyte balance and prevent uremia, dialysis or

kidney transplantation is considered. Kidney transplantation involves transplanting a

kidney from a living donor or deceased donor to a recipient, who has ESRD for the

client who is not a candidate for renal transplantation or who has had a transplant

failure, dialysis is life sustaining.4

Dialysis is used to remove fluid and uremic waste products from the body

when the kidneys are unable to do so. The need for dialysis may be acute or chronic.

Acute dialysis is indicated when there is high and increasing level of serum

potassium, fluid overload or impending pulmonary edema, increasing acidosis,

pericarditis. It may also be used to remove certain medications and other toxins from

blood. Chronic or maintenance dialysis is indicated in ESRD in the presence of

uremic sign and symptoms affecting all body system, hyperkaelemia and fluid

overload not responsive to diuretics. Patient with no renal function can be maintained

by dialysis for years. Haemodialysis is the most common method of dialysis.

Haemodialysis is used for patients who are acutely ill and require short term dialysis

and for patient with ESRD who require long term or permanent therapy.5

Under stress some people become distress or whereas others remains resilient.

Coping theorists assumes that these outcomes result from people’s coping efforts to

alter the stressful situation or to regulate their emotional reactions. Coping, thus, is a

process explanation for differences in stress outcomes. Patients receiving

haemodialysis use various strategies to cope with the stressors related to their disease

and treatment procedures. The kind of coping strategies they use also depends on their

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personal experience, social support system, individual beliefs and availability of

resources.7

A high percentage of patients on haemodialysis have other conditions not

associated to the primary kidney disease, which are an important cause of morbi-

mortality. The Dialysis Outcomes and Practice Patterns Study (DOPPS) gathers

information about 8615 haemodialysis patients and finds a high prevalence of

coronary heart disease, heart failure, cerebrovascular disease and peripheral vascular

disease among others. Patient treated with haemodialysis have a high prevalence of

co-morbidity that includes an elevated morbidity risk. Co-morbidity is a major reason

for the frequent hospitalization of patient having haemodialysis. Co-morbidity has an

effect on several health outcomes.8

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NEED FOR THE STUDY“To keep the body in good health is a duty... otherwise we shall not be able to

keep our mind strong and clear”

- Buddha

Need for the study means scientific method which refers to a body of

technique for investigation phenomena, acquiring new knowledge or collecting and

integrating previous knowledge to be termed scientific method of enquiry must be

based on gathering empirical and measurable evidence subject to specific principles

of reasoning.

Chronic kidney disease (CKD) Stage IV is an important non-communicable

disease epidemic that affects the world including India. There were estimated 1.2

million dialysis patients worldwide in 2002, based on an average annual growth rate

of 6%. Presently there are around 1.5 million dialysis patient across the world. In

India, it has been presumed that nearly 100,000 new patients with CKD Stage IV

require renal replacement therapy every year, based on the data which was provided

by a tertiary referral center. And there are only 400 dialysis centers amounting to

1000 dialysis stations. The current economics of dialysis is back breaking for an

average Indian where GNP is about 19,350 annually and the cost of dialysis is

estimated to be 31,500 monthly.9

According to WHO report 2007-08, 1311 out of 10,000 populations is

suffering from non-communicable disease i.e 13.11%. In India among that 3% of

population suffering from other chronic disease associated with End Stage Renal

Disease and undergoing Hemodialysis. And also suggest that there is a nearly 1% of

new cases will add to this in every year. 10

The adequate primary care of patients with renal failure includes decision

about the choice of the modality of treatment, down to the everyday answering to

questions of patients, relatives and staff, which requires knowledge of the major

psychological stress of the illness and psychiatric complaints resulting from these

stresses and their treatment. The patient on dialysis is threatened with many potential

losses and changes in the life style. In the initial stage a patient may need only rest

and dietary restriction but as the disease progresses, the patient physically may not be

6

able to cope up with his work and may take medical leave for hospitalization. This

may affect his employment, which indirectly may affect the whole family especially if

the patient is the bread earner and hence financial situation also gets jeopardized.

These physical and psychological stresses can lead to delirium, depression, anxiety,

suicide, uncooperative behavior, sexual dysfunction and psychosis.6

These patients may develop different coping strategies in response to the

various stressors they face. Stressors and coping strategies of patients undergoing

dialysis treatment have been investigated by researcher. But, few studies have

considered the effect of co-morbidity on the relationship between coping and stress.

