Impact of Pranayam to Relieve Stress among the Caregivers of Schizophrenic Patients at selected Hospital, MHI, S.C.B, Cuttack, Odisha, India

Dr Sikandar Kumar¹*, Mrs. Saibalini Parida², Mrs. Sinmayee Kumari Devi³

¹Vice Principal cum HOD of Psychiatric Nursing, Lord Jagannath Mission College of Nursing,, Bhubaneswar, Odisha.

²Sister Tutor, L.H.V Training School, Berhampur, Ganjam, Odisha

³Associate Professor, Dept. of Obstetrics and Gynecological Nursing, Lord Jagannath Mission College of Nursing,, Bhubaneswar, Odisha.

*Corresponding Author’s Email: sikkandar.kumar@gmail.com

ABSTRACT:

A quasi experimental research design was undertaken among 50 caregivers of Schizophrenics Patients at mental health Institute, S.C.B. Medical College, Hospital Cuttack, Odisha, selected by Purposive Sampling technique, data were collected from Dtd. 10.11.2014 to 12.12.2014 by using Depressive Anxiety Stress Scale (DASS) to assess the level of stress among the caregivers of schizophrenic patient in the form of structured interview schedule. The collected data were analyzed by using descriptive and inferential statistics. Findings revealed that in Pre-test, 54% of the caregivers had moderate stress and 34% of them had mild stress. But in post test majority 62% of caregivers have no stress and 36% have mild level of stress.

Factor wise comparison showed that there is effectiveness of pranayam in decreasing stress. Highly significant difference was found between Pre and Post stress Score. No significant association was found.

No significant association was found between post test stress and demographic variables like sex, religion, educational, type of family, duration of care given, relationship, monthly income, residence, family history of schizophrenic patient and previous exposure to programme of pranayama. But there was an association between post test stress with age and marital status.

KEYWORDS: Stress, Pranayam , caregivers, schizophrenic patient,

Introduction

“Yoga is not an ancient myth buried in oblivion. It is the most valuable in heritance of present. It is the essential need of today and the culture of tomorrow”

-Swami Satyananda Saraswati

Mental health is a state of balance between the individual and the surrounding world, a state of harmony between oneself and others, a co-existence between the realities of the self and that of other people and the environment¹.

Modern life is full of hassles, deadlines, frustrations, and demands. For many people, stress is so common place that it has become a way of life. Stress isn‘t always bad, in small doses, it can help you perform under pressure and motivate people to do their best. But when they are constantly running in emergency mode, the mind and body pay the price^2.

With the emergence of complementary or alternative Medicine bases in the neurosciences interest has increase in treatment of different type of chronic psychiatric disorders and physical disorder. The neuroscientist has placed greater emphasis evaluating the greater efficacy due to the ineffectiveness and dangerous of antibiotics. Yoga therapy has great importance^.According to medical scientists yoga therapy is a successful because of the balance created in the nervous and endocrine system which directly influences all other system and organs of the body³.

The effects of yogic practices during and after performance are currently being researched by scientists and doctors around the world. Their result shows that asanas, pranayama, mudras and bandhas are a potent means to restore and maintain physical and mental health³.

The purpose of this research is to understand whether caregivers of schizophrenic patients stress and effect of stress management by deep breathing exercises i.e. Pranayama. Pranayama, which is a part of Yoga, is the gentle, mindful and controlled deep breathing exercises that can provide a non- or low-impact workout for people in almost any physical condition.. Pranayama is a Sanskrit word meaning "lengthening of the prana or breath". The word is composed of two Sanskrit words, Prana, life force, or vital energy, particularly, the breath, and "ayama", to lengthen or extend. It is often translated as control of the life force (prana). When used as a technical term in yoga, it is often translated more specifically as "breathe control". Pranayama - The Art of Yoga Breathing. When the Breath wanders, the mind is unsteady, but when the Breath is still, so is the mind. In a Yogic point of view, proper breathing is to bring more oxygen to the blood and to the brain, and to control Prana or the vital life energy. Pranayama and Yoga goes hand in hand with the Asanas. One of the Five Principles of Yoga is Pranayama or the science of breath control.⁴

Pranayama, helps in better management of stress and ensures an overall feeling of well being. Pranayama breathing exercises are the connection between the physical and mental disciplines of yoga. Because the breath, body and mind are so closely linked, a change in one immediately affects the other and two by developing control of one’s breathing; one can bring about beneficial changes in his body and mind. Yogic breathing energizes and cleanses the body, calms and relaxes the mind, and serves as a perfect warm-up for practicing yoga poses. It strengthens respiratory and immune systems, reduces stress, and energizes greater alertness to body and brain. It promotes healing on emotional, physical and psychological levels. ⁵

Of all mental illness that cause suffering in society schizophrenia probably is responsible for lengthier hospitalization, greater chaos in family life, more exorbitant cost to individuals and governments, and more fear than any others. Because it is a such an enormours threat to life and happiness and because it’s causes are unsolved puzzle, it has probably been studied more than any other mental disorder⁶.

