Anxiety in Cancer Treatment: A Case Study

Anxiety in Cancer Treatment: A Case Study Case Study Celine Laurie Cyr-Martel Patient Presenting problem: Celine is a 25 year old female who presented to the emergency department (E.D.) with increased abdominal pain over the last 2 weeks. Patient recently completed chemotherapy and cancer treatment for intestinal cancer. Celine has been under increased stress due to her living situation and is concerned that her cancer has returned. She reports the pain is different than when she was initially diagnosed. She had an appointment with her oncologist on Monday, but by Friday night the pain was excruciating and she presented to the ED on Saturday morning. Background and demographics: Celine was born in a suburb of Maine, never knowing her biological father, was raised (a term she uses loosely), by her mother and resided with her mother and biological brother two years her senior. The patient reports most of her life, her mother was an addict. According to Celine, from an early age – which she reports as 5-10 years of age, she remembers her mother’s drug of choice as alcohol. When her maternal grandparents visited, the addiction was hidden. While Celine was in Junior high and high school, her mother’s drug of choice was cocaine. Celine reports her mother would make her steal either food or money. Celine was told that if she was caught, â€Å"nothing bad would happen.† Celine was fearful if she told anyone of the environment, the state would make her live in foster care. From ages 12-15, Celine found her mother clinically dead twice, Celine called 911 and her mother was revived. Both times, the mother entered rehab with the intention of becoming sober and clean. In those  times Celine stayed with her maternal grandparents. Her mother would â€Å"get clean† and  Celine and her brother would return home. Celine’s brother experienced a traumatic  brain injury his senior year in high school while riding an All-Terrain Vehicle (ATC). His home care fell to Celine. It was at this time Celine, who had just turned 16, was diagnosed with intestinal cancer. According to Celine, while she was going through Chemotherapy, her mother would steal her pain meds, leaving Celine to endure the pain. She was deemed in remission at the  age of 19 after a 3 year battle, the cancer returned last year at age 24. Celine completed high school as an above average student, but was unable to attend college due to increased anxiety. At the age of 21, Celine who was still living with her mother and acting as care taker, found her mother unconscious and called emergency services. Her mother was un able to be revived. Celine contacted the State at this time, to request help with her brother. According to Celine, the state was surprised to learn that no one had previously intervened. Celine moved into her own apartment and is currently on disability, due to her medical and anxiety concerns. Her brother lives in a group home setting, whom she visits seldom. Celine reports that in the last six months she has noticed increased anger and is working with her therapist to determine the reasons and rationale. The two scales used to determine intervention and resources for both the anxiety and the patients history of intestinal cancer were the GAD-7 (Lowe, Decker, Muller, Brahler, Schellberg, Herzog, Herzberg, 2008; Spitzer, Kroenke, Williams, Lowe, 2006) and the Cancer Behavior Inventory (CBI-B) (Heitzmann, Merluzzi, Jean-Pierre, Roscoe, Kirsh, Passik, 2011; Merluzzi, Nairn, Hedge, Martinez Sanchez, Dunn 2001; Merluzzi, Martinez Sanchez, 1997). Measurements CBI-B:The CBI-B is a shorter version of a previously well-established measure of the Cancer Behavior Inventory Long Version (Heitzmann, Merluzzi, Jean-Pierre, Roscoe Kirsh 2011). The long version is a 33-item tool, developed to measure how well an individual copes with cancer. The long and short version of the CBI, measure items on a nine point scale from â€Å"not at all confident† to â€Å"totally confident.† The internal consistency in the longer version of 33 items produced a co-efficient of 0.94 and the test-retest for the 33 item CBI was 0.74 (Merluzzi, Nairn, Hedge, Martinez Sanchez, Dunn 2001; Merluzzi, Martinez Sanchez, 1997). As my interaction with this patient was limited due to the emergency department location, the patient agreed to participate using the shorter version, 12 item CBI-B. The Cronbach co-efficient of the 12 item version, indicated an internal consistency of .84, attained in three different samples (Heitzmann, Merluzzi, Jean-Pierre, Roscoe, Kirsh 2011). Thus, the results in using this assessment indicate acceptable reliability to the degree to which the patient believes she is able to cope and maintain her health during her experience with cancer. The quality of life measures were also positively correlated with the negative correlations or depression and the impact of sickness, demonstrating the validity of the CBI-B (Heitzmann, Merluzzi, Jean-Pierre, Roscoe, Kirsh 2011). Patients who believe they are able to cope with the illness are more apt to connect with the resources to face the multiple challenges of the disease. . GAD-7: Reviewing validity studies for the GAD-7, resulted in agreement this measurement tool is appropriate and validated for use in primary care (Spitzer, Kroenke, Williams, Lowe, 2006), those in a hospital program, (Kertz, Bigda-Peyton, Bjorgvinsson. 2013), and the general population (Lowe, Decker, Muller, Brahler, Schellberg, Herzog, Herzberg, 2008). Spitzer et al., (2008) used a large sample size (2982), and took into account ethnicities, age, education, and relationship status. The diversity and sample size allowed for various correlations, producing a Cronbach which resulted in a score of 0.92 indicating an excellent internal consistency. Within the general population, there is evidence to support the validity and the reliability of the GAD-7. Lowe et al., (2008) used a sample of 5,032 participants. The researchers assessed the construct validity by comparing scores of those diagnosed with general anxiety disorder in primary care settings, to the scores of those diagnosed wit h GAD in the general population. The internal consistency resulted in an acceptable 0.89. Although a smaller sample size of 232 was selected from a partial hospital program to measure the validity of the GAD-7 (Kertz, Bigda-Peyton, Bjorgvinsson 2013), the study concluded that due to the brevity, easy administration, that the GAD-7 had strong construct validity. The associations with self-esteem, depression, resilience and how satisfied a patient is with their life, demonstrated good reliability and construct validity within the GAD-7 in all three studies (Lowe et al., 2008; Spitzer et al., 2006; Kertz, Bigda-Peyton, Bjorgvinsson 2013). Administration: The CBI-B and the GAD-7 were administered twice; upon the initial assessment and the third contact. (The second contact was by phone to ascertain the results of her appointment with her oncologist. The patient advised that the results of her blood work was â€Å"looking positive.