Such an investigation is important as the incidence of ESRD and co-morbid

conditions continuously increases.11

The research study was conducted to determine relationships among

treatment-related stressors and coping strategies of chronic haemodialysis patients.

The study was consisted of 224 participants of whom 135 were males (60%) and 89

were females (40%). Mean age was 51.54 (SD=14.03) years, mean duration of

dialysis was 5.13(SD=3.69) years and the majority (76%) were married. The majority

of participants attended hemodialysis for four hours, three times a week. All of the

participants were Muslim. The most frequent stressors reported were: limitation of

vacation (80.4%), followed by fatigue (79.9%), uncertainty about future (79.0%),

limitation of activities (75.9%) and life depend on hemodialysis machine (75.0%).

The total score of coping scale was 151.71(SD=23.60, min=77, max=232),

demonstrating moderate wide range of scores. The most frequently used coping

strategies were turning to religion (Mean=14.10, SD=3.99), active coping

(Mean=11.43, SD=3.03) and suppression of competing activities (Mean=11.22,

SD=2.15). The study was concluded that the most frequently used coping strategy is

“Turning to religion” by haemodialysis patients which is different from previous

studies.12

During the clinical research in dialysis and nephrology ward, while

conversing with patients investigator identified various difficulties they face related to

frequent hospitalization and their expressions of worries due to the cost of therapy,

altered family roles, responsibility and fear of future, these lead to increased stress

levels among patients undergoing both kinds of dialysis. Hence the researcher felt that

7

there is a strong need to study the stress and coping among haemodialysis patients to

create awareness about physical and psychological health along with providing

support and counselling to patients.

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6.3. REVIEW OF LITERATURE

The review of literature in a research report is a summary of current

knowledge about a particular problem and includes what is known and not known

about the problem. The literature is reviewed to summarize knowledge for use in

practice or to provide a basis for conducting a study. Review of literature section

includes a description of the current knowledge of a particular problem, the gaps in

this knowledge base and the contribution of the study to the development of

knowledge in this area.

A cross-sectional descriptive study was conducted to evaluate the depression,

suicidal ideation and coping strategies in haemodialysis patients with renal failure at

Ataturk Medical Technology Vocational Training School, Ege University, Bornova,

Izmir, Turkey. Study was done on convenient sample of 92 adults with an age range

of 19-65 who had chronic renal failure and consecutively admitted to the Dialysis

Center of Kadikoy and Dialysis Center of Kahraman in Turkey. Data were collected

by using socio-demographic form, Beck Depression Inventory, Suicide Behaviors

Questionnaire and Coping Strategies with Stress Inventory scale .The results of study

revealed that there were positive correlations between depression and Suicide

Behaviors Questionnaire (r = 0·469, p = 0·001), between patients0·00) and suicidal

ideation (r = 0·27, p = 0·01). Depression and behavioral disengagement had a positive

correlation (p = 0·001, r = 0·410). Depression and suicidal ideation was increased

with lower education status (F = 7·42, p = 0·001; F = 4·51, p = 0·014). Age and

depression (r = 0·43). Finally the study was concluded that

haemodialysis patients frequently experience depression. Hence the study was

recommended that suicidal ideation increased as the severity of depression increased.

Depression and suicidal ideation were increasing with age in patients with

chronic renal failure. Therefore, it is considered as necessary for dialysis patients to

be under regular psychiatric evaluation with risk assessment.13

A study was conducted on Quality of life and coping: differences

between patients receiving continuous ambulatory peritoneal dialysis (CAPD) and

those under hospital haemodialysis (HHD), at Escuela d Enfermerí de Vitoria-Gasteiz,

Vitoria, España, begona. A cross-sectional study in 61 patients aged<70 years old

under HHD and 32 patients receiving CAPD. Data were collected by Charlson Index,

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the State-Trait Anxiety Inventory (Stai-R), the Perceived Stress Scale (PSS), the MOS

Social Support Survey and the Short-Form 36 questionnaire for quality of

life. Coping strategies, perceived control and satisfaction with life were also analyzed.

Statistical analyses were adjusted by differences in age and sex. The results of study

were revealed that women accounted for 35.5% of the patients. The mean age was 54

years. The CAPD group was younger and had a higher proportion of women.

