J.S.S.COLLEGE OF NURSING
1ST MAIN SARASWATHIPURAM, MYSORE
SYNOPSIS SUBMISSION
BY,
Ms.KITTY. P. WILSON
1ST YEAR M.Sc. NURSING
J.S.S COLLEGE OF NURSING
1STMAIN, SARASWATHIPURAM
MYSORE- 570009
GUIDE:
MS. BUVANESWARI.R
ASST. PROFESSOR
PSYCHIATRIC NURSING DEPARTMENT
J.S.S COLLEGE OF NURSING
1STMAIN, SARASWATHIPURAM,
MYSORE- 570009
BATCH: 2010-2012
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE : AND ADDRESS (IN BLOCK LETTERS) / MS. KITTY. P. WILSON1ST YEAR M.Sc. NURSING
J.S.S COLLEGE OF NURSING
1st MAIN ROAD, SARASWATHIPURAM
MYSORE- 570009
2 / NAME OF THE INSTITUTE : / J.S.S COLLEGE OF NURSING
MYSORE
3 / COURSE OF THE STUDY :AND SUBJECT / 1ST YEAR M.Sc. NURSING
PSYCHIATRIC NURSING
4 / DATE OF ADMISSION TO : COURSE / 30.06.2010
5 / TITLE OF THE TOPIC : / A STUDY TO ASSESS THE EFFECT OF SELF WORTH THERAPY ON SELF ESTEEM, DEPRESSION AND QUALITY OF LIFE AMONG ELDERLY IN SELECTED OLD AGE HOMES OFMYSORE.
6. BRIEF RESUME OF THE INTENDED WORK.
6.0. INTRODUCTION:
Self-worth comes from one thing – thinking that you are worthy
-WAYNE DYER
There is no one who would like to grow old. Every human being on the earth follows a cycle which is determined by nature that takes through the phases of childhood, adolescence, adulthood and maturity. Each stage has its own responsibilities and its particular problems. With the advancement of age, the entire scenario undergoes drastic changes. Responsibilities are passed on to the next generation and slowly fade out giving rise to complicated set of problems1.
The elderly are a precious asset for any country. With rich experience and wisdom, they contribute their might for sustenance and progress of the nation. Their special health and economic issues differ from those of the general population. The United Nations principles address the independence, participation care, self- fulfillment and dignity of older person as an ensured priority2.
The care of the elderly is drawing more and more attention of the Government and public. It is already a major social health problem in affluent countries. The diminishing joint family system in India and the various other social factors created a boom in emergence of old age homes especially in cities. Various surveys done in India and abroad have confirmed that most of the elderly people consider homes as a place where they can drive greatest emotional satisfaction2.
Self esteem, self acceptance and a sense of self-worth are vital to feeling happy. When we lose the sense that we are worthy or loveable, it is easy to become depressed in turn leads to low self esteem and quality of life3.
Self-concept also called self-construction or self-perspective is a multi-dimensional construct that refers to an individual's perception of "self" in relation to any number of characteristics, such as academics and non academics, gender roles and sexuality, racial identity, and many others. The self-concept is composed of relatively permanent self-assessments, such as personality attributes, knowledge of one's skills and abilities, one's occupation and hobbies, and awareness of one's physical attributes. A person's self-concept may change with time, possibly going through turbulent periods of identity crisis and reassessment3.
Self esteem is a human basic need according to Maslow’s hierarchy. People need to feel worthy of living. Self esteem is important in the maintenance of self concept. Self esteem is our sense of self worth. It is an evaluation that an individual makes and maintain about the self. Self esteem can be understood by thinking of the relationship between a person’s self concept and the idea self. The ideal self consists of the aspirations, goals, values and standards of behavior that a person considers ideal and strives to attain .The ideal self originates in the preschool years and develops throughout the life; it is influenced by societal norms and the expectations and demands of parents and significant others. In general, a person whose self concept varies widely from the ideal self has low self esteem3.
