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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

KARNATAKA, BANGALORE
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.

Name of the Candidate and

Ms.VIPINA MOHAN

Address

1ST YEAR M.Sc NURSING

[In Block Letters]

ALVAS

COLLEGE

OF

NURSING
MOODBIDRI
2.

Name of the Institution

ALVAS COLLEGE OF
NURSING, MOODBIDRI

3.

Course of the Study,

1ST YEAR M.Sc NURSING

Subject

MEDICAL SURGICAL
NURSING

4.

Date of Admission to Course

Title of the Topic

1/6/2011

Effectiveness of Jacobsons progressive muscle relaxation technique on stress among


elderly hypertensive inmates in selected old age homes of Dakshina Kannada
District.

6. BRIEF RESUME OF THE INTENDED WORK:


6.1. Need for the study
An anxious mind cannot exist in a relaxed body
-Edmund Jacobson
Cardiovascular disease is the leading cause of death in the world. Hypertension
or silent killer is an important medical and public health issue. Hypertension is a
condition that afflicts 1 billion people worldwide and is a leading cause of morbidity and
mortality. According to estimates there are 31.5 million hypertensives in rural and 34
million in urban population in India1.
Stress is one of the variables that have positive correlation in the development of
hypertension. Stress increases peripheral vascular resistance and cardiac output and
stimulates sympathetic nervous system activity. People exposed to high levels of
repeated psychological stress develop hypertension largely. A report from American
Institute of Stress estimates that 60-90% of all primary care visits involve stress related
hypertension2. Reducing stress can lower high blood pressure. In order to cope with
stress, the person needs to learn how to relax. Relaxation is an active process involving
technique that calms the body and mind. Relaxation techniques such as deep breathing,
meditation, progressive muscle relaxation, biofeedback etc,can help activate this
relaxation response. Progressive muscle relaxation is a technique for reducing anxiety
by alternately tensing and relaxing the muscles3.
An experimental study was conducted to determine the effectiveness of yoga and
exercise therapies (meditation and progressive muscle relaxation technique) to control
BP among 221 hypertensive individuals in Gujarat. The results revealed that progressive
muscle relaxation technique lowered systolic BP by 4.7mmof Hg and diastolic BP by
3.1mm of Hg.The study concluded that if yoga and exercise therapies should follow
together, there is significant reduction in the stress score. 4

A comparative study was conducted to find the effectiveness of Galvanic Skin


Response biofeedback and progressive muscle relaxation training in reducing blood
pressure and respiratory rate among 30 highly stressed individuals in Amritsar. Training
was given for 20 minutes daily for 10 consecutive days. The results revealed that post
training values indicated that progressive muscle relaxation group showed significant
differences for systolic blood pressure[P<0.05] and diastolic blood pressure [P<0.01]
and the study concluded that galvanic skin response biofeedback and progressive muscle
relaxation training resulted in lowering both systolic and diastolic blood pressure.5
In the light of exposure to hypertensive patients, the investigator recognized that
most of the hypertensive patients are stressed especially the older people and they need
some relaxation technique to calm their mind, hence, the present study aimed at
reducing stress among elderly hypertensive patients in selected old age homes by using
Jacobsons progressive muscle relaxation technique.
6.2.Review of literature
A quasi-experimental study was conducted to evaluate the effectiveness of
progressive muscle relaxation on blood pressure and psychological status among 40
hypertensive subjects in Taiwan. The result revealed that progressive muscle relaxation
training has an immediate effect, reducing the pulse rate 2.35bpm, systolic B.P 5.44 mm
of Hg and diastolic B.P 3.48 mmHg after two weeks of training. After 4 weeks of
progressive muscle relaxation further decrease in pulse rate 2.9 bpm, systolic B.P 5.1
mmHg and diastolic B.P 3.1 mmHg occurred. The study concluded that progressive
muscle relaxation significantly lowered patients perception on stress and it enhanced
patients perception on health and progressive muscle relaxation is beneficial for patients
with essential hypertension.6
A randomized control trial was conducted to assess the effectiveness of stress
reduction approaches such as transcendental meditation and progressive muscle
relaxation among 127 older African Americans in Sanfrancisco. The results revealed that
progressive muscle relaxation lowered the systolic B.P by 4.7 mm of Hg [P=0.054] and

