Front 2017

EFFECTIVENESS OF BENSONS RELAXATION TECHNIQUE
ON STRESS AMONG HEMODIALYSIS PATIENTS
RESHMA. R. S
JOSCO COLLEGE OF NURSING
EDAPPON
PANDALAM
DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT
OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF SCIENCE IN NURSING
KERALA UNIVERSITY OF HEALTH SCIENCES
2017
i
EFFECTIVENESS OF BENSONS RELAXATION TECHNIQUE
ONSTRESS AMONG HEMODIALYSIS PATIENTS
By
RESHMA. R. S
Dissertation submitted to the
Kerala University of Health Sciences
Thrissur
In partial fulfillment of the requirements for the degree of
Master of Science
in
Medical Surgical- Nephrology- UrologyNursing Speciality
Under the guidance of
Asso. Prof. (Mrs.) Rekha S
Department of Medical Surgical Nursing
Josco College of Nursing
Edappon, Pandalam
2017
ii
DECLARATION BY THE CANDIDATE
I hereby declare that this dissertation entitled Effectiveness of Bensons
relaxation technique on stress among hemodialysis patients is a bonafide and
genuine research work carried out by me under the guidance of Asso. Prof. (Mrs.)
Rekha S, Head of the department, Medical Surgical Nursing, Josco College of
Nursing, Edappon, Pandalam.
Signature of the candidate
RESHMA.R.S
Date: / / 2017
Place: Edappon
iii
CERTIFICATE BY THE GUIDE
This is to certify that the dissertation entitled Effectiveness of Bensons
relaxation technique on stress among hemodialysis patients is a bonafide
research work done by Mrs. Reshma. R.S, Josco College of Nursing in partial
fulfillment of the requirement for the degree of Master of Science in Medical
Surgical Nursing.
Signature of the Guide
Asso. Prof. (Mrs.) Rekha S
Head of the department
Medical Surgical Nursing
Edappon, Pandalam
Date: / / 2017
Place: Edappon
iv
ENDORSEMENT BY THE HOD, PRINCIPAL/HEAD OF THE
INSTITUTION
This is to certify that the dissertation entitled Effectivenessof Bensons
relaxation technique on stress among hemodialysis patients is a bonafide
research work done by Mrs. Reshma.R.S, Josco College of Nursing in partial
fulfillment of the requirement for the degree of Master of Science in Medical
Surgical Nursing.
Signature of the Principal
Prof. (Mrs.) Evangeline J
Principal
Edappon, Pandalam
Date: / / 2017
Place: Edappon
(College seal)
v
COPYRIGHT
DECLARATION BY THE CANDIDATE
I hereby declare that the Kerala University of Health Sciences, Kerala shall
have the rights to preserve, use and disseminate this dissertation in print or electronic
format for academic/research purpose.
RESHMA. R.S
Date: / / 2017
Place: Edappon
vi
ACKNOWLEDGEMENT
God is faithful and He will take care of you if you trust Him
Hard work is the key to success I thank Lord Almighty for his abundant
blessing, wisdom, strength, courage and health guidance, will power and a source of
light throughout the dissertation.
There are several hands and hearts behind this work where, this final shape of
concrete cannot be achieved without an optional inspiration during the course of work
for which I would like to express my gratitude.
I acknowledge my sincere gratitude to Dr. Jose Koshy George, Chairman of
Josco Group of Institutions, for having given me the valuable opportunity to do this
project work as a part of my M.Sc. Programme and also for given permission to
conduct study in the institution itself.
The existence of this report owes much to the support and encouragement of
eminent personalityProf. (Mrs.) Evangeline J, Principal, Josco College of Nursing,
who has been atremendous mentor for me. I express my heartfelt gratitude for her
encouragement,inspiration, expert guidance, valuable suggestions, constructive
criticisms, support aswell as for providing all facilities for successful completion of
this study. Without herguidance and persistence help, this thesis would not have been
possible.
It is my bounden duty to express at the outset, my heartiest and respectful
gratitude to Prof. (Mrs.) Anju A R, Vice Principal, class coordinator, Josco College
of Nursing for her patience and diligence.
It is my bounden duty to express at the outset, my heartiest and respectful
gratitude to my Guide,Assoc. Prof. (Mrs.) Rekha S, HOD (Medical Surgical
vii
Nursing), Josco College of Nursing for offering valuable advices, patient corrections
and support during the study.
I express my heartiest gratitude to Asso.Prof. (Mrs.)Sini KunjuKunju,
research Co-ordinator, HOD (Mental Health Nursing), for her guidance, support,
valuable suggestions and corrections leading us to complete the study successfully.
I am very much obligated to my Co-guide, Mrs. Remya B for validating the
content and for their valuable assistance. My heartfelt thanks to my first year class co-
coordinatorMrs. Annamma Jacob, Associate Professor, Medical Surgical Nursing
for her valuable suggestions and Mrs. Bindhu P T, Assoc. Professor, Community
Health Nursing for their support and guidance.
I am thankful to all subject experts who have extended their support in content
and tool validation. I also extend my gratitude to Mr.Vipin Xavier, Assistant
Professor, Dept. of Biostatistics, St.Josephs College of Pharmacy, Cherthala who
opened me into the substantial world of statistics and for the statistical corrections
during analysis.
I am immensely thankful to the InstitutionalEthical Review Board for their
guidance in selecting and refining the problem and express thanks to all ethical
committee members for approving the study.
I am grateful to all Hemodialysis Patients for participating in the study,
without them this piece of work would not have come true. I extend my deep gratitude
toManagement of Century hospital for granting permission to conduct the main
study.
I am deeply thankful to the office staff and library staff of Josco College of
Nursing and all well-wishers, who helped for the successful completion of this study.
viii
I appreciate Print City DTP works for their computer proficiency and their
meticulous work.
Most importantly this would not have been possible without the love and
patience ofmy dear parents, my husband, loving daughter, friends and family
