“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED ...



“A study to assess the effectiveness of structured teaching programme on stress and coping strategies among secondary school children in selected schools at bangalore”.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

mRS. GEETHA .m

M.S.c NURSING- iST YEAR

COLUMBIA COLLEGE OF NURSING BANGALORE-43

2010-2011

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

Annexure ii

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

|1. |NAME OF THE CANDIDATE AND ADDRESS |GEETHA.M. |

| | |1st year M. Sc Nursing, |

| | |COLUMBIA COLLEGE OF NURSING, |

| | |84/1 5th main Road OMBR Layout Bansvadi Bangalore-43 |

|2. |NAME OF THE INSTITUTION |COLUMBIA COLLEGE OF NURSING |

|3. |COURSE OF STUDY AND SUBJECT |I st year M.Sc Nursing |

| | |PAEDIATRIC NURSING |

|4. |DATE AND ADMSSION TO THE COURSE |09.06.2010 |

|5. |TITLE OF THE TOPIC |“A study to assess the effectiveness of structured teaching programme on |

| | |stress and coping strategies among secondary school children in selected |

| | |schools at Bangalore”. |

|6. |BRIEF RESUME OF INTENDED WORK | |

| |INTRODUCTION | |

| |6.1 NEED FOR THE STUDY |Enclosed. |

| |6.2REVIEW OF LITERATURE |Enclosed. |

| |6.3 STATEMENT OF PROBLEM |Enclosed. |

| |6.4 OBJECTIVES OF THE STUDY |Enclosed. |

| |6.5 OPERATIONAL DEFINITION |Enclosed. |

| |6.6 ASSUMPTION |Enclosed. |

| |6.7 DELIMITATIONS | |

| |6.8 HYPOTHESIS |Enclosed |

| | |Enclosed. |

| | |Enclosed |

| | | |

|7. |MATERIALS AND METHODS |

| |7.1 SOURCES OF DATA: Data will be collected from selected secondary school children’s at Bangalore. |

| |7.2 Methods of Data Collection: Descriptive Method |

| |7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON THE PATIENT OR OTHER HUMAN OR ANIMALS? |

| |, |

| |Yes, the study requires intervention in the form of structured teaching programme which will not have any harmful effect on a |

| |study participant. |

| |7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? |

| |Yes, Ethical committee’s report is here with enclosed. |

| |8. LIST OF REFRENCESS : Enclosed |

BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“Give a man fish and he is fed for a day. Teach a man how to fish and he is fed for a life time”.-J. WILLAMS

School is your child’s “job.” It’s where he spends most of his time. His work is scored and measured, and compares himself with others every day. Academic stress and social pressure are two big causes of anxiety for school-age children. Meeting parents and teachers high expectations for school can be stressful. The build-up of schoolwork, homework, after-school activities, tests, projects, and changes in routine can be overwhelming. Children’s also feel pressure to be popular with their friends and classmates’. Saying no to a friend is stressful. It’s also stressful to keep up with a friend’s nice clothes or expensive toys. Stress is often seen as a apparent physical reaction: mourn, sweaty palms, flying, aggressive or defensive outbursts, rocking and self-comforting behaviors, headaches and stomachaches, nervous behavior of fine motor skills (e.g. hair twirling or pulling, chewing and sucking, wounding of skin and nails), accidents of the toilet, and sleep disturbances.1

Experts stress that children may react globally through depression and avoidance, excessive shyness, hyper-alertness, excessive worry worry , the “freezing” in social situations, seemingly obsessive interest in objects, routines, Food and persistent about “what comes after,” and excessive clinging. Typical school children can whine when things don’t go their way, be aggressive, question adults, try out new behaviors, complain about school, have fears and nightmares, and lose concentration. Reactions to stress may include withdrawal, feelings of being unloved, being distrustful, not attending to school or friendships, and having difficulty naming their feelings. Under stress, they may worry about the future, complain of head or stomachaches, have trouble sleeping, have a loss of appetite, or need to urinate frequently.2

As adults, we are usually busy as parents and workers and often feel stressed and experience burn-out at times, but would you ever think that children can experience stress too. Most of us probably think that childhood is a time when children are carefree, having no worries or responsibilities; yet, studies tell us that many children experience extreme stress and have similar symptoms as those of adults. Like adults, children often have bad feelings and have difficulty handling their stress. Unlike adults, though, children do not have the means or the skills to understand or manage their stress in appropriate ways. Children must depend upon us to help them. As parents and caregivers we need to recognize when children are feelings stressed and help them feel better. We can also help by decreasing the discomfort for the child and, in some instances, by assisting a child or family in dealing with the situation that caused the stress.3