Charlson Comorbidity Index scores were similar in patients receiving HHD and in

those receiving CAPD. The use of psychoactive drugs was higher in the CAPD group

than in the HHD group (38% vs. 13%; p<0.01). The CAPD group scored significantly

higher in strategies of seeking help, emotional regulation skills, problem resolving

and distraction. No differences were found in social support between the two groups.

No significant differences were found in the physical or mental components or in the

seven dimensions of the SF-36. Satisfaction with life was higher in the CAPD group

(7.12 versus 6.21; p=0.07). The study was concluded that no differences in the

perception of quality of life were found between patients receiving the two modalities.

The CAPD group tended to show greater satisfaction with life and more

adaptive coping strategies. Hence the study was recommended that emotional

regulation skills, problem resolving and distraction in CAPD patients may have

greater acceptance and control over the disease process.14

A cross sectional study was conducted to examine the relationships among

coping, co morbidity and stress in patients having haemodialysis at National Sun Yat-

sen University Taipei, Taiwan. Study was conducted on 2642 patients, who had been

having haemodialysis for at least 3 months; patients were interviewed by nursing

managers in 27 participating centers. In this study the stressors were experienced by

haemodialysis (HD) patients were measured by using the revised version of

haemodialysis stressor scales developed by Baldree et al; coping strategies were

measured using the Jalowiec coping scale. In this study, 43.5% patients had at least

one co-morbidity. Patients with co-morbidities being renal disease found 33.7%,

diabetes 32.3% and unknown reasons 12.6%, while those without co-morbidities were

found to be undergoing haemodialysis for treatment of renal disease 48.5%, unknown

reasons 20.9% and diabetes 14.3%. Independent sample t-tests were performed to

compare the mean stress scores and coping scores. Compared with those with no co-

morbidities, those with co-morbidities had higher average stress scores (27.52 ±

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15.77; t = 5.37, P < 0.001) and coping score: emotional oriented coping (6.25 ± 4.93; t

= 4.74, P < 0.001), support seeking (4.10 ± 2.55; t = 2.60, P = 0.009) and avoidance

(0.94 ± 1.48; t = 3.87, P < 0.001). There was no statistically significant difference

between the two groups with regard to problem-oriented coping strategies and

isolated thought. This statistically significant and positive relationship suggest that

patients having haemodialysis who reported higher levels of use of coping strategies

were also reported as higher levels of stress. And co-morbidity had a 0.05 (P < 0.01)

main effect in indicating that patients having haemodialysis with co-morbid

conditions had higher level of stress. Hierarchical regression was used to analyze the

data. Finally the study was recommended that co morbidity not only has a direct

impact on stress but also has a moderating effect on the relationship between coping

and stress.11

A study was conducted on assessment of the relationship between quality of

life and stress in the haemodialysis patients in Mazandaran university of Medical

sciences, sari, Iran. The aim of this study was to determine the relationship between

quality of life with stress in the haemodialysis patients. Data were collected in

questionnaire in three months. In the questionnaire, first quality of life then stress was

studied and the variables are described. Then the relation between them was

determined by statistical analysis. Descriptive correlation study was done on 100

haemodialysis patients under, 42% with partial comfortable life had moderate tension.

Pearson correlation coefficient showed that there is a significant linear relationship

with quality of life and degree of tension, (r=0.802) that with increased tension,

quality life declines (p<0.001), positive correlation between the number of

haemodialysis patients per week and the history of dialysis (p=0.001). History of

dialysis in 69% of the the patients was 1-5years and 74% of them dialyzed in morning

trice a week. Results of study were revealed that quality of life was decreased due to

increase of stress. Hence the study was recommended that, the nurses and the other

members of medication team should know to reduce the patient's stress using the

supportive procedures and adaptation techniques and it helps in improving quality of

life by proper intervention method.15

A study was conducted to investigate the relationship between stressors and

coping strategies in patients with haemodialysis (HD), in Institute of Hospital and

Health Care Administration, National Yang-Ming University, Beitou District, Taipei,

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Taiwan. In this study the stressors experienced by HD patients were measured using

the revised version of haemodialysis stressor scales developed by Baldree et al;

coping strategies were measured using the Jalowiec coping scale, were used to

interview 2642(mean age 57 years; 53.5% females) receiving haemodialysis from five

centers, five regional hospital, ten community hospitals and seven independent

haemodialysis centers in 13 countries. Data was collected using structured

questionnaire. Data was analyzed using descriptive analysis and Pearson s correlation.