diastolic pressure by 3.3 mm of Hg [P0.02 mm of Hg].The study concluded that


selected stress reduction techniques demonstrated efficacy in reducing hypertension in
this sample of older African Americans.7
An experimental study was conducted to evaluate the effectiveness of relaxation
training as complementary therapy for hypertension control and implications of
evidenced based medicine among nine hypertensive Chinese subjects in Hongkong. The
empirical work examined the effects of 3 relaxation therapies for the reduction of high
B.P such as progressive muscle relaxation, stretch release relaxation and cognitive
imagery relaxation. The results revealed that in the context of the study, all relaxation
therapies can reduce B.P, and the study concluded that stretch release relaxation and
progressive muscle relaxation therapies appeared to be more effective in lowering B.P
compared to cognitive imagery relaxation.8
An experimental study was conducted to assess the effectiveness of progressive
muscle relaxation on anxiety among 73 chronically ill patients with diabetes mellitus,
hypertension and low back pain in selected hospitals of Mangalore. Out of that, 35 were
selected and progressive muscle relaxation was given for 2 weeks. The study results
shown that mean pretest score was 52.4 and mean posttest score was 38.14.There was a
significant reduction in anxiety score. The study concluded that progressive muscle
relaxation could be implemented in nursing homes, rehabilitation centers and
community health centers.9
A quasi-experimental study was conducted to determine the effectiveness of
progressive muscle relaxation technique on anxiety among 40 elderly people in
Bangalore. The results shown that mean level of anxiety during pretest was 89.82 and
during posttest, it was reduced to 69.55.The study concluded that there was an
effectiveness found after progressive muscle relaxation technique.10
An experimental study was conducted on progressive muscle relaxation therapy
in essential hypertension and stress among 171hypertensive patients. The analysis of BP
dynamic during 6 week revealed significantly (p<0.001) systolic BP (10.40.8) and

diastolic BP (7.7+0.6) by the end of one year control group BP returned to the initial
level. BP reduction has been found in 62% of patients in the main group and only 12%
of patients of the control group. The study concluded that relaxation therapy is effective
in reducing BP and stress.11
6.3. Problem statement
The effectiveness of Jacobsons progressive muscle relaxation technique on
stress among elderly hypertensive inmates in selected old age homes of Dakshina
Kannada District.
6.4. Objectives
The objectives of the study are to;
assess the pretest level of stress among experimental and control group.
assess the post test level of stress among experimental and control group.
evaluate the effectiveness of Jacobsons progressive muscle relaxation
technique among experimental group.
compare the effectiveness of Jacobsons progressive muscle relaxation
technique on stress between experimental group and control group.
find out the association between pretest level of stress and selected
demographic variables among both the groups.
6.5. Operational definitions
Effectiveness: In this study, it refers to the extent to which Jacobsons
progressive muscle relaxation technique has achieved the desired effect on of
stress among elderly hypertensive patients.
Jacobsons progressive muscle relaxation technique: In this study, it refers to
a relaxation technique in which a person first tenses and releases major muscle
groups of the body in a prefixed and systematic order, usually beginning at the
body and progressing downwards and is performed for about 20-30 minutes
daily for 10 consecutive days.
Stress: In this study,it refers to the body's reaction to a change that requires a

physical, mental or emotional adjustment or response..


Elderly hypertensive inmates: In this study it refers to elderly person in age
group 50 years and above with essential hypertension.
6.6. Assumptions
The study assumes that;
stress is the risk factor for the development of hypertension.
complementary therapies can reduce stress levels to a certain extent.
6.7. Delimitations
The study is limited to;
elderly hypertensive inmates of selected old age homes
6.8. Hypotheses
The study is based on the following hypotheses, which will be tested at 0.05
level of significance.
H1

-There will be significant difference between mean pretest and posttest level
of stress among hypertensive inmates in the experimental group.

H2

-There will be significant difference in level of stress among hypertensive


inmates in the experimental group and control group.

H3

-There will be significant association between pretest stress level and selected
demographic variables among both the groups.

MATERIAL AND METHOD


7.1. Source of data:
Data will be collected from the hypertensive inmates who are having stress in
selected old age homes of Dakshina Kannada District.
7.1.1. Research design:
The research design adopted for the present study is quasi-experimental nonequivalent control group design.

7.
E

O1

O2

O1

O2

E Experimental group
C Control group
O1 Pre technique assessment of level of stress
X Intervention
O2 Post technique assessment of level of stress
7.1.2. Setting:
Setting consists of selected old age homes of Dakshina Kannada District.
7.1.3. Population:
Population for the study consists of elderly hypertensive inmates who are having
stress in selected old age homes of Dakshina Kannada District.
7.2.Method of data collection
7.2.1. Sampling procedure:Sampling procedure selected is non-probability purposive sampling technique.