Stress is the body's reaction to a physical or emotional situation that causes imbalance in a person's life. Occasional stress is normal and predictable in our daily lives. Normal stress serves to present us with challenges for greater learning and opportunity, such as the stress that we may experience before meeting new people. On the other hand, constant stress can cause us many problems and, unless handled, can add to the stress of another situation. Children react in different ways to stress. Some children become ill. Some may become withdrawn and nervous while others show anger and demand attention. In some instances, development is affected. There are also some children who do not seem bothered by stress. We often call these children resilient. Stress becomes a problem when the ordinary stress of daily life becomes overwhelming. When under stress, there is an increase in heart rate, breathing is faster, and muscles tense up. When there are several stressors, the level and duration of the stress are greater.4

Problems begin when ordinary stress becomes too much stress – or distress. There are a variety of reasons for children to feel stress. Death, divorce, remarriage, moving, long illness, abuse, family or community violence, natural disaster, fear of failure, and cultural conflict may each heighten stress. Under stress, the heart rate and breathing are at a higher speed and muscles are tense. Multiple stressors worsen the stress level and the length of the stress. Our bodies need relief from stress to reestablish balance.6

Both negative and positive events can cause stress. Family events are often a source of stress for children. The breakup of a family is a negative event that can cause stress in children. Events such as physical abuse, separation, rejection, and fights are some other negative sources of stress. Other events such as a parent losing a job, or the death of a parent, grandparent, or sibling can create stress. Positive events that cause stress in children include birthday parties, new pets, and the birth of new siblings. Everyday family obligations, events, and routines can create stress and tension for the young child, as in the case of an active family that may be so busy that the needs of a young child may be overlooked. Parents and caregivers need to be aware of what is happening in a child's life that may affect the child's behavior. A sudden change in a child¼s behavior may be related to stress. Caregivers can talk with the parents about what is going on in the home.6

6.1 NEED FOR THE STUDY

In the process of growing, secondary school children experience stress either good or bad depending on how they cope. School training further adds to this stressful situation. It is noteworthy that persistent over stress will impair students’ academic achievement, personal and professional development. Stress is the body's physical, chemical, and emotional reaction to an overwhelming, confusing, or exciting situation. Children of all ages can experience stress, but how they respond to it depends on their age, temperament, and family environment. Kids experience two different types of stress. The first is normative stress, which occurs at different stages of a child's development. Learning to walk, talk, use the toilet, and make friends can be stressful for a child. But these are productive forms of anxiety in that they help a child grow and become more independent. The second kind of stress is life-change stress, and it's typically more confusing and upsetting to children. Events or situations that can trigger life-change stress include:7

Divorce. When parents divorce, or even when they fight, a child's sense of security is threatened, making him feel alone and scared.

Moving. Children who move from a familiar home, community, school, or group of friends often have feelings of insecurity, confusion, and anxiety.

Death. Children are very confused by death, whether it's the death of a family member, friend, or beloved pet. A child may feel that he somehow caused the death, which can create a great deal of guilt and stress.

Activity overload. Running from school to athletic activities to music lessons without taking time to relax can cause feelings of anxiety in a child.

Peer pressure. Preschoolers and school-age children can be influenced by what other children think and how they act. Conforming to these standards--and not wanting to be different from others--can also cause children to feel anxious.8

Childhood stress can be caused by any situation that requires a person to adapt or change. The situation often produces anxiety. Stress may be caused by positive changes, such as starting a new activity, but it is most commonly linked with negative changes such as illness or death in the family. Stress is a response to any situation or factor that creates a negative emotional or physical change or both. People of all ages can experience stress. In small quantities, stress is good -- it can motivate you and help you be more productive. However, excessive stress can interfere with life, activities, and health. Stress can affect the way people think, act, and feel. Children learn how to respond to stress by what they have seen and experienced in the past. Most stresses experienced by children may seem insignificant to adults, but because children have few previous experiences from which to learn, even situations that require small changes can have enormous impacts on a child's feelings of safety and security. It is not necessary to be a therapist to help children cope with stress. One key element in reducing stress is a stress-free environment. A stress-free environment is based on social support, having the ability to find hope by thinking through solutions, and being able to anticipate stress and learn ways to avoid it.9