Results of this study were revealed that there was significant positive relationship

between all the subscales of stress and the coping subscales with coefficient ranging

from 0.12 to 0.51 (P<.01). Daily activity subscale scores had positive association with

using emotional oriented, avoidance, and isolated thoughts as coping styles and

negative correlation with support seeking from health professionals. The use of

emotion oriented, support seeking, avoidance and isolated thoughts to cope was

higher with the patients who perceived the greater stress related to physical

symptoms, depending on medical staff, and blood vessel problems. A positive

correlation was found between the fluid and food restriction and role ambiguity

subscales and the emotion oriented, support seeking, avoidance and isolated thoughts

coping strategies. Coping strategies like emotion oriented, avoidance and isolated

thoughts also had positive relationships with reproductive system functioning. The

problem oriented strategies was seldom used to ease their stressors by HD patients.

Another coping strategies were used infrequently was the support seeking. Thus the

study was recommended that further study is needed to manage the stressors in

haemodialysis patients.16

The study was conducted to assess the relationship between emotion- and

task-oriented coping (EOC/TOC) with stress and employment in patients undergoing

maintenance haemodialysis. Department of Hygiene and Public Health, Teikyo

University School of Medicine, Japan. The study was included 317 individuals aged

18 to 64 yr who had uremia and had been undergoing haemodialysis regularly for at

least three months. Subjects were evaluated  with requested to complete the following

questionnaires: the Japanese version of the Coping Inventory for Stressful Situations,

the Short Form-36 Health Survey, an item on itchiness, the Self-Efficacy on Health-

Related Behavior Scale, the Japanese version of the Health Locus of Control Scale,

the Social Support Scale, and the Japanese version of the Hospital Anxiety and

12

Depression Scale. Among men, age, physical functioning, EOC, and depression

differed significantly (p<0.05) depending on employment. Among women, marital

status, household composition, EOC, depression, and anxiety differed significantly

(p<0.05) depending on employment. TOC was not significantly associated with

employment in either sex. Multiple logistic regression analyses, including possible

confounders, indicated that when EOC increased by 10 points, the associated adjusted

odds ratio of an unemployed or economically inactive status changed by 1.48 (95%

confidence interval, 1.04-2.11; p=0.030) in men and by 1.88 (95% confidence

interval, 1.02-3.46; p=0.042) in women. Hence the study was recommended that

emotion- and task-oriented coping (EOC/TOC) associated with employment in

patients receiving maintenance haemodialysis.17

The study was conducted to assess the possible interactive effects of age, sex,

duration of haemodialysis (HD), educational and income levels, and stress coping

mechanisms on depression and anxiety in patients on maintenance HD, at Department

of Hygiene and Public Health, Teikyo University School of Medicine, Itabashi-ku,

Tokyo, Japan. In this study 416 subjects were investigated (N=416), who are regularly

undergoing HD for more than 1 year, who did not have apparent cerebrovascular

disease or serious intellectual impairment. The interactive effects of age, sex, duration

of HD, and educational and income levels, in relation to stress coping mechanisms, on

depression or anxiety were assessed by hierarchical multiple regression analyses. The

results of the study was revealed that regression lines illustrating significant (P<.05)

interactions were constructed. The decrease in depression accompanying the increase

in task-oriented stress coping was greater in highly educated patients than it was in the

other patients. Anxiety levels decreased when patients had both high income and

demonstrated a range of task-oriented stress coping mechanisms. For patients 

undergoing HD for long duration, or with a relatively high income, the decrease of

depression and anxiety accompanying a decrease of emotion-

oriented stresscoping was greater, as compared with other patients. The decrease of

depression accompanying an increase of avoidance-oriented stress coping was greater

in patients with low income and in older patients than it was in the other patients.

Finally the study was concluded that development of specific and focused

interventions for depression or anxiety in maintenance HD patients. Hence the study

was recommended that depression and anxiety levels decreased when patients had

13

both high income and demonstrated a range of task-oriented stress coping

mechanisms and high education.18

A cross sectional study was conducted on Level of stress and coping abilities

in patients on chronic haemodialysis and peritoneal dialysis, in College of Nursing &

Dept of Nephrology, Sri Ramachandra Medical College & Research Institute

(Deemed University), Porur, Chennai. Study was done on 50 patients with End Stage

Renal Disease, who are on chronic peritoneal dialysis and on chronic haemodialysis.