†) When initially administered, CBI-B score was 64. (Figure 1) The scores indicating the patient was able to maintain her abilities when confronting her disease, but not yet at a point where confidence was paramount. As the CBI-B was administered only twice, a wide variation in scores was not expected. The third contact, the patient agreed to meet in the conference room of the emergency department. I asked if this would be a hardship as her grandmother would be traveling three hours. The patient advised she had an appointment with her oncologist, and she wanted me to explain the measurement tools to her grandmother. Results of the second administration of the CBI-B was 91; (Figure II) indicating an increase in self efficacy within two weeks. The initial score from the GAD-7 was 19 (Figure III) indicating severe anxiety. The patient is currently being treated for her anxiety, so the elevated score was not a surprise to this practitioner. However, the patient was concerned as she had been working on decreasing her anxiety with her current therapist. The patient was hesitant to take the GAD-7 the second time as she was apprehensive it might not change. Upon taking the second test, (Figure IV) the patients score actually resulted in positive news for Celine decreasing by 5 points. Scores: The patient attributed the positive change in the scores for both the GAD -7 and the CBI-B as a result of relocation to her maternal grandparent’s home on the coast of Maine where she was close to the ocean able to use her photography and find â€Å"peace in her heart.† As evident in the CBI-B, relaxation, coping, consolation, and having some-one whom she could share her concerns and feelings. These scores had increased. The patient advises that she has been able to use the breathing techniques when she begins to feel overwhelmed. The decrease in the anxiety scores may also be correlated to the relocation, support systems, access to hobbies. Although, the patient’s score still borders on severe, her future outlook presents as positive when speaking of her living situation. Celine admits to worry about her cancer, but believes she will continue to improve. Celine’s passion has always been with the artistic realm. Her grandparents have become involved in Celine’s life. They live three hours away on the coast of Maine. Celine finds solace at the ocean. The Grandparents purchased a camera for Celine two years prior. She currently takes photographs of nature, her grandfather makes the frames for the pictures and they are sold at fairs. Celine advises a few of her pictures have been placed in the reception area of a local hospital. Discussion: Both measurement tools used with this patient were of great validity in the emergency department setting. As there is not always a chance to follow up with patients, I was fortunate to gather information not just from the tool itself, but the patient’s reactions, participation, and discussion when using the measurement tools. Follow up with her therapist would be paramount to continue addressing the anxiety. The patient advises she will be attempting to locate another therapist closer to her grandmother. We were able to locate several therapists in a nearby town. The young woman’s resiliency may be the result of the hardships already endured at a young age. According to Merluzzi Martinez Sanchez (1997), social supports, whether perceived or actual are positively correlated to self-efficacy. {The second and final meeting resulted in opening a dialogue between the patient and her grandmother}. Celine began an on line class for photography and is hopeful to cr eate her own business. The two chosen measurements correlated well together. The ability to regulate ones affect, adapt to the negatively of cancer, and express those thoughts, the more positive the outcome (Merluzzi, et al., 2001). If the therapist can continue to address the anxiety in terms of self-efficacy, it is possible that Celine will continue to increase her good health.

Study Of Aging And Care Health And Social Care Essay

The word â€Å" Aging † and â€Å" Old Age † are extremely subjective. â€Å" Aging † is defined as the clip from birth to the present for a life single, as measured in specific units ( John Anne ) . The significance of old and aging depend to a great extent on how old the talker is and that individual ‘s experiences. The procedure of aging is a complex 1 that can be described chronologically, physiologically, and functionally. Chronological age refers to the figure of old ages a individual has lived. Physiological age refers to the finding of age by organic structure map. Although age- related alterations affect everyone, it ‘s impossible to nail precisely when these alterations occur. Functional age refers to a individual ‘s ability to lend to society and profit others and himself. In an effort to farther specify the aging population, old age has been divided into chronological classs: Young-old ( ages 65 to 74 ) Middle-old ( ages 75 to 84 ) Old-old ( age 85 and older ) Demographic ripening is a planetary phenomenon. By 2025, the universe ‘s population is expected to include more than 830 million people at an age of 65 years. With a relatively immature population, India is still poised to go place to the 2nd largest figure of older individuals in the universe. Recent statistics related aged individuals in India ; showed that every bit many as 75 % 0f aged individuals were populating in rural countries. About 48.2 % of aged individuals were adult females, out of whom 55 % were widows. A entire 73 % of aged individuals were illiterate and dependent on physical labour. One tierce was reported to be populating below the poorness line, i.e. , 66 % of older individuals were in vulnerable state of affairs without equal nutrient, vesture, or shelter. About 90 % of the aged were from the unrecognised sector, i.e. , they have no regular beginning of income. The socio economic jobs of aged are now yearss aggravated by factors such as the deficiency of societal security and inadequate installations for wellness attention, rehabilitation etc The particular characteristics of aged population in increasing in the India are a bulk ( 80 % ) of them are in the rural countries, therefore doing service bringing a challenge, Feminization of the aged population ( 50 % 0f the aged population would be adult females by the 2016 ) , a big per centum ( 30 % ) of the aged are below poorness line. And another ground is Increase in the figure of the older ( individuals above 80 year ) . National sample study ( 2004 ) reveals that bulk of the aged in both rural ( 50. 