Self esteem is influenced by the amount of control that people they have over life goals and successes. A person with high self esteem tends to attribute success to personal qualities and effort. When successful, an individual with low self esteem tends to attribute this to luck or others help rather than personal ability. Failure in work, failure in relationship and chronic illness may affect the self esteem3.
As life expectancy continues to rise, one of the greatest challenges of public health is to improve the quality of laters years of life. The progressive rise in life expectancy contributes to an increase in the prevalence of chronic illnesses in the elderly population. Despite suffering from chronic conditions, elderly individuals can have a good level of health and remain capable of carrying out basic survival activities, their social lives and finances. Therefore, one of the greatest public challenges is to increase the number of years of a healthy and quality of life. The concept of quality of life encompasses satisfaction and wellbeing, containing subjective and multidimensional characteristics. It includes the sense of well being and happiness regardless of illness and dysfunction. Health related quality of life is a multidimensional approach that takes into account physical, mental and social aspects that are more clearly related to symptoms, disabilities and limitations caused by disease4.
In our ageing society, the problem of depression can reach further than the undoubted emotional suffering of elderly individual. It is also the characteristic of the fabric of today’s society in which families disperse and are leaving the elderly isolated, especially those who survive the death of their partners. Elderly depression can be described as medically interactive, “If I have been ill for some time, my illness can be the cause of my depression; that’s logical. It applies also in reverse I am clinically depressed, and then I may become more vulnerable to other diseases of ageing. Co-morbidity with depression is a profound and growing problem in old age. The complexity of elderly depression has been described in terms of “vulnerabilities to relapse, recurrence and chronicity”. Contributing factors for depression are listed as advanced age,gender,loneliness and isolation, reduced sense of purpose, health problems,fears,multiple personal loss or bereavement, chronic insomnia, limited access to treatment,cerebrovascular disease,alzheimer’s disease,parkinson’s disease and depletion of psycho social resources5,6.
Depression in older people has been effectively treated by anti- depressants, psychotherapy alone or combined with pharmacotherapy. However, the safety of drug therapy among older people remains questionable due to age related changes in pharmacokinetics and poly pharmacy. Therefore non pharmacological therapies such as reminiscence therapy, and life review, cognitive behavior therapy, music therapy, and self worth therapy found effective in reducing depression among elderly7.
Self-worth is the quality of being worthy of esteem or respect. Self-worth is integrally related to self-image and sense of self-esteem. Self-worth relates to issues of control. The greater the sense of self-worth, the greater the confidence, that you can take and keep control over your life. Often, people with low self-worth are those who set impossible, rigid, or inflexible standards for themselves. Others with low-self-worth can be those people who, for whatever reason, have a tendency to avoid and deny their problems, choosing not to deal with their life issues head-on. But this is a vicious cycle, because it is only through confronting and mastering our challenges that we can develop the sense of power that engenders and enriches our self-worth. When individuals suffer from low self-worth, they find it difficult to deal with anxiety. They sleep poorly, they harbor negative feelings about themselves, and they are unable to enjoy life to its fullest. But through self worth Therapy, people who have issues around their self-worth can learn to view themselves more realistically. They can learn how to recognize, appreciate, and value their assets and strengths, and thereby affirm and strengthen their self-perceived value as worthwhile human beings8.
6.1 NEED FOR THE STUDY:
In the year 2002 there was an estimated 605 million old person in the world, of which 400 million are living in low income countries. By 2025, the number of elderly people is expected to rise more than 1.2 billion with about 840 million of these in low income countries. The number of persons above 60 years of age is increased very rapidly especially in India .India is the second most country in the world with 76.6 million people at or above the age of 60,constituting7.7% of the total population. This population is facing numerous problems, owing to the social and cultural changes that are taking place with in the Indian society. Currently 7.6% of India’s population is above 60 years old and figure is likely to reach 12.6% by 20252,9.