The results showed that the overall mean stress score in haemodialysis patients was

higher (78.3%) than in peritoneal dialysis patients (43.3% p<0.001). Coping ability

score for haemodialysis patients was 51.9% as compared to peritoneal dialysis

patients (60.9% p<0.001). This study was suggested that peritoneal dialysis patients

have better quality of life when compared to haemodialysis patient. Ultimately this

study has come to conclusion that, the comparison of stress and coping ability among

chronic haemodialysis and peritoneal dialysis patients in physical, psychological and

socio-economic aspects showed higher level of stress among the chronic

haemodialysis patients were compared with the peritoneal dialysis patients. The study

was suggested that, limitations in handling stress not only adversely affects the quality

of life, but also increases the risk for morbidity and mortality. There were close links

between emotional well being and clinical outcomes in dialysis patients. Hence the

study was recommended that there is life style modification is important for stress

handling in dialysis patients.6

The study was conducted on Identification of stressors and use

of coping methods in chronic hemodialysis patients in College of Nursing, Ohio State

University, Columbus. In this study data were collected from 68 patients who were

undergoing HD and study has included a convenience sample of 68 haemodialysis

patients. Sixty-eight subjects completed the Haemodialysis Stressor Scale and the

Jalowiec Coping Scale. Although Baldree et al. reported no significant difference in

ratings of physiological and psychosocial stressors, results of this study showed that

physiological stressors were more troublesome than psychosocial stressors, t = 10.85,

p less than .0001. Subjects used problem-oriented coping more often than affective

methods to handle stress, t = 10.93, p less than .0001, supporting the Baldree et al.

findings. Total haemodialysis stressor scores were related to total coping scores, r

= .43, and physiological stressors to affective coping, r = .38. Thus the study was

14

concluded that the psychosocial stressors were associated with affective-oriented, r

= .43, and problem-oriented coping, r = .33. Length of time of hemodialysis was

associated with problem-oriented coping, r = .26. Hence the study was recommended

that the further research studies are needed to know the exact relationships between

stressor and coping scores.19

The study was conducted on stress identification and coping patterns in

patients on haemodialysis. The study was included 35 patients on haemodialysis and

assessed for types and severity of stressors and methods of coping strategies

with stress. In this study coping was measured with a tested scale and stress was

evaluated with a scale. Test-retest reliability of the stressor scale was satisfactory

(rs=71). Results of this study indicates that stressors experienced by the memodialysis

patients can be measured with an objective tool, psychosocial stressors have an

impact equal to that of physiological stressors. Fluid restriction was ranked as the

highest psychosocial stressor and the top physiological stressors were muscle cramps

and fatigue. Patients on dialysis for one to three years indicated the greatest amount

of stress. Patients used problem-oriented coping methods significantly more than

affective-oriented methods (t= 7.06), (p greater than .001). Thus the study was

concluded that the optimism and controlling the situation were the two most

common coping methods. Hence the study was recommended that there is a need of

creating more awareness on use of important coping tools for HD patients.20

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6.4. STATEMENT OF PROBLEM

“A study to evaluate the effectiveness of planned teaching programme on

knowledge regarding stress management and coping strategies among the

patients undergoing haemodialysis in selected hospitals at Bijapur”.

6.5. OBJECTIVES OF THE STUDY

1. To assess the level of knowledge regarding stress management among the

patients undergoing hemodialysis.

2. To identify the coping strategies adopted by the persons affected by ESRD

who are undergoing haemodialysis

3. To evaluate the effectiveness of planned teaching programme on stress

management among the patients undergoing haemodialysis.

4. To determine the association between the knowledge score on stress

management and coping strategies among the patients undergoing

haemodialysis their selected personal variables as, age, gender, religion,

education, marital status, occupation, income, place of residence, presence co-

morbid illness and duration of receiving current renal treatment.

6.6. OPERATIONAL DEFINITIONS

1. EVALUATE: It refers to recognizing the knowledge after pre test and

post test score regarding stress management and use coping strategies

among haemodialsis patients.

2. EFFECTIVENESS: It refers to the extent to which the planned teaching

programme has achieved the desired effect as measured by the subjects

gain in knowledge scores.

3. PLANNED TEACHING PROGRAMME: It refers to systematically

planned, organized & executed teaching activity with specific objectives

prepared by investigator to impart knowledge regarding the stress

management and coping strategies.

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4. KNOWLEDGE: It refers to correct response of patients under going

haemodialysis regarding stress management and use of coping strategies

as elicited through Structured Interview Schedule.