School children between age of 4 and 17, were screened from seven schools of Trivandrum district through purposive random sampling. Two divisions randomly selected from each class of the identified schools were screened to get a sample of 30 children with stress from each age group giving equal representation to boys and girls. Thus a total of 667 students were screened to get the desired sample. The split-half reliability coefficients were calculated for the different components of the whole test after correction, using Spearman-Brown Prophecy Formula. The data collected was analyzed statistically to understand the prevalence of stress among children and also to find out the variation in stress based on age, and gender. The results indicate that 93 to 100% of the children aged 4 to 17 years showed medium to moderate stress while 1.9% severe stress. Only 1.79% came under normal group. This suggests that in every age more than 90% of the school children of the state are facing above normal levels of stress and tension. This result agree with the observations made by many psychologists, doctors and counselors that most of the children of today  are facing severe stress  which they find very hard to cope up with. Many of the psychosomatic problems and suicides commonly seen in our children are found to be the results of this stress.10

Children are continuously confronted with everyday stressors in their daily routine, and their ability to deal with these stressors has been found to be significantly related to their psychological adjustment. In fact, numerous studies have indicated that having a repertoire of coping skills at a young age can be a "buffer" or moderator" of the effects of negative life stress on the development of psychological maladjustment. Because of the importance of developing adequate skills to navigate life's daily challenges, a number of school-based interventions have been designed with the goal of teaching children specific "problem-focused" skills that are presumed to enhance coping, yet fewer programs have taught children "emotion focused" skills such as cognitive restructuring or emotional regulation to deal with more uncontrollable stressors.11

A cross sectional study was conducted among N=100 secondary school students with an objective to assess the prevalence stress and coping strategies. The samples were selected using simple random sampling. The validated 12 item general health questionnaires and brief cope were used to identify stress level, stressors and coping strategies .after analysis, the results showed that prevalence of stress among students was high about 26.1%. it was found that the main stressors were related to academic and tried to use one or the other coping strategies. As educational requirements get more stringent in all levels of education, students everywhere experience considerable school stress. Here are some student stress relief tips and tools that students can use to learn study skills, prepare for exams and minimize their school stress levels to make learning easier, including an explanation of the importance of student stress management, and resources to help you reduce the school stress you experience.12

From the above literature review the investigator found that, as the good foundation lays the basic step towards building a strong tower. As educational requirements get more stringent in all levels of education. Students everywhere experiences considerable school stress. Hence this motivated the investigator to assess the prevalence of stress and provide Structured teaching programme regarding coping strategies among secondary school children.

6.2 REVIEW OF LITERATURE

A study was conducted among N=500 high school students with an objective to identify the coping strategies used with by different personality types among two high schools. The student’s grade point average and grade point level were obtained from high school records. Descriptive statistics were applied, coping strategies factor were determined from the coping strategies inventory, by factor analysis. The results showed that students can affect their grade point average by their selection of coping strategies appropriately 28 % of variance can be seen among the students.13

A correlation study was conducted between stress and coping strategies among N=200 secondary school children with an objective to assess the prevalence of stress and coping strategies. Coping strategies were characterized as negative, destructive behavior or positive constructive behavior. A rank correlation statistics was used for analysis along with paired‘t’ test. The results ruled that secondary school children who have failed to develop proper coping mechanism have greater difficulty dealing with academic performance.14

A study was conducted among N=300 High school children with an objectives to assess high school stress. Descriptive inferential statistics were used for analysis by using perceived stress scale among the study participants. The results showed that approximately 55% of the participants had increased stress level due to many demands and rapid changes that cause stressful life, in which students face increasing amounts of school work, rapidly changing curriculum assignment deadlines and exams, these factors make the students worry.15

A study was Conducted among N=200 teenagers in a private school with an objectives to assess academic stress and coping and to implement teaching programme on coping skills. The results showed that most of the students had reported finding with new friends. (76.2%). (63.4%) adjustment; (72.1%) new responsibilities. The frequent academic source of stress was increased due to class work load and the study concluded that teenagers are exposed to variety of stressors. Such as establishment of student support system and improving to equip them with effective coping skills.16