Stress can cause a person’s sympathetic nervous system to activate and produce a “fight or flight” response. Several studies have found that prolonged or frequent activation of this response mechanism leads to increased individual vulnerability towards depression, decreased job satisfaction, disrupted personal relationships, psychological distress and even suicide^{7, 8}.

OBJECTIVES:

To assess the level of stress among the caregivers of schizophrenic Patients

To find out the effectiveness of VATM on pranayama on relieving of stress among the caregivers of schizophrenic Patients.

To find out the association between levels of stress with their selected demographic variables

Hypothesis:-

H₀ – There will be significant difference in the level of stress among caregivers of schizophrenic Patients Prior to and after administration of pranayam

H₁– There will be significant association between post test stress with their selected demographic variable.

Inclusive Criteria:-

- The purposed study was conducted on caregivers of schizophrenic patient who were :-

- The caregivers of schizophrenic patient

- willing to participate in the study with informed consent

- can communicate in Odia

Available during the period of data collection

MATERIAL AND METHOD:

An evaluative research approach with quasi-experimental research design was adopted for this study in order to measure the effects of VATM on Pranayama to relieving the stress among the caregivers of schizophrenic patients. The study was conducted in Institute of Mental Health, SCB, Medical College and Hospital, Cuttack Odisha, where 50 caregivers of schizophrenic patient were selected by purposive sampling technique. The tool was developed in 2 sections. Section -A includes the demographic variable and section-B (i): includes Depressive Anxiety Stress Scale (DASS) to assess the level of stress among the caregivers of schizophrenic patient. Whereas, section-B (ii) includes the Video Asisted Teaching Module on Pranayam.

Validity and Reliability:

The content validity of the tool was established from various experts in field of psychiatric Nursing, Psychiatrists, Clinical Psychologist, Statistician, Sociologists. Suggestions were given by the experts and the tool was modified accordingly.

Reliability of the tool was tested by test-retest method by using karl-pearsons’s correlation coefficient formula, where the ‘r’ value was 0.89 and it was found to be more reliable.

Preparation of Final Draft:-

Preparation of final draft was done after in cooperating the experts opinion and suggestions. The content was in Odia in the form of Video. The average time taken to show the video was around 45 min.

Procedure for data collection:

Data collection is the identification of subjects and systematic gathering of information relevant to research purpose. The investigator collected data from mental health institute SCB Medical College and Hospital, Cuttack, Odisha from 10.11.2014 to 12.12.2014. Permission was obtained from the HOD of Psychiatry Department of Institute of Mental Health, SCB MCH, Cuttack Odisha, and informed consent was taken from the respondents. The researcher prepared the Video Assisted Teaching Module (VATM) on Pranayama in a compact disc. Which includes the overall description of Schizophrenia, Role of caregivers, Definition of stress, factors influencing stress, sign and symptoms of stress, different stress reduction technique, definition Pranayama, types of Pranayama Nadisodhan and Bhramari, Benefits of Pranayama, procedure for pranayam, Nadisadhan Pranayama before Practice of Hand position 1^st stage of Nadisodhan 2^nd Stage of Nandisodhan Brahmani Pranayama and its steps, Benefits andcontraindication.

Pre-test was done by structured interview schedule with the use of Depressive Anxiety Stress Scale (DASS) to assess the level of stress among the caregivers followed by administration of Video Assisted Teaching Module on Pranayam by L.C.D projector. And the respondents were instructed to practice the Pranayam Every day. Post test was done after 7 days. All subjects were very cooperative and the investigator expressed her gratitude for their cooperation.

Planned for data analysis

The collected data were organized, tabulated and analyzed by using descriptive and inferential statistics.

Table-1: Factor wise analysis of level of stress among the caregivers of schizophrenic patient

Factors	PRE-TEST								POST-TEST
	No stress		Mild		Moderate		Severe		No stress		Mild		Moderate		Severe
	No	%	No	%	No	%	No	%	No	%	No	%	No	%	No	%
Physical	3	6	20	40	23	46	4	8	30	60	20	40	-	-	-	-
Emotional	14	28	13	26	19	38	4	8	43	86	7	14	-	-	-	-
Social	7	14	19	38	21	42	3	6	31	62	19	38	-	-	-	-
Treatment	12	24	30	60	8	16	--	--	46	92	4	8	-	-	-	-
Financial	7	14	13	26	22	44	8	16	22	44	27	54	1	2	-	-

H0₁: There is no significant association between level of stress among caregivers of Schizophrenic patients with their demographic variables.