The World Health Organization estimated that the overall prevalence rate of depressive disorders among the elderly generally varies between 10% and 20% depending on cultural situations.The community-based mental health studies in India have revealed that the point prevalence of depressive disorders in the elderly Indian population varies between 13% and 25%.Although India is the second most populated country in the world in terms of elderly population of 60 years and above, depression in the elderly is not yet perceived as a public health problem in India. A very few community-based studies have been conducted in India so far, to address this issue10.
A survey on report of the status of the old in India showsthat75 % suffer from physical disability, 60%face a great sense of alienation, 48%are extremely lonely, 46%face economic problems. The elderly are considered high risk group for multiple morbidity - physical, mental and social. The prevalence rate of mental morbidity among those aged 60+ was estimated at 89/1000 which projected onto the population yielded a figure of nearly 4 million. An affective disorder, particularly depression is the most common diagnosis in this age group. Neurotic disorders are relatively infrequent. Affective disorders, particularly depression, later paraphrenia and dementias form the bulk of morbidity in higher age group. The risk of psychiatric illness increases pari passu with age. The overall prevalence of psychiatric morbidity rises from 71.5 percent of those over 60 (but below 70) to 124 in the 70s to 122 in those over 80. Nearly 43% of psychiatric outpatients in 60+ age group are said to suffer from geriatric depression. Not only the depression is more common in older age groups, the elderly also form a high risk group for self destructive behavior. Suicide rates increase sharply and are around 12/100,000 while it is 7/100,000 for general population. Psychological factors, chronic diseases, social problems, isolation and losses combine to push elderly into depression. Recent studies show that depressive disorders are aggravated by physical illness2.
Self esteem is the experience of being competent to cope with the basic challenges of life and of being worthy of happiness. It consists of two components; self-efficacy and self- respect. Self-efficacy is the confidence in one’s ability to think, learn, choose, and make appropriate decisions, and by extension, to master challenges and manage change; and self-respect is the confidence in one’s right to be happy and by extension, confidence that achievement, success, friendship, respect, love and fulfillment are appropriate for oneself. Self-efficacy and self-respect are the dual pillars of healthy self-esteem; if either one is absent, self-esteem is impaired8.
Self-esteem is a basic human need that it makes an essential contribution to the life process; that it is indispensable to normal and healthy development; that it has value for survival. Without positive self-esteem, psychological growth is stunted. Positive self-esteem operates, in effect, as the immune system of consciousness, providing resistance, strength, and a capacity for regeneration. When self-esteem is low, resilience in the face of life’s adversities is diminishes. Clients crumble before vicissitudes that a healthier sense of self could vanish. They tend to be more influenced by the desire to avoid pain than to experience joy; negatives have more power over them than positives. Self-esteem empowers, energizes and motivates. It inspires persons to achieve and allows them to make pleasure and pride in their achievements. It allows them to experience satisfaction. The more solid a clients self-esteem, the better equipped he or she is to cope with adversity in their personal lives or their careers3,8.
There are several key factors which influences on an individual’s amount of self esteem. One of the greatest factors affecting self esteem is one’s experiences encountered in childhood. Other factors impacting upon self esteem include painful events or experiences such as bereavement, divorce, serious illness or bullying11. A study was conducted to explore the factors influencing the self esteem and functional health. Data were collected in 1992 and 1994 from 737 older people living in a North Carolina metropolitan area. Functional health was derived from questions asking respondents about their difficulties in performing seven activities. Rosenberg’s scale was used to assess self esteem scale and was measured in terms of competent, sociable and confident. Results shows that functional health has a positive effect on self-esteem and encourages increases in self-esteem over two years and also shows that self- esteem has a positive effect on functional health and changes in functional health. The findings confirmed that health influences self and individuals may be motivated by their desire to affirm a sense of self-worth and positive identities to maintain and improve their physical health12.