A study was conducted on the level of stress among N=155 students in urban and rural secondary school with an objective to determine the relationship between stress level and academic achievement. The study used survey method by administering student’s life stress inventory questionnaires. The results showed that 30% of the student experienced high stress, 20% of student experienced medium stress, and 50%, students experienced low stress. This study concluded that there are many factors which influence students stress such as academic work load, parenting style, parent’s education background environment of students which creates an impact in student’s life.17

A study was conducted among N=400 school age children with an objective to assess the difference of stressors between males and females. The results revealed that 41. 2% girls, rated stressors, stating it upset me a lot, where as only 16.2% of boys had rated there the stressors. Hence the study concluded that academic stressors are most found in girls than boys due to lack of coping skills among females.18

A study was conducted among N=1723 adolescence school boys on depression, nervousness, and academic stress, with an objective to determine the prevalence rate and severity of depression, anxiety and academic stress. Standardized anxiety depression stress scales were used to analyses the perceived factor. The results revealed that 59.4% had at least one of three disorders, 40.7% had at least two, 22.6% had all the three disorders more over more than one third of the participant 38.2% had suffered from depression while 48.9% had nervousness and 35.5% had academic stress.19

6.3 STATEMENT OF THE PROBLEM

“A study to assess the effectiveness of structured teaching programme on stress and coping strategies among secondary school children in selected schools at Bangalore”..

6.4 OBJECTIVE OF THE STUDY

1. To assess the prevalence of stress and coping strategies among school children.

2. To prepare and implement structured teaching programme regarding stress and coping strategies.

3. To evaluate the effectiveness of structured teaching programme regarding stress and coping strategies.

4. To determine the association of stress and coping strategies among secondary school children with selected socio demographic variables.

6.5 OPERATIONAL DEFINITION

Assess – This refers to the way of finding the existing knowledge regarding bullying behavior.

Effectiveness – Refers to the influence of changes in level of stress and coping strategies to reduce psychological stress among study participants.

Structured teaching programme – Refers to as educating the study participants on stress and coping strategies.

Stress – Is a state of normal or emotional strain among study participant.

Coping strategies – An action directed towards managing internal or external demands that tax persons coping. It is an effort to deal directly with the source of stress such as altering a situation and emotional reaction.

Secondary school children – it refers to the school children who are studying in, 8th, 9th, &, 10th standard at selected schools.

6.6 ASSUMPTIONS

The study has following assumptions:

1. Secondary school children’s may perceive some stress and use coping strategies to overcome.

2. Stress and coping strategies can be assessed.

3. Structured teaching programme is an accepted strategy to enhance the coping skills.

6.7 DELIMITATIONS

The study is delimited to

1. Secondary school children who are studying in 8th, 9th, and 10th standard.

2. Selected private schools in Bangalore.

6.8 HYPOTHESIS

H1 – There will be significant degrees in stress level after structured teaching programme.

H2 – There will be significant association between mean pretest stress and coping level scores of secondary school children’s and selected socio demographic variables.

7. MATERIAL AND METHODS

7.1 SOURCES OF DATA

Data will be collected from selected secondary school children.

7.1.1 Research design

One group pre test – post test

7.1.2 RESEARCH APPROACH

Pre experimental

7.1.3 SETTING

The study will be conducted in schools at Bangalore.

7.1.4 POPULATION

In this study the population consists of secondary school children studying in selected schools at Bangalore.

7.2 METHODS OF DATA COLLECTION

7.2.1 SAMPLING technique

Simple random sampling.

7.2.2 SAMPLE size

60.

7.2.3 Inclusion criteria

The study includes secondary school children who are:

➢ Studying in selected institution.

➢ Willing to participate in the study.

➢ Present available at the time of study.

➢ Able to read in English.

7.2.4 Exclusion criteria

The study includes secondary school children’s who are :

➢ Not available during or at the time of study.

➢ Sick during data collection.

7.2.5 INSTRUMENTS INTENTED TO BE USED

➢ Socio demographic proforma.

➢ Perceived stress scale.

➢ Brief scope scale.

7.2.6 Method of data collection

Formal permission will be obtained from the concerned authorities and participants after explaining the purpose of the study by the investigator. Prior to the data collection the pretest will be conducted by administering socio demographic proforma and perceived stress scale and brief cope scale following which the same day structured teaching programme will be conducted for the participants. After seven days the post test will be conducted by using the same tool that was used for pre test.