20 % ) and urban ( 57.35 % ) countries are wholly dependent on others for economic support. About 15.20 % of the aged in rural countries and 13.71 % of the aged in the urban countries are partly dependent on others. Aging is a normal portion of human development. The forms of aging – what happens, how and when – vary greatly among older people. Although specific alterations are identified as portion of the normal aging procedure, each individual ages in his ain manner. As the old ages accumulate, people become more diverse instead than more similar, each influenced by physical, societal, and environmental factors. How a individual ages depends on a combination of both familial and environmental factors such as life experiences, available support systems, get bying accomplishments. Acknowledging that every person has his or her ain alone familial make-up and environment, which interacts with each other, helps us to understand why the aging procedure can happen at such different rates in different people. An overall, familial factor seems to be more powerful than environmental factors in the finding the big differences among people in aging and lifetime. The aging procedure will impact the old age people physically, psychologically, socially, spiritually. As ageing advancement, physically old age people become less active. Based on wear and tare theory of aging, degenerative alterations takes topographic point about in all the systems such as encephalon, cardio vascular system, respiratory system castanetss exposing the aged people to a greater grade of physical unwellnesss. As a individual ages, centripetal capablenesss such as hearing, vision, touch, gustatory sensation, and odor are deteriorating. Hearing and vision losingss are more disconcerting, because they straight affect ability to execute activities of day-to-day life, endanger the bodily safety, and distort communicating. Reports besides shows that Prevalence of chronic diseases among the aged in general seem to be really high. It is higher in the urban countries ( 55 % ) than in the rural countries ( 52 % ) . Onset of damage was 60 old ages or above 54 % ( balmy motor disablement ) to 69 % ( ocular damage ) of the aged patients. However, disablements are more common among aged females compared to male up to age 80, beyond which disablement becomes less due to increased figure of adult female aged. Psychosocially, due to the aging procedure old people are frequently down and experience loneliness. Because old people are frequently ill and tired and besides retired, old people normally do n't hold money, they must pass money for medicines. They ca n't eat a batch of dishes, because of wellness grounds ; liver, bosom and weak dentition. Old age people frequently have depressions and sometimes do n't desire to populate any longer due to the loss of partner. ( Miller, 2007 ) Aged people are extremely prone to mental morbidities due to ageing of the encephalon, jobs associated with physical wellness, intellectual pathology, socio – economic factors such as break down of the household support systems, and lessening in economic independency. The mental upsets that are often encountered include Dementia and Mood Disorders. Other upsets include neurotic and personality upsets, drug and intoxicant maltreatment, craze, and mental psychosis. Emotional upsets are the most common psychological issue faced by the aged people which result from the societal mal accommodations. Failure to accommodate consequences in resentment, inner backdown, depression, fatigue of life and even suicide. Sexual accommodations – After the age of 40, there is surcease of reproduction by adult females and decline of sexual activity on the portion of work forces. As a consequence, physical and emotional perturbation may happen. Jealousy, crossness are really common and frequent. Impaired memory, stiff mentality and opposition to alter are some of the mental alterations in the aged. The rapid urbanisation and societal modernisation has brought in a interruption down in household values and frame work of household support, economic insecurity, societal isolation, and aged maltreatment taking to a host of psychological unwellnesss. In the last decennaries joint household system was really common, with batch of household members about. In such a state of affairs the old age people got much attending from all their kids. Even after their retirement they were engaged with some other work like little shopping, traveling out with their expansive kids etc. , so they do n't experience lonely believing about themselves, and their jobs and aging procedure. Their kids besides provided attention to the parents. Today due to the socio cultural alterations the joint household form has changed to atomic 1s. And even if there is a joint household the members are restricted to 4 or 5. This has created great impact on the old age people as they are left entirely due to the higher instruction and settled occupations of their kids in abroad and now yearss even with the females working, they receive no attending at all. Some do direct fiscal aid for their parents but whereas, some do non even turn to hold expression towards their parents. Since the kids are off and no organic structure to care for them, they feel lonely, go down and more concerned about their wellness jobs much more. The development of old age places was based on back uping the old age people. There are old age places run by the authorities and non governmental organisations. Even though some old age places are giving proper attention with all installations to the people, some old age places are supplying merely shelter and nutrient, and there are no medical installations available. Harmonizing to national sample study ( 2002 ) , there were 728 Old age places in India. Out of these, 325 places are free of cost while 95 old age places are on wage & A ; stay installations. A sum of 278 old age places all over the state are available for the ill and 101 places are entirely for adult females. Kerala has 124 old age places which is the maximal in any province. Reports show that, admittance to a nursing place cause situational depression in the aged. Unfortunately every bit many as 50 per centum of all nursing place occupants are clinically depressed. Nursing place staff often fails to place depression in aged occupants, possibly because it is so prevailing, but it is non merely merely a normal portion of the aging procedure. It can be treated. Aged people remaining in old age place will hold concerns about personal jobs or state of affairs that can straiten their slumber. Emotional emphasis causes a individual to be tense and frequently leads to frustration when slumber does non come. Aged people often experiences losingss that lead to emphasize such as retirement, physical damage, and loss of loved one time. Due to physical jobs like hurting, take a breathing trouble, and emotional perturbations old age place occupants are sing hapless quality of slumber and psychological well-being. There are several surveies which bespeaking sleep fluctuation during old age. Dr. Michael Vitiello, ( 2009 ) stated that slumber starts to deteriorate in late in-between age and steadily erodes from so on. With aging, the proportion of entire sleep clip spent in deep ( stage 3 or 4 ) non rapid oculus motion sleep lessenings. The aged tend to hold more trouble falling and remaining asleep than younger grownups. The aged tend to fall asleep earlier in the eventide and awaken earlier in the forenoon. With aging, recovery from perturbations in the sleep-wake rhythm and in circadian beat tends to go more hard. Many drugs normally used by the aged and many upsets common among the aged can upset slumber. Since emotional perturbations and sleep want are more common among old age place occupants every one needs to develop methods for raising the relaxation response, the natural unwinding of the emphasis response. Relaxation lowers the blood force per unit area, respiration, and pulse rates, releases musculus tenseness, and eases emotional strains. During emphasis and anxiousness external respiration becomes shallow and rapid. Taking a