members for their love, sacrifice and encouragement for completion of the study.
Lastly my sincere thanks and gratitude to all those who had directly or
indirectly helped me with their support and encouragement during the course of the
work for the development of this thesis.
RESHMA. R .S
Date: / / 2017
Place: Edappon
ix
ABSTRACT
S R Reshma, Asso. Prof. S Rekha, Prof. J Evangeline, B Remya
A pre experimental study was conducted to assess the effectiveness of
Bensons relaxation technique on stress among hemodialysis patients in a selected
hospital at Alappuzha district. The objectives of the study were to assess the pretest
and posttest level of stress among hemodialysis patients,to find out the effectiveness
of Benson[s relaxation technique on stress among hemodialysis patients, to find out
the association with pre test level of stress and selected socio demographic variables
and to find out the association with pre test level of stress and selected clinical
variables. One-group pre test post test only design was selected for the study. The
sample composed of 35 hemodialysis patients, selected by non-probability purposive
sampling technique. The conceptual framework of the study was Roys Adaptation
Theory. Bensons relaxation technique was administered to the experimental group
daily 10 minutes, for a period of 25 days. The mean post test score 17.69 with SD
5.63 was significantly lower than the mean pre test score 24.71 with SD 5.42 with a
mean difference of7.02. The calculatedt value 19.78 is significant at p<0.05 level
with degree of freedom at 34.Hence we can conclude that the Bensons relaxation
technique is very effective in reducing stress level of hemodialysis patients in a
selected hospital at Alappuzha district. The calculated Chi-square value was less than
the table value at p<0.05 level of significance. So there was no significant association
between pre test level of stress and selected socio demographic variables and clinical
variables.
Keywords: Hemodialysis patients; Stress; Bensons relaxation technique.
x
TABLE OF CONTENTS
List of tables
List of figures / Graphs
Chapters Titles Page No.
1. INTRODUCTION 01-13
2. REVIEW OF LITERATURE 14-226
3. METHODOLOGY 23-35
4. ANALYSIS AND INTERPRETATION 36-79
5. RESULTS 80-86
6. DISCUSSION, SUMMARY AND 87-94
CONCLUSION
REFERENCES 95-100
APPENDICES 101-157
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LIST OF TABLES
Sl. No Title Page No.
1. Schematic representation of the research design. 27
2. Interpretation of stress scores. 32
3. Mean, SD, Mean difference and calculated value of 75
stress among hemodialysis patients before and after
practicing Bensons relaxation technique.
4. Association between the pretest level of stress and 77-78
selected socio demographic variables.
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LIST OF FIGURES
Sl.No Title Page No.
1. Conceptual framework of the study based on Kings Goal 13
Attainment Theory.
2. Schematic representation of the study design. 27
3. Cylindrical diagram showing percentage distribution of 39
samples based on age in years.
4. Cone diagram showing percentage distribution of 40
samples based on sex.
5. Pyramidal diagram showing percentage distribution of 41
samples based on religion.
samples based on education.
samples based on type of family.
samples based on marital status.
9. Bar diagram showing percentage distribution of samples 45
based on occupation.
samples based on place of residence.
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based on family income per month.
samples based on percentage of income spent for
treatment.
samples based on money expended so far for treatment.
14. Pie diagram showing percentage distribution of samples 50
based on financial support.
samples based on medical insurance.
based on co-morbidities.
samples based on family history of chronic kidney
disease.
18. Doughnut diagram showing percentage distribution of 54
samples based on duration of dialysis treatment.
samples based on total number of dialysis done.
based on average loss of working days per week.
based on performance of daily activity.
samples based on level of physical activity.
xiv
samples based on most commonly faced problem before
dialysis.
based on most commonly faced problem during dialysis.
based on most commonly faced problem after dialysis.
based on post dialysis weight.
samples based on temperature.
samples based on Pulse.
samples based on Respiration.
based on systolic blood pressure.
31. Doughnut diagram showing percentage distribution of 67
samples based on diastolic blood pressure.
based on serum sodium.
samples based on blood urea nitrogen.
samples based on serum potassium.
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samples based on serum creatinine.
36. Bar diagram showing distribution of samples based on 72
pretest level of stress.
37. Bar diagram showing distribution of samples based on 73
posttest level of stress.
38. Bar diagram showing comparison of pretest and posttest 74
level of stress among hemodialysis patients .
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LIST OF APPENDICES
Sl.No. Title Page No.
A. Ethical committee clearance certificate 102-103
B. Letter granting permission to conduct pilot study 104-107
C. Letter granting permission to conduct main study 108-111
D. Letter requesting for content validity 112
E. Criteria rating scale for validation of tool 113-116
F. List of experts for content validity 117-118
G. Certification for content/ tool validity 119-127
H. Informed consent (English) 128
I. Informed consent (Malayalam) 129
J. Attendance certificate 130
K. Data collection schedule 131
L. Translation certificate (English) 132
M. Translation certificate (Malayalam) 133
N. Therapy training certificate 134
O. Tool (English) 135-143
P. Tool (Malayalam) 144-149
Q. Bensons relaxation technique 150-151
R. Certificate for English editing 152
S. Master data sheet 153-156
T. Statistical formula used in the study 157
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EFFECTIVENESS OF BENSONS RELAXATION TECHNIQUE