7.2.7 DATA ANALYSIS PLAN

Data analysis is the systematic organization and synthesis of research data and testing of research hypothesis using those data. The data obtain will be analyzed using both descriptive and inferential statistics as on the bases of objective and hypothesis of the study.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON THE PATIENT OR OTHER HUMAN OR ANIMALS?

Yes, the study requires intervention in the form of structured teaching programme which will not have any harmful effect on a study participant.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION?

Yes, Ethical committee’s report is here with enclosed.

8 LIST OF REFERENCES

1. Honig, A. S. (1986). Stress and Coping in Children. In J. McCracken (Ed.), Reducing Stress in children’s Lives.

2. Novella.J.Ruffin. Children and Stress: Caring strategies to Guide Children. Virginia Cooperative Extension

3. Schaefer,C.(Ed).(1979). The therapeutic use of Child’s play. New Jersey: Aroson. University Extension. (1993). Stress and coping with Disaster Manual. Columbia Missouri.

4. Gale A. Buchanan, “Tips for parents, Children and stress” Cooperative Extension work. August 2001.

5. National Network for Family Resiliency (1995). Family Resiliency: Building Strengths to meet challenges. T. Ames: Iowa State University Extension.

6. Daniel N. Brooks. Specific Stressors and The Specific Stress Symptoms They Eict in School- Age Children.

7. Stansbury, K., & Harris, M. L. (2000). Individual differences in stress reactions during a peer entry episode: Effects of age, temperament, approach behaviour, and self-perceived peer competence. Journal of Experimental Child Psychology, 76(1), 50-63.

8. Larzelere MM, Jones GN. Stress and Health. Primary Care: Clinics in Office Practice. December 2008;35(4).

9. The Journal of the Royal Society for the Promotion of Health, “Stress Management:Students Stress:Study Stress:Exam Stress Depression”, Vol.127,No. 1, 33-37(2007) DOI:10.1177/1466424007070492.

10. Kochenderfer-Ladd, B., & Skinner, K. (2002). Children’s coping    strategies: Moderators of the effects of peer victimization? Developmental Psychology, 38(2), 267-278.

11. Pincus DB, Friedman AG, Improving Children’s Coping with everyday Stress : Clinical Child Family Psychology Rev.2004 Dec;7(4):223-40.

12. Muhamad Saiful Bahri Yusoff. Stress, Stressors and Coping Strategies Among Secondary School Students. ASEAN Journal of Psychiatry, Vol.11 (2) July- December 2010.

13. Lary Lee Andelt, Identification of Coping Strategies used by personality temperament groups which facilitate success in high school students” (January 1, 1994). ETD collection for Univesity Of Nebraska – Lincoln. Paper AA19430158. .

14. Levey- Thors. C., Schiaffino, K.M., Zaleski,E.H.,(1998). Coping mechanisms, stress, social support, and health problems in college students. Fordam University, Department Of Psychology. Vol.2, No.3, 127-137.

15. Dr. David Rainham ‘Stressed Out’ – Taking Control of Students Stress’, an interactive Teacher’s Guide, and other students stress and coping materials. For more information .Visit

16. Shields N. Stress, active coping,and academic performance among persisting and non persisting students. Journal of Applied Biobehavioral Research. 2001;6:65-81.

17. Tajularipin Sulaiman, Aminuddin Hassan. The Level of Stress Among Students in Urban and Rural Secondary Schools in Malaysia. European Journal of Social Sciences –Volume -10, November 2 (2009).

18.. Khalid Al-S Gelber, MD, SSCFM, CABFM, JBFM, “Depression, nervousness and stress among Saudi adolescent school boys, Sphere of Family and Community Medicine, Faculty of Medicine, King Khalid University.

19. Keith J. Loud, Catherine M. Gordon, Lyle J. Micheli and Alison E. Field, “Correlation of stress breaks among preadolescent and adolesecent girls,”Pediatric 2005, 115, E399-E406 DOI: 10.1542/peds.2004-1868.

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|9. |SIGNATURE OF THE CANDIDATE | |

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|10 |REMARKS OF THE GUIDE | |

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| 11 |NAME AND DESIGNATION OF | |

| |11.1 GUIDE | |

| |11.2 SIGNATURE | |

| |11.3 CO-GUIDE | |

| |11.4 SIGNATURE | |

| |11.5 HEAD OF THE DEPARTMENT | |

| |11.6 SIGNATURE | |

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| 12 |12.1 REMARKS OF THE PRINCIPAL | |

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| |12.2 SIGNATURE | |

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