deep breath is an automatic and effectual technique for weaving down. Deep external respiration exercises consciously escalate this natural physiological reaction and can be really utile during a nerve-racking state of affairs, or for keeping a relaxed province during the twenty-four hours and besides it promotes sleep, there by it improves the psychological well-being of the aged people. American doctor Edmund Jacobson ( 1920 ) argued that since musculus tenseness accompanies anxiousness, one can cut down anxiousness by larning how to loosen up the muscular tenseness. PMR entails a physical and mental constituent. Progressive relaxation involves alternately tensing and loosen uping the musculuss. A individual utilizing PMR may get down by sitting or lying down in a comfy place. With the eyes closed, the musculuss are tensed ( 10 seconds ) and relaxed ( 20 seconds ) consecutive through assorted parts of the organic structure. The whole PMR session takes about 30 proceedingss. Numerous controlled surveies have evaluated relaxation therapies for the intervention of insomnia. These surveies are chiefly combined with other methods such as biofeedback, sleep limitation, and self-contradictory purpose ( seeking non to kip ) . Overall, the grounds indicates that relaxation therapies may be slightly helpful for insomnia at that place by it helps to better the physical and psychological well being.Need FOR THE STUDYOld age people are like the tones of cognition and experience in your basket but their suggestion non suit for this coevals. ( Henry Donald ) Presently, in this modern universe there is a great diminution in the joint household system, less importance to the household values and reduced regard to aged people which consequences in economic insecurity, societal isolation, and aged maltreatment taking to increased figure of elderly destitute in India. As a consequence there are legion old age places has emerged as a new tendency to take care the aged in India, fundamentally it was the civilization followed in western states. Old age places are a necessity in the present twenty-four hours scenario as the younger coevals are remaining off from the parents due to occupation, instruction, settled in abroad and besides due to the scarceness of the resources to run into their demands ( like medical sweeps, nutrients etc ) . But old age places should see merely as a secondary option. Elders in the household are decidedly an plus. It is they who can leave the much needed ethical values and codification of behavior in the younger coevals. It is the duty of each and every citizen in India particularly wellness attention forces to safe guard life of aged people. We need to take immediate steps to better the quality of life of aged particularly those who do non hold anybody to take attention of them. Old age places should hold equal physical installations, nutrient, safety and security, and medical installations. Unfortunately non all the old age places are holding all the installations particularly the medical installations. Reports shows that about 50 per centum of all nursing place occupants are clinically depressed. And another common issue of aged people remaining in old age place is their slumber is disrupted by brief argus-eyed minutes typically enduring approximately 3 to 10 seconds. And besides they are holding job in falling asleep. The clip taken to kip after traveling to bed is prolonged. By bettering sleep and emotional stableness one can advance the psychosocial well-being and quality of life of aged people. Relaxation therapy is one of the best method to better concentration, emotional stableness and advancing slumber by easing organic structure and head and cut downing emphasis and anxiousness. From the literature reappraisal it is rather apparent that relaxation therapy is good to better the psycho societal well-being and quality of slumber. There are different techniques in transporting out the relaxation therapy and some of the technique has already been tried out in station operative hurting decrease, anxiousness decrease in India and in other states. Among all the relaxation techniques deep external respiration and progressive musculus relaxation a technique does non take much clip to execute, requires no particular equipments, except a composure and comfy topographic point to make the exercising. Both are really simple to learn and pattern by any age group. The research worker, during her clinical poster in geriatric ward, visited assorted old age places and community countries and found out that most of the aged people are enduring from wakefulness, and emotional perturbation, memory shortage, hapless concentration. They are really much worried about their jobs. There is a demand for effectual, low-priced intercessions that are ecologically acceptable and efficient. Old age place occupants are chiefly take attention by the geriatric nurse who is remaining along with them in old age place every bit good as in clinical scene. Old age place staffs need to take stairss to better the quality of life of aged people by loosen uping their head and organic structure and bettering their slumber. So the research worker wanted to make something for the benefit of this population. The research worker felt a demand to measure the consequence of deep external respiration and progressive musculus relaxation technique on bettering psycho societal well- being and quality of slumber in aged people remaining in old age place.STATEMENT OF PROBLEM:A survey to measure the effectivity of selected relaxation techniques on the degree of psychosocial well-being and quality of slumber among old age people in selected old age place at Coimbatore.AIM OF THE STUDYThe purpose of the survey is to measure whether relaxation technique make a difference in the degree of psychosocial well-being and slumber among old age people after the relaxation therapy compared to those who do non have relaxation therapy.Specific OBJECTIVESThe specific aims of the survey were, To measure and compare the degree of psychosocial well-being ( cognitive, emotional, societal, and religious well-being ) in the experimental and control group, before and after the intercession To measure and compare the quality of slumber in the experimental and control group before and after the intercession To tie in the selected demographic variables like age, gender, physical unwellness, supportive system with degree of psychosocial well-being and quality of slumberHypothesisH1: There will be a important difference in the average mark of psychosocial well-being in the experimental group before and after the intercession H2: There will be a important difference in the average mark of cognitive well-being in the experimental group before and after the intercession H3: There will be a important difference in the average mark of emotional well-being in the experimental group before and after the intercession H4: There will be a important difference in the average mark of societal well-being in the experimental group before and after the intercession H5: There will be a important difference in the average mark of religious well-being in the experimental group before and after the intercession H6: There will be a important difference in the quality of slumber in