5. STRESS: In this study stress refers to alteration in function of mind and

body due to changes in the physical, physiological, psychological,

economic, social constraints of patients on haemodialysis.

6. COPING STRATEGIES: Coping strategies are efforts directed to

reduce stress. In this study it refers to behaviors which primarily used by

patients in solving physical, physiologic, psychological, social conditions.

7. HAEMODIALYSIS: Haemodialysis is the procedure of circulation of

patient’s blood through an artificial membrane (Dialyzer) which acts as a

semi permeable membrane to remove waste products and excess fluids

from the body.

6.7. ASSUMPTIONS

1. The haemodialysis patients may have limited knowledge regarding

coping strategies.

2. The haemodialysis patients may face limited degree of stress.

3. The haemodialysis patients may adopt coping strategies in order to

overcome stress.

4. The haemodialysis patients are may gain knowledge through planned

teaching programme in order to overcome stress.

6.8. HYPOTHESIS.

H0 - There is no significant association between pre test knowledge score

with selected socio demographic variables.

H1 - There is significant association between pre test knowledge score with

selected socio demographic variable.

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7. MATERIAL AND METHODS

7.1 SOURCE OF DATA : Patients undergoing haemodialysis in

selected hospitals at Bijapur.

7.2 METHODS OF DATA COLLECTION

7.2.1. Research Design : Pre-experimental One group pre test-post

test research design, research approach

adopted in this study is evaluative approach.

7.2.2. Research Variables

Independent variable : Planned teaching programme knowledge

regarding stress management and coping

strategies among the patients undergoing

haemodialysis in selected hospitals at

Bijapur.

Dependent variables : Knowledge regarding stress management

and coping strategies among the patients

undergoing haemodialysis in selected

hospitals at Bijapur.

Extraneous variables : Extraneous variables such as age, gender,

religion, marital status, educational status,

occupation and income, duration of illness,

and source of information.

7.2.3. Setting : Selected hospitals at Bijapur, Karnataka.

7.2.4. Population : Patients who are undergoing haemodialysis

in selected hospitals at Bijapur

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7.2.5. Sample size : Patients who are undergoing haemodialysis

in selected hospitals at Bijapur. Who fulfill

the inclusion criteria and the sample size is

60.

7.2.6. Criteria for the sample selection

Inclusion criteria: The patients,

Who are undergoing haemodialysis

Who know to read and write Kannada

Who are willing to participate

Who are available during data collection

Exclusion criteria: The patients

Who are not willing to participate in the

study.

Who are not available at the time of study.

7.2.7. Sampling Technique : Non - probability, convenient sampling

technique.

7.2.8. Tool for data collection : The tool consist of the following section,

Section A : It includes selected socio demographic

variables.

Section B : Stessors scale to assess stress level among

haemodialysis patients in selected hospitals

at Bijapur.

Section C : Structured interview schedule as a coping

scale to assess the coping Strategies of

haemodialysis patients.

19

7.2.9. Method of data collection : On 1st day (pre test) the patient’s knowledge

will be assessed by the investigator through

structured interview schedule. On the same

day planned teaching programme will be

conducted on the same knowledge regarding

stress management and coping strategies

patients undergoing haemodialysis. On 8th

day of the pre test, post test will be

conducted with the same structured

interview schedule.

7.2.10. Plan for the data analysis : The collected data will be analyzed using

descriptive and inferential statistics.

Descriptive statistics : Frequency, percentage, mean and standard

deviation will be used.

Inferential statistics : Coefficient- correlation and chi-square test

will be used.

7.3. DOES THE STUDY REQUIRES ANY INVESTIGATION OR

INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER

HUMAN OR ANIMALS? : Yes, there is intervention as a planned teaching programme and there is

No active manipulation on the subject.

7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM

YOURINSTITUTION

: Yes ethical clearance will be obtained from the institution to conduct the

study.

20

8. LIST OF REFERENCES.

1. “Health-Wikipedia” Nov, 2011, available from, http://www.google.co.in,

retrieved on 24/11’2011.

2. “Haemodialysis Risks by Mayo Clinic staff”, available from,

http://www.mayoclinic.com /health /hemodialysis, retrieved on 22/11/2011.

3. Functional status and well being in the ESRD in India & Pakistan: incidence,

causes and management, ETHN & DTS 2006; 16: 20-23. available from,

http://www.google.co.in, retrieved on 22/11/2011

4. Priscilla LeMone, Koren Burke, A text book of “Medical surgical nursing

critical thinking in client care”, South Africa: Dorling Kindersely (India) Pvt

Ltd, 4thedition, 2008, 919 p.