Quality of life is the degree to which a person enjoys the important possibilities of his or her life. Possibilities result from the opportunities and limitations each person has in his or her life and reflect the interaction of personal and environmental factors. In Quality of life research, one often distinguishes between the subjective and objective Quality of life. Subjective Quality of life is about feeling good and being satisfied with things in general. Objective Quality of life is about fulfilling the societal and cultural demands for material wealth, social status and physical well being. According to Johns Hopkins Medical Letter Health there are significant factors which increase longevity, prevent or delay disabling illness, and improve the Quality of life. They are exercise, nutrition, and cessation of smoking, avoidance of excessive alcohol, stress reduction, cultivating satisfying relationships and challenging the mind13.
A study was conducted to explore subjectively perceived Quality of life and related factors of elderly nursing homes residents. Sample of 161 aged 65 and older were selected from 10 nursing homes in Southern Taiwan. Results shows that activities of daily living, social support from nursing aids, socioeconomic status, physical function and frequency of interaction with family were the significant predictors in the Quality of life14.
A study was conducted to investigate the interpersonalself-concepts and globalself-worthrelated to psychotic and depressive psychopathology in persons with psychosis. Participants with psychosis (n=83) and healthy controls (n=33) were assessed for globalself-worth, interpersonalself-concepts, and dysfunctional beliefs using the FrankfurtSelf-Concept Scale, delusions Inventory, the Paranoia Checklist, the Beck Depression Inventory and Dysfunctional Attitude Scale. The results shows that low globalself-worthwas associated with depression, whereas the more specific perception of not being accepted by relevant others was related to psychotic symptoms15.
Nurses play a vital role in health promotion of elderlies with the nursing interventions focusing on primary prevention (health promotion) which consists of education, nutritional assessment and guidance,appropriate exercise prescription,avoidance of tobacco and limiting exposure to known carcinogens.Nurses do have significant role in achieving secondary prevention by screening questions and health assessment, referral for examination and testing, disease cure and aggressive treatment to limit disability and stop disease progression to collaborate in treatment. Psychotherapy is an efficient and effective therapy for individuals who want to achieve greater personal happiness through rebuilding self confidence and self esteem, adjusting to challenges in work environments, alleviating depression, managing uncertainty and change, reducing anxiety.The roles of the nurse in the tertiary prevention (restoration and rehabilitation) are multidisciplinary rehabilitation and appropriate services which aids to increase independence.Psychotherapy is an efficient and effective therapy for individuals who want to achieve greater personal happiness through rebuilding self confidence and self esteem, adjusting to challenging work environment, alleviating depression, managing uncertainty and change, reducing anxiety and sorting out important relationships. There are many psychotherapies like Cognitive Behavior Therapy, Group Therapy, Family Therapy, Reminiscence Therapy, Self-work Therapy, Validation Therapy and Individual Therapy and thus nurses can also effectively intervene with the use of self-worth therapy to overcome the problems of elderly. Thus nurses can also effectively intervene with the use of self-worth therapy to overcome the problems of elderly16.
Self worth Therapy refers to teaching strategies to self manages depressive symptoms and provide dignity therapy. Dignity Therapy is a brief, flexible intervention, which allows individual to complete an interview and create a document regarding their life, identity and what they want to leave in writing for their loved ones. Dignity Therapy is based on Question Protocols. Studies shows that Dignity Therapy is a part of self worth therapy and their findings proved that it is an effective way to enhance individual’s dignity, quality of life, self esteem and to diminish sufferings and depression. Self worth Therapy helps to improve the physical, psychological, social, and emotional well-being; Therapy helps for a normalized, balanced lifestyle for all people, and essential as a means of self-expression, release, and socialization, to achieve the highest possible level of independence and quality of life.The Advantages of this therapy arethe trainees learn a vocation, gain a sense of self worth, economic independence, learn to improve inter personal relationship7,8,17.