ON STRESS AMONG HEMODIALYSIS PATIENTS

JOSCO COLLEGE OF NURSING

DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT

OF THE REQUIREMENTS FOR THE DEGREE OF

MASTER OF SCIENCE IN NURSING

KERALA UNIVERSITY OF HEALTH SCIENCES

ONSTRESS AMONG HEMODIALYSIS PATIENTS

Dissertation submitted to the

Kerala University of Health Sciences

In partial fulfillment of the requirements for the degree of

Medical Surgical- Nephrology- UrologyNursing Speciality

Under the guidance of

Asso. Prof. (Mrs.) Rekha S

Department of Medical Surgical Nursing

Josco College of Nursing

I hereby declare that this dissertation entitled Effectiveness of Bensons

relaxation technique on stress among hemodialysis patients is a bonafide and

Rekha S, Head of the department, Medical Surgical Nursing, Josco College of

Nursing, Edappon, Pandalam.

Signature of the candidate

This is to certify that the dissertation entitled Effectiveness of Bensons

relaxation technique on stress among hemodialysis patients is a bonafide

fulfillment of the requirement for the degree of Master of Science in Medical

Signature of the Guide

Asso. Prof. (Mrs.) Rekha S

Head of the department

Medical Surgical Nursing

Josco College of Nursing

This is to certify that the dissertation entitled Effectivenessof Bensons

relaxation technique on stress among hemodialysis patients is a bonafide

research work done by Mrs. Reshma.R.S, Josco College of Nursing in partial

fulfillment of the requirement for the degree of Master of Science in Medical

Signature of the Principal

Prof. (Mrs.) Evangeline J

Josco College of Nursing

DECLARATION BY THE CANDIDATE

format for academic/research purpose.

Signature of the candidate

light throughout the dissertation.

for which I would like to express my gratitude.

I acknowledge my sincere gratitude to Dr. Jose Koshy George, Chairman of

conduct study in the institution itself.

eminent personalityProf. (Mrs.) Evangeline J, Principal, Josco College of Nursing,

encouragement,inspiration, expert guidance, valuable suggestions, constructive

It is my bounden duty to express at the outset, my heartiest and respectful

of Nursing for her patience and diligence.

It is my bounden duty to express at the outset, my heartiest and respectful

gratitude to my Guide,Assoc. Prof. (Mrs.) Rekha S, HOD (Medical Surgical

and support during the study.

I express my heartiest gratitude to Asso.Prof. (Mrs.)Sini KunjuKunju,

valuable suggestions and corrections leading us to complete the study successfully.

I am very much obligated to my Co-guide, Mrs. Remya B for validating the

coordinatorMrs. Annamma Jacob, Associate Professor, Medical Surgical Nursing

Health Nursing for their support and guidance.

and tool validation. I also extend my gratitude to Mr.Vipin Xavier, Assistant

Professor, Dept. of Biostatistics, St.Josephs College of Pharmacy, Cherthala who

I am immensely thankful to the InstitutionalEthical Review Board for their

committee members for approving the study.

I am grateful to all Hemodialysis Patients for participating in the study,

toManagement of Century hospital for granting permission to conduct the main

work for the development of this thesis.

Signature of the candidate