5. Brunner and Suddarht’s, textbook of “Medical surgical nursing”, Vol 2, 11 th

edition, 2008, 1527, 1560, 1531, 1537p

6. TR Udaya Kumar, A Amalraj, P Soundarajan, Gabraham, Indian Journal of

Nephrology, “Level of stress and coping abilities in patients on chronic

haemodialysis and peritoneal dialysis”, 2003; available on

http://www.google.co.in, retrieved on 23/11/2011.

7. Niall Bolger. Journal of personality and social psychology, “Coping as a

personality process: A prospective study,” 1990, 525-537p, available from,

http://www.google.co.in, retrieved on 20/11/2011.

8. Anaya Fernandez, et al, “The relationship between co-morbidity, anemia and

response to erythropoiesis-stimulating agents in chronic hemodialysis.

Nefrologia”, 2008, 186-192, available from, http://www.google.co.in,

retrieved on 22/11/2011.

9. Agrawal K S, A journal on “Chronic kidney diseases and its prevention in

India”, 2005, available from, http://www.google.co.in, retrieved on

24/11/2011.

21

10. WHO report on “World Health Statistics 2007-08, 2009, available from,

http://www.google.co.in, retrieved on 26/11/2011.

11. Shu-Chuan Jennifer Yeh, Chia-Hsiung Huang, Hsueh-Chih Chou, Journal of

Advance Nursing “Relationships among coping, co-morbidity and stress in

patients having haemodialysis, February, 2008 , 166-174p.

12. Cinar S, Barlas GU, Alpar SE, “Stressors and Coping Strategies in

Hemodialysis Patients” in Pak J MedSci 2009, 447-452p, available from,

http://www.google.co.in, retrieved on 24/11/2011.

13. Keskin G, Engin E, “The evaluation of depression, suicidal ideation

and coping strategies in haemodialysis patients with renal failure” in

Bornova, Izmir, Turkey, 2011.

14. Ruiz de Alegría-Fernández de Retana B , et al, “Quality of life and coping:

differences between patients receiving continuous ambulatory

peritoneal dialysis and those under hospitalhemodialysis”, in Enfermerí de

Vitoria-Gasteiz, Vitoria, España, Mar-Apr;2009.

15. Shafipour V, Jafari H, Shafipour L, Nasiri E, “ Assessment of the relationship

between quality of life and stress in the haemodialysis patients” in

Mazandaran university of Medical sciences, sari, Iran, 2008.

16. Shu-Chuan Jennifer Yeh, Hsueh-Chih Chou, journal of bio behavioural

medicine “Coping strategies and stressors in patients with

haemodialysis”, .2007, 182-190p.

17. Takaki J , Yano E, “The relationship between coping with stress and

employment in patients receiving maintenance haemodialysis”, in department

of hygiene and public health, Teikyo University School of Medicine, Japan,

Jul 2006.

22

18. Takaki J , et al, “Possible interactive effects of demographic factors

and stress coping mechanisms on depression and anxiety in

maintenancehemodialysis patients” in department of hygiene and public

health, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan,

Mar 2005.

19. Gurlis JA, Menke EM, “Identification of stressors and use of coping methods

in chronic hemodialysis patients” in college of nursing, Ohio State University,

Columbus, Jul-Aug, 1988.

20. Baldree KS, Murphy SP, Powers MJ. Stress identification and coping patterns

in patients on haemodialysis, Mar-Apr, 1982.

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9. Signature of the candidate :

10. Remarks of the guide :

11. Name and designation of

11.1 Guide : Mrs. ASMA. SASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRIC NURSING, TULZA BHAVANI COLLEGE OF NURSING, BIJAPUR.

11.2 Signature :

11.3 Co-Guide (if any) : MR. SHANKARLING M. REDDIASSISTANT PROFESSOR TULZA BHAVANI COLLEGE OF NURSING, BIJAPUR.

11.4 Signature :

11.5 Head of the department : Mrs. ASMA. SASSOCIATE PROFESSOR DEPARTMENT OF PSYCHIATRIC NURSING, TULZA BHAVANI COLLEGE OF NURSING, BIJAPUR.

11.6 Signature :

12. 12.1 Remarks of the :

Principal

12.2 Signature :

24