the experimental group before and after the intercession H7: There is important relation between degree of psychosocial well-being and quality of slumber in the experimental and control groupOPERATIONAL DEFINITIONSSleep: Sleep is a province of remainder in which the nervous system is inactive, the eyes are closed, the musculuss are relaxed and the head is unconscious. The features of slumber can be verbalized by a individual who experiences the slumber. In this survey, the self study of slumber is measured by standard Pittsburg sleep quality index graduated table Psycho Social Wellbeing: a subjective term that means different things to different people. A feeling of health by an person. In this survey it include the felling of health in psychological, societal, religious and behavioural facet of an person, which is measured by a modified ego reported psycho societal wellbeing assessment graduated table Cognitive well-being ; cognitive well-being is a subjective phenomena which reflects the ability of the single sing how to believe, comprehend, retrieve and larn facts and thoughts, which is measured by a modified ego reported psycho societal wellbeing assessment graduated table. Emotional well-being ; it is a subjective statement which reflects how positively an single feels, perceives, and reacts to the internal and external stimulations and it can be assessed by increasing bosom rate, respiration, BP. In this survey emotional well-being is measured by single mark obtained from modified psycho societal wellbeing assessment graduated table. Social well-being ; it is a subjective statement, which reflects how good an person is able to interact with the fellow people, is able to set to state of affairss, is able to keep positive societal position, is able to affect in group activities, which is measured by a modified ego reported psycho societal wellbeing assessment graduated table. Religious well-being: It is a subjective statement which reflects how an single perceives sing God, how of import does one see supplication to be in their life, which is measured by a modified ego reported psycho societal wellbeing assessment graduated table. Relaxation Techniques: It is individualized or combined, consistently executed exercisings, used to ease the organic structure and head by wind offing natural emphasis response therefore take downing the blood force per unit area, respiration and pulse rate, loosen uping the musculus and easing emotional strains. In this survey, relaxation techniques used are deep external respiration exercising and progressive musculus relaxation techniques. Deep Breathing Exercise is a technique of external respiration in which a individual inhale through nose slowly and deeply to the count of 10, where the tummy and venters expands, but the thorax does non lift up. Exhale through the oral cavity easy and wholly. Progressive Muscle Relaxation Technique is an exercising, in which a individual sits in a chair comfortably.. He so tenses each musculus every bit tightly as he can, for a count of one to ten and so releases it wholly.Premise:1. Aging is a normal portion of human development. 2. The forms of aging vary greatly among older people. 3. Aging is an nonvoluntary procedure which alters normal biological, psychological and societal maps. 4. Psycho societal well-being of the older people will change based on certaidemographic factors such as Age, Sex, Education, available supportive system. 5. Variability in the sleep behaviours of older people is common.Restrictions:As sample size is little consequence can non be generalized Datas on psycho societal well-being and quality of slumber based on verbal study may non be a true contemplation of what they experience.Boundary lines:The survey is delimited to one old age place in Coimbatore. The survey is delimited to people in the age group 65-85 yearScope of the surveyThis survey will assist to measure the degree of psycho societal well-being and quality of slumber of the old age people remaining in old age place before and after the intercession. If there is important betterment in the degree of psycho societal well-being and quality of slumber, it is a clear indicant of effectivity of relaxation techniques. These relaxation techniques will be good for the aged people remaining in old age place. It can be easy implemented and taught by nurses who are employed in old age places every bit good as in geriatric ward in infirmaries.CONCEPTUAL FRAME WORKConceptual frame work refers to interconnected constructs or abstractions that are assembled together in some rational strategy by virtuousness of their relevancy to a common subject ( Polit Hunger – 1997 ) Theoretical theoretical account for this survey was derived from Callista Roy ‘s Adaptation Theory ( 1996 ) . Roy employs a feedback rhythm of input, throughput, and end product. Input is identified as stimulations, which can come from the environment or from within a individual. Stimuli are classified as focal ( instantly facing the individual ) , contextual ( all other stimulations, that are present ) or residuary ( non particular such as cultural beliefs or attitude about unwellness ) . Input besides includes a individual ‘s version degree ( the scope of stimulation to which a individual can accommodate easy. Through input we can do usage of a individual ‘s procedures and effecters. â€Å" Procedure † refers to the control mechanisms that a individual uses as an adaptative system. â€Å" Effecters † refers to the physiological map, self concept, and function map involved in version. In the adaptative system, the term â€Å" system † is defined as ego parts connected to work as a whole for some intent and it so by virtuousness of the mutuality of its parts. This has two major internal control procedure called â€Å" regulator † and â€Å" cognator † . Regulator bomber system consists of internal procedure including chemical, impersonal, and endocrine – transmit the stimulations, doing end product – physiological response, cognator and bomber system regulates self constructs, function map and inter dependance. End product is the result of the system ; when the system is a individual, end product is categorized as adaptative responses ( Those that promote a individual ‘s unity ) or uneffective responses ( those that do non advance end accomplishment ) these responses provide feedback for the system. The modified theoretical account in this survey explains the input as the focal stimulation viz. hapless psycho societal well-being and hapless quality of slumber. The contextual stimulation are age, sex, instruction, continuance of remaining in old age place, no of kids, presence of visitants. The get bying mechanism of the cognator subsystem occurs as a consequence of relaxation therapy. The experimental group is subjected to relaxation therapy. The adaptative responses among the experimental group of old age people show betterment in the psycho societal well-being and quality of slumber. The control group that has non undergone the relaxation therapy might non demo an effectual version. Figure – 1 high spots he conceptual model based on modified Roy ‘s version theoretical account. CHAPTER – ThreeRESEARCH METHODOLOGYMethodology of research organizes all the constituents of the survey in a manner that