BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
SUBMITTED BY:
Ms.S.RAJALAKSHMI,
M.Sc., NURSING, I YEAR,
2009-2011 BATCH,
HARSHA COLLEGE OF NURSING,
BANGALORE.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SUBMITTED BY:
Ms. RAJALAKSHMI
M.Sc., NURSING, 1ST YEAR,
2009 - 2011 BATCH,
HARSHA COLLEGE OF NURSING,
BANGALORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE& ADDRESS / Ms. Rajalakshmi
1st Year M.Sc., ( Nursing )
Harsha College of Nursing ,
No. 193 / 4 , Sondekoppa circle,
Nh – 4 , Nelamangala,
Bangalore – 562 123
2 / NAME OF THE INSTITUTION / Harsha College of Nursing
3 / COURSE OF STUDY & SUBJECT / M.Sc. Nursing
Psychiatry nursing
4 / DATE OF ADMISSION / 8th JUNE 2009
5 / TITLE :
“A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE OF CAREGIVERS REGARDING PREVENTION AND MANAGEMENT OF BEHAVIORAL PROBLEMS OF THE INSTITUTIONALIZED ORPHANS BETWEEN THE AGE OF 6 – 12 YEARS IN SELECTED ORPHANAGES, BANGALORE”.
6. BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION
A nation’s child is its supremely important asset and the nation’s future lies in their proper development. An investment in children is indeed an investment in the nation’s future. A healthy and educated child of today is the active and intelligence child of tomorrow.
Bestow blessing on those little, innocent lives bloomed on earth, which have brought the message of joy from heavenly garden.
------RabindranathTagore.
Children are mirror of a nation. They are our future and our most precious resources. The quality of tomorrow’s world and perhaps even its survival will be determined by the well-being, safety and the physical and intellectual development of children today. To predict the future of a nation, it has been remarked, one need not consult the stars; it can more easily and plainly be read in the faces of its children.
In the conflict torn developing countries, where adoption and foster care are little practiced, orphanages remain one of the few means of survival of innumerable orphans. The practice of placing deprived children having minimum or no emotional and material resources, in large residential institutions like orphanages, destitute homes and charity educational institutions has since long been prevailing in socio-economically poor Asian countries1.
As a result of chronic conflict in many areas and the recent natural disaster including Tsunami and Kashmir earthquake in these regions, there has been an exponential increase in the number of orphans in all these disaster areas.
India has 375 million children, more than any other country in the world. There are more children under the age of fourteen and above 14 years in India than the entire population of the United States.
Behavior problems have also been examined in recent studies of institutionalized children. These studies have found that orphanage children display rather unique behavior problems when compared with either home-reared non-adopted children or within country-adoptees.
Ames and her colleagues attribute most of the behavior problems of orphanage children to their orphanage experience given that early-adopted children who were adopted before two months of age did not appear different from Canadian-born children in any problem area (Ames 1997; Fisher et al. 1997).
Later Deprivation Studies
It was not until late 1989 and early 1990 that researchers once again could address the impact of extreme deprivation on young children, when the Ceausescu regime in Romania was overthrown. At this time the outside world became aware of thousands of children who had been housed in Romanian state-run orphanages. The conditions in Romanian orphanages were similar to or worse than the conditions described by Goldfarb (Ames 1990; Groze and Ileana 1996)4.
Children spent from twenty to twenty-four hours a day in their cribs, with little visual or auditory stimulation (Ames 1990, 1997), and child-to-caregiver ratios ranged from 10:1 for infants to as high as 20:1 for children over three years of age (Chisholm et al. 1995).
Therefore researchers were once again permitted the opportunity to evaluate the developmental impact of extreme deprivation. Sandra Kaler and Betty Jo Freeman (1994) examined the cognitive and social-emotional developmental status of children within an orphanage in Romania and found that the majority of orphanage children were severely delayed.
Since the early 1990s three major studies have examined the developmental outcomes of children who had spent their first year or two of life in a Romanian orphanage and were subsequently adopted. Two studies in Canada (Ames 1997; Marcovitch et al. 1997) and one in the United Kingdom (Rutter et al. 1998) have followed these children post adoption.
These studies represent an improvement on the earlier literature given they have used large samples of children, comparison groups, and standardized measures that evaluate several aspects of children's development. We now know more about the impact of institutionalization on children's physical, intellectual, behavioral, and social-emotional development.
Social-Emotional Development
For many reasons indiscriminate friendliness is a behavior that is particularly relevant to any study of institutionalized children. References to indiscriminately friendly behavior are evident in the early literature on the social development of institutionalized children who were later fostered or adopted (Goldfarb 1955; Provence and Lipton 1962)5.
Tizard (1977) characterized indiscriminate friendliness as behavior that was affectionate and friendly toward all adults (including strangers) without the fear or caution characteristic of normal children. In these cases a child's behavior toward other adults could not be discriminated from his or her behavior toward caregivers.
Studies of institutionalized children have also examined indiscriminate friendliness. In Ames's study parents were asked five questions assessing (a) whether their child wandered without distress; (b) whether their child was willing to go home with a stranger; (c) how friendly their child was with new adults; (d) whether their child was ever shy; and (e) what their child typically did upon meeting new adults.
These researchers found that orphanage children displayed significantly more indiscriminate friendliness than both early-adopted and Canadian-born children, and orphanage children were just as indiscriminate three years post adoption as they were initially (Chisholm 1998). Similarly, Thomas O'Connor, Michael Rutter, and their colleagues in the United Kingdom (2000) found that indiscriminate friendliness was associated with length of deprivation in their sample of Romanian adoptees.
Attachment
Indiscriminate friendliness is particularly relevant to the study of attachment because some researchers have suggested that indiscriminately friendly behavior may be indicative of nonattachment, a term used to describe an attachment disorder that results from an infant not having had the opportunity to form an attachment relationship (Lieberman and Pawl 1988) or a reactive attachment disorder6.
It is important to note, however, that these recent findings further suggest that when the attachment process does go wrong in previously institutionalized children, it may go very wrong. In Chisholm's study (1998) significantly more orphanage children than Canadian-born or early adopted children displayed atypical attachment patterns, which some researchers have suggested are risk factors in the development of psychopathology (Carlson and Sroufe 1995; Crittenden 1988).
Intellectual Development
Elinor Ames and her colleagues (Morison, Ames, and Chisholm 1995) examined children's development; eleven months post adoption, assessing delays in four areas: fine motor, gross motor, personal-social, and language. They