Table No 2: Association of Post test score of caregivers of schizophrenic patients

Factor	Z- Value	Level of Significance
Physical Factor	10.021	Highly Significant
Emotional Factor	8.289	Highly Significant
Social Factor	9.096	Highly Significant
Treatment Factor	8.695	Highly Significant
Financial Factor	7.26	Highly Significant
Overall	10.7	Highly Significant

Table no 3: Association between post test stress score of the caregivers of Schizophrenic patients on Pranayama with their demographical variable.

S.L	Demographic variable	c² Calculated value	c² Table value	D.F	Level of significance
1	Age	9.13	7.82	3	Significant
2	Sex	0.03	3.84	1	Not Significant
3	Religion	0	7.82	3	Not Significant
4	Educational Qualification	5.25	7.08	3	Not Significant
5	Occupational Status	6.04	9.49	4	Not Significant
6	Marital Status	6.48	5.99	2	Significant
7	Type of family	1.8	5.99	2	Not Significant
8	Duration of care giving by caregiver	6.27	7.82	3	Not Significant
9	Relationship	6.65	7.82	3	Not Significant
10	Monthly Income	5.1	12.59	6	Not Significant
11	Residence	0.08	5.99	2	Not Significant
12	Family History of caregivers of Schizophrenic Patients	0.21	3.84	1	Not Significant
13	Previous exposure to Programmes of Pranayama	0	3.84	1	Not Significant

Table no-2: “Z” test was calculated to assess the significant difference between pre and post test stress scores which shows highly significant difference between area wise score values of pre test and post test stress score. Hence, the null hypothesis is rejected (P≤0.05) and the statistical hypothesis is accepted.

Table no-3: Chi-square was calculated to find out the association between the level of stress among caregivers of Schizophrenic patients with their selected demographic variables reveals that there was no significant association between level of stress when compared to sex, religion, educational, type of family, duration of caregiven, relationship, monthly income, residence, family history of schizophrenic patients and previous exposure to programme of pranayama (P>0.05). However, there was significant association between level of stress when compared to age and marital status (P<0.005).

Hence, the difference observed in the mean score values were by chance and not true difference with compared to sex, religion, educational, type of family, duration of care given, relationship, monthly income, residence, family history of schizophrenic patients and previous exposure to programme of pranayama. Whereas true difference was observed with age and marital status (Table no.3).

NURSING IMPLICATION:

· The content of the video Assisted Teaching model will help the Nursing students who will be future staff Nurses and lecturers for reinforcing their knowledge on Pranayama (Nadisodhana and Bhramari)

· The finding will help the Nursing students to aware the caregivers, patients regarding Pranayama and its benefit.

· The clinical instructors can teach and guide the students working in psychiatric wards regarding Pranayama with the help of this teaching module.

· With technological advances and ever growing challenges of nursing the nurse administrations have responsibility to provide the nurse with substantive educational opportunities.

· Nursing administration should provide necessary facilities and opportunities for nursing students and staffs to equip themselves with knowledge and skill to practice Pranayama.

· Nursing Administration should plan and organize continuing nursing, Education, Seminar, Conference, Workshop on Pranayama.

The finding can utilized as evidence based practice in clinical practice beneficial for psychiatric nursing students and staff.

RECOMMENDATIONS:

· A similar study on a large sample may help to draw more definite conclusion and make generalization.

· An experimental study can be under taken with control groups.

· A similar study can be conducted in other settings.

A multiple time series design can be adopted for the observation of skill and practice which will increase the certainty with which the researcher can generalize findings.

REFERENCES:

1. Sreevani R., A Guide to Mental Health and Psychiatric Nursing, 3^rd Edition, 2010, Jaypee Brothers Medical Publishers (P) Ltd.

2. Jose Gutierrez-Maldonado, Alejandra Caqueo-Urizar, Claudia Miranda-Castillo. Quality of life in caregivers of patients with schizophrenia: A literature review. 2009 September; 7 : 84.

3. Stress Kills 6 I.T. Geeks (2005). http://sv.typepad.com/arian/ 2005/04/ stress_kills_6_html

4. Mental and Emotional Benefits of Pranayama://www.costarica-yoga.com/pranayama.html.

5. Townsend Marry C. Psychiatric Mental Health Nursing, Philadelphia: F A Davis and company. 7^th edition 2012, P_p-256.

6. Sally Wai-chi Chan, Archives of Psychiatric Nursing, Vol. 25, No. 5 (October), Published by Elsevier Inc 2011: pp 339–349.

7. Flanagan, N. A., and Flanagan, T. J. (2002). An analysis of the relationship ^{between job satisfaction and job stress in
correctional nurses. Research}in Nursing and Health, 25(4), 282-294.

8. Raingruber, B., and Robinson, C. (2007). The effectiveness of Tai Chi, Yoga, Meditation, and Reiki Healing sessions in promoting health and enhancing problem solving abilities of registered nurses. Issues in Mental Health Nursing, 28, 1141-1155.