is most likely to take to valid replies to the bomber jobs that have been posed ( Burns and Grove, 2002 ) . It refers to assorted logical stairss that are by and large adopted by the research worker in analyzing the research job. This chapter presents the research design, puting, population, sample size and sampling technique, trying standards, tools used, building of the tools, cogency, dependability, pilot survey, and informations aggregation adopted for the survey.RESEARCH APPROACHThe research attack is an overall program chosen to transport out the survey. The choice of research attack is the basic process for the behavior of research enquiry. An appraising attack was used in this survey as the survey aimed at measuring the effectivity of selected relaxation techniques on psycho societal well being and quality of slumberRESEARCH DESIGNA quasi experimental pretest and station trial two group design was used to prove the effectivity of relaxation therapy over psycho societal well-being and slumber of old age people in old age place.Experimental group1st hebdomad 2nd hebdomad 3rd hebdomad 4th hebdomadO1 XXXXXXX XXXXXXX XXXXXXX XXXXXXX O2Control groupO1 — — — — — — â €” — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — – O2 O1 Pre intercession appraisal of degree of psychosocial well-being and quality of slumber in experimental and control group. O2 station intercession appraisal of degree of psychosocial well-being and quality of slumber after 4 hebdomads in experimental and control group. Ten deep external respiration exercising and progressive musculus relaxation technique.Variables IN THE SurveyIndependent variable – selected relaxation techniques ( Deep external respiration exercising and progressive musculus relaxation technique ) Dependent variables _ Psycho Social Wellbeing ( cognitive, Emotional, Social and Spiritual ) and Quality of SleepSetting OF THE STUDYâ€Å" Puting † refers to the country where the survey is conducted. The scene for the survey was a selected old age place at Coimbatore. Entire population of the old age place is 150 members. It is managed by Samaritan sisters entirely for aged and destitute. The standard for the admittance in old age place are aged and destitute above 60 old ages. It is a service oriented place and no fees for stay and nutrient. A medical squad contains 1 general doctor and 2 nurses will see one time in a month to the place and provides medical service to the people. The old age place contains two separate block for male and female. Common dining hall, supplication hall, garden. In each block there are two floors – Land floor is called ill ward where aged bed ridden people are shacking. In first floor nomadic aged people are shacking.TARGET POPULATIONThe population under the survey was all the males and females were remaining in the old age place and fulfilled the standards for sample choice.SAMPLE SIZESample refers to a subset of population that is selected to take part in a peculiar survey ( Burns and Grove 2002 ) . In this survey the sample size consisted of 50 inmates of the old age place ( 25 samples in control group and 25 in experimental group ) .Sampling TechniqueThe samples who fulfilled the standards were selected by simple random sampling technique. Lot method was used to delegate the samples into experimental group and control group. Sampling CRITERIAInclusion standardsAged people both male and female in the age group of 65-85yrs Those who were willing to take part Those who were physically and mentally able to take part in the surveyExclusion standardsThose who were bed ridden unable to sit entirely and do exert Those who were mentally unqualified to follow the bids Un co-operative peopleResearch ToolThe tool used for the informations aggregation was An interview agenda organized in 3 parts. Part 1: Demographic informations consisted of personal information like age, sex, matrimonial position, instruction, continuance of stay in old age place, presence of relations, visitants and presence of physical unwellness, sentiment about immediate environment which include nutrient, safety and security and comfort. Part 2: Psycho societal wellbeing graduated table. It was prepared by the research worker with expert ‘s counsel by utilizing geriatric depression graduated table and WHO Health Related Quality of Life index graduated table. It was designed to measure the psycho societal well-being in four dimensions ( cognitive, emotional, societal and religious well-being ) . There are 6 points in each dimension. Some inquiries are positive and some negative. There are two columns ‘yes ‘ ‘no ‘ to enter the response. Positive inquiries were 2 and 3 in cognitive dimension, 1, 3 and 4 in emotional dimension, 2, 3, 4, 5 and 6 in societal dimension, and all 6questions in religious dimension. Negative inquiries were 1, 4, 5 and 6 in cognitive dimension, 2, 5 and 6 in emotional dimension, 1 and 6 in societal dimension. Part 3: Pittsburg sleep quality index graduated table. It was standardized tool to measure quality of slumber. It has 9 points ( subjective slumber quality, sleep continuance, sleep latency, sleep efficiency, sleep perturbation, usage of sleep medicines and twenty-four hours clip disfunctions, which subjectively describe the individual ‘s sleep quality for the month.Marking AND INTERPRETATION OF MarkingScoring – psycho societal well-being appraisalFor positive inquiries a response in the ‘yes ‘ column was given a mark of 1and in the ‘no ‘ column a mark of ‘0 ‘ was given. For negative inquiries a response in the ‘yes ‘ column was given a mark of 0 and in the ‘no ‘ column a mark of ‘1 ‘ was given. In all the dimensions the maximal mark was ‘6 ‘ and the minimal mark was ‘0 ‘ .The mark was interpreted as0 – 2 Poor 3 – 4 Moderate 5 – 6 Good It was same in all four dimensions ( cognitive, emotional, societal and religious well-being )Scoring – Pittsburg sleep quality index graduated tableIn hiting the Pittsburg sleep quality index graduated table, seven constituent tonss are derived, each scored ‘0 ‘ ( no trouble ) to 3 ( terrible trouble ) . The constituent tonss are summed to bring forth over all mark ( run 0 to 21 ) . In seven constituents each one is interpreted as 0 Very good 1 Reasonably good 2 Reasonably bad 3 Very badOverall PSQI MarkSum of seven constituents tonss & lt ; 5 – Good slumber quality & gt ; 5 – Poor sleep qualityDEVELOPMENT OF TEACHING PLAN ON DEEP BREATHING AND PROGRESSIVE MUSCLE RELAXATION TECHNIQUEDeep external respiration exercisingDeep external respiration is a powerful anti-stress technique. When we bring air down into the lower part of the lungs, where the O exchange is most efficient, bosom rate slows, blood force per unit area decreases, musculuss relax, anxiousness simplicities and the head composure.Progressive musculus relaxation techniqueProgressive Muscle Relaxation is a relaxation technique used to let go of emphasis by straining and so loosen uping each musculus group of the organic structure, one group at a clip. Deep external respiration and progressive musculus relaxation are basically a province of bring oning deep musculus relaxation of the whole organic structure and relaxed respiratory beat A instruction program on Deep external respiration and progressive musculus relaxation technique is prepared