7.2.2. Sampling size:Sample consists of 60 hypertensive inmates of an old age home who are having
stress with 30 each in experimental and control group.
7.2.3. Inclusion criteria:Elderly inmates of old age homes who are;
having blood pressure above 140/90 mm of Hg.
having stress.

able to follow instructions.


above 50 years of age.
able to understand Kannada or English.
7.2.4. Exclusion criteria:Patients who are;
bed ridden
not able to perform relaxation exercise regularly
psychologically unstable
7.2.5. Instruments used: Demographic Proforma
Modified Holmes and Rahe stress rating scale
7.2.6. Data collection method: Administrative permission will be obtained from the old age homes prior
to the study.
Subjects will be selected using non probability purposive sampling
technique.
The informed consent will be taken from the subjects.
Data will be collected for the period of 1 month.
The stress among hypertensive inmates will be assessed using Modified
Holmes and Rahe stress rating scale.
The investigator after undergoing a course on Jacobsons progressive
muscle relaxation technique will administer the technique to the study
subjects for 10 consecutive days.
The level of stress will be reassessed using the same rating scale after
intervention.
7.2.7. Plan for data analysis:

Data will be analyzed using both descriptive and inferential statistics.


Demographic data will be analyzed using frequency and percentage.
Assessment of level of stress among hypertensive inmates will be
analyzed by computing frequency, percentage, mean, median, mean
percentage and standard deviation.
Pairedt test will be used to evaluate the effectiveness of Jacobsons
progressive muscle relaxation technique among experimental group.
Comparison of pretest and posttest level of stress among experimental
and control group will be done using independentt test.
Association between pretest level of stress scores and selected
demographic variables will be analyzed using chi square test.
7.3. Does the study require any investigations or interventions to be conducted on
patients or other humans or animals? If so, please describe briefly.
Yes, administration of modified Holmes and Rahe Jacobsons progressive muscle
relaxation technique to the elderly hypertensive inmates after obtaining informed
consent.
7.4. Has ethical clearance obtained?
Yes, ethical clearance has been obtained from the ethical committee.

8 LIST OF REFERENCES
1.Wesa MK, Grimm HR. Recommendations and guidelines regarding the preferred
research protocol for investigating the impact of an optimal healing environment on
patients with hypertension. J ALTERN COMPLEM MED 2004;10:245-50
2.Stress and high blood pressure. 2011;[2]. Available at
http//www.webmd.com/hypertension-high-blood-pressure/guide/hypertension-easing
stress. Accessed on August , 2011.
3.Progressive muscle relaxation. 2010;[1]. Available at
http//in.wikipedia.org/wiki/progressive_muscle_relaxation. Accessed July, 2010.
4.Yeligar RR, Shah AK. The most reliable approach to kill a silent killer. IJPSR 2010
July;18(1-3):[2]. Available from: http//www.ijpsr.com. Accessed July, 2011.
5.Khanna A, Paul M, Sandhu SJ. A study to compare the effectiveness of GSR
biofeedback training and PMRT in reducing BP and respiratory rate among highly
stressed individuals. J PHYSIOL PHARMACOL 2007;51(3):296-300.
6.Sheila S, Barbara I, Shyan HL, Lin CM. Effects of progressive muscle relaxation on
blood pressure and psychosocial status for clients with essential hypertension in Taiwan.
HNP 2003 January/February;17(1):[1].
7.Schneider HR, Staggers F, Alexander NC, Shepherd W, Rainforth M, Kondwani K ,et
al. A randomized controlled trial of stress reduction for hypertension in older African
Americans. Am J Hypertens 2005;18:[1]. Available from:
http//hyper.ahajournals.org/cgi/content/full/26/5/820-. Accessed June 15, 2007.
8.Yung P, French P, Leung B. Relaxation training as a complementary therapy for mild
hypertension control and the implications of evidence based medicine. Complement

Ther Nurs Midwifery 2001 May;7(2):Available from:


http//www.ncbi.nlm.nih.gov/pubmed/11855773. Accessed March 12,2002.
9.Verma N. A study on effectiveness of progressive muscle relaxation on anxiety among
chronically ill patients in selected hospitals of Mangalore. (Unpublished masters
dissertation in Rajiv Gandhi University of Health Sciences,Bangalore);2009 May.
10.Thomas G. A quasi experimental study to determine the effectiveness of progressive
muscle relaxation on anxiety among elderly people in selected old age homes at
Bangalore.(Unpublished masters dissertation in Rajiv Gandhi University of Health
Sciences,Bangalore;2006 May.
11.Alvazian TA, Zaitsev VP. Predictors of the efficacy of relaxation therapy in
hypertension. Ter Arkh 1991;63(9):Available from:
http//www.ncbi.nlm.nih.gov/pubmed/1759200.Accessed May 2010.