to assist people to larn the exercising.The undermentioned stairss were adopted to develop the instruction program1. Development of purpose and aims based on the survey aims 2. Choice of learning larning content 3. Choice of learning acquisition activities 4. Choice of Audio Visual Aids 5. Organization of the contentThe contents included were1. Basic constructs of deep external respiration exercising and progressive musculus relaxation technique 2. Advantages of deep external respiration exercising and progressive musculus relaxation technique 3. Presentation of the relaxation techniques 4. Practice and re presentation 5. Palingenesis 6. Direction to follow upDeep external respiration exercisingExhale wholly through your oral cavity, doing a whoosh sound. Near your oral cavity and inhale softly through your olfactory organ to a mental count of four. Keep your breath for a count of seven Exhale wholly through your oral cavity, doing a whoosh sound to a count of eight. This is one breath. Now inhale once more and reiterate the rhythm three more times for a sum of four breaths.Progressive musculus relaxation techniqueAfter the deep external respirationClench your fists. Keep for 7-10 seconds and so let go of for 15-20 seconds. Tighten your biceps by pulling your forearms up toward your shoulders and â€Å" doing a musculus † with both weaponries. Hold†¦ and so loosen up. Tighten your triceps — the musculuss on the bottoms of your upper weaponries — by widening your weaponries out directly and locking your cubituss. Hold†¦ and so loosen up. Strain the musculuss in your brow by raising your superciliums every bit far as you can. Keep†¦ and so loosen up. Imagine your forehead musculuss going smooth and hitch as they relax. Strain the musculuss around your eyes by clinching your palpebras tightly shut. Keep†¦ and so relax.A Imagine esthesiss of deep relaxation distributing all around them. Tighten your jaws by opening your oral cavity so widely that you stretch the musculuss around the flexible joints of your jaw. Tighten the musculuss in the dorsum of your cervix by drawing your caput manner back ; as if you were traveling to touch your caput to your dorsum ( be gentle with this musculus group to avoid hurt ) . Tighten your shoulders by raising them up as if degree Fahrenheit you were traveling to touch your ears. Hold†¦ and so loosen up. Tighten the musculuss around your shoulder blades by forcing your shoulder blades back as if you were traveling to touch them together. Tighten the musculuss of your thorax by taking in a deep breath. Clasp for up to 10 seconds†¦ and so let go of easy. Tighten your tummy musculuss by sucking your tummy in. Keep†¦ and so let go of. Imagine a moving ridge of relaxation distributing through your venters. Try to touch both elbows together behind your dorsum. imperativeness the little of your dorsum into the chair or floor Tighten your natess by drawing them together. Keep†¦ and so loosen up. Imagine the musculuss in your hips traveling loose and hitch. Widen your leg maintaining your pes relaxed, imperativeness the dorsum of your articulatio genus towards the floor Tighten your calf musculuss by-pulling your toes toward you ( flex carefully to avoid spasms ) . Hold†¦ and so loosen up. Tighten your pess by curving your toes downward. Keep†¦ and so loosen up. Mentally scan your organic structure for any residuary tenseness. If a peculiar country remains tense, reiterate one or two tense-relax rhythms for that group of musculus. The first bill of exchange of learning program is derived by maintaining in head the aims, literacy degree of the sample, and simpleness of the linguistic communication. The instruction program is developed in English and it is translated into Tamil ( appendix page no )DEVELOPMENT OF THE TOOLThe tool was developed based on the aims of the survey, Review of literature and treatment with expertsVALIDITY OF THE RESEARCH TOOLThe research tool including the aim of the survey along with the standards check list were submitted to five experts – three Nursing, one Geriatric doctor and one Clinical Psychologist. The three nursing experts were Professors with Masters Degree in Nursing and working in different colleges of nursing in Coimbatore with more than 5 old ages of experience. The geriatric doctor was working in a private infirmary in Coimbatore for more than 20 old ages. The Clinical Psychologist was working in a private infirmary in Coimbatore and had an experience crossing 15 old ages which included private pattern. Harmonizing to the expert ‘s sentiment alterations had been done and concluding proof done.RELIABILITY OF THE RESEARCH TOOLThe dependability of the psycho societal wellbeing assessment graduated table was tested by split half method. The trial was administered to 10 patients. Correlation co- efficient was calculated by Karl Pearson ‘s method. The obtained ‘r ‘ value was 0. 82 for overall psycho societal well being assessment graduated table Which confirmed that there was high positive correlativity and internal consistence of the tool.PILOT STUDY REPORTA pilot survey was conducted in the same old age place, where chief survey was intended to be carried out, to prove the feasibleness of survey. Permission was obtained from the concerned governments of the Old age place. The survey was carried out from 1 – 8 – 10 to 14 – 8 – 10, over a period of 14 yearss. 10 samples were selected, 5 in experimental and 5 in control group. Both male and female were included in this survey. The experimental and control group were selected by utilizing Simple Random Sampling technique – lottery method. After self debut, the research worker explained the nature of survey to the samples. After developing good resonance, the research worker collected the baseline informations on psychosocial well-being and quality of slumber of the samples for the past one month by questioning the samples separately. Deep Breathing and Progressive Muscle Relaxation techniques were taught and demonstrated to the 5 samples of the experimental group as a group learning and they were asked to re-demonstrate. The relaxation therapy was carried out for 30 proceedingss every twenty-four hours and it was continued for 14 yearss in the presence of research worker. On the 14th twenty-four hours the research worker conducted the Post trial was conducted by the research worker by utilizing same tool. The tools used were Psychosocial Wellbeing Assessment tool and The Pittsburgh Sleep Quality Index. The Psychosocial Wellbeing appraisal tool is holding 4 dimensions – Cognitive, Emotional, Social and Spiritual. The dependability of each dimensions were checked and the overall dependability of the tool was checked. The overall dependability of the tool was 0.82. Pilot survey proved the adequateness of the tools and techniques. Hence no alterations were required.DATA COLLECTION PROCEDUREThe chief survey was conducted in the same old age place where the pilot survey was conducted. Before beginning of informations aggregation one time once more the old age place authorization was informed and permission obtained. A hall was arranged for showing the exercising. Based on the sampling standards and technique 25 samples were selected for experimental group and the same figure of samples was selected for control group. After set uping good resonance and obtaining their willingness the research worker explained the intent of the survey ; obtain the willingness and engagement in the survey. By utilizing psycho societal well being assessment graduated table, and Pittsburg sleep Quality Index baseline information was collected from both group. The following twenty-four hours onwards the research worker stayed in the old age place from 5 – 6 autopsy. The experimental group was divided into two subgroups, male and female individually. harmonizing to learning program relaxation therapy taugt and demonstrated seperately for male and female in 2 session. The old age people were asked to re-demonstrate and carryout the exercisings 30 proceedingss a twenty-four hours for 30 yearss in the presence of research worker. For control group no intercession was given. In both groups, On 30th twenty-four hours the research worker conducted the station trial by utilizing the same tool collected on degree of psycho societal well-being and quality of slumber. The survey was done from 15 – 8 – 2009 to 15 – 9 – 2009.Plan FOR DATA ANALYSISThe information obtained would be analyzed in footings of the aims of the survey utilizing descriptive and illative statistics.Descriptive statistics:Frequency and per centum distribution were used to analyse demographic variables, to measure the degree of psycho societal well-being, and quality of slumber of experimental and control group before the intercession. Mean and standard divergence were used to find the difference in degree of psycho societal well-being, and quality of slumber.Inferential statistics:‘t ‘ trial was used to find the important of the difference in degree of psycho societal well-being and quality of slumber. ‘Chi square ‘ trial was used to tie in the demographic variables with degree of psycho societal well-being and quality of slumber.

Economic development and social standing of women in low income countries Essay

‘The hand that rocks the cradle is the hand that rules the world’ is a famous saying that is pertinent to the argument that analysts make about development of women in low income countries depending on the raising of social standing of women in these countries. Because, Women are the nourishing ground of human resource of any society. Children are the future citizens of a Nation and the global world. High standards of women in society lead to a rich human resource. A productive human resource is the most important potential of a country for economic growth and prosperity, which further brings about a total development of that nation. Women are the grassroots of such a growth. Therefore it is very logical to argue that economic development in low income countries highly depends on women and their empowerment, the raising of their social standing in that society. â€Å"Family is a social institution found in all cooperative groups to oversee the bearing and raising of children throughout the world† wrote John J Macionis (2006). Children who are raised by equal status, educated mothers, in developed countries grow up to go to higher levels of education and become responsible adults of the nation. The women thus use their time and resources to development of their children. But the women in under developed low income countries do not have an access to such resources like education and good health. Their social standing is low and hence these nations give rise to an underdeveloped population which in turn results in low economy of the country. These countries are patriarchal and believe in supremacy of Economic development men. Women are a neglected section and thus they remain at the lowest strata of that society. â€Å"Gender stratification plays a vital role in socialization of families, peers, schooling, and mass media† says John J Macios (2007). Raising standards of women will therefore bring about an elevation in the standards with which they raise their own children. Upliftment of women, their empowerment, providing these women social dignity, facilities of good health and sanitation, education and career skills is an important factor that needs attention in low income Countries. With an equality of genders both, men and women could make valuable contributions to the economy of their country. Not only economic development but the overall enrichment of the human resource of the whole world will then take place. Sociologists the world over argue about the dependence of social status of women in low income countries with their economy because investment in human resource is the only answer to development and optimization of natural resource. Respected, educated, healthy, happy mothers are the only answer to a well developed world. Not just for a few countries and not just for economy but for the good health of the Universe, women all over the world deserve a high status in society. They really are the ones who teach children to become good and responsible adults, and this is the only way economic development can take place. Therefore sociologists agree and analysts argue that economy of the country depends upon the social standing of women in that country with special reference to the low income nations of the world. References Macionis, J. J. (2006). Society: The Basics. Pearson Education.

The Homeland Security Act Of 2002 Pulls Apart Immigration

Introduction On March 1, 2003, U.S. Citizenship and Immigration Services (USCIS) assumed accountability for the immigration service occupations of the federal government. The Homeland Security Act of 2002 pulls apart the Immigration and Naturalization Service (INS) and detached the agency into three modules within the Department of Homeland Security (DHS). The Homeland Security Act created USCIS to develop the security and efficiency of national immigration services by converging exclusively on the administration of value applications. The law also shaped Immigration and Customs Enforcement (ICE) and Customs and Border Protection (CBP) to oversee immigration implementation and border security. USCIS doles from a legacy of more than 100†¦show more content†¦Budget Overview The President s Fiscal Year (FY) 2016 Budget Request of $41.2 billion for the Department of Homeland Security reflects the constant commitment to safeguarding a homeland that is safe and secure. A safe and secure homeland is one in which the liberties of all Americans are guaranteed, privacy is secure, and the resources by which we tradeoff with the world-through travel, lawful immigration, trade, commerce, and exchange, are secured. The FY 2016 Budget centers resources on key competences in each of their mission areas. These includes, but is not limited to â€Å"preventing terrorism and improving security, fortifying and managing the borders, enforcing and supervising the immigration laws, safeguarding and securing cyberspace, and solidifying national preparedness and resilience† (Johnson, 2015). Enhancing DHS unity of effort will facilitate the Department to best fulfill its mission errands in service to the Nation. Consistent with this strategic vision, the FY 2016 President’s Budget will help to reinforce DHS’s existing business routes, develop new ones in areas of necessity, update the organizational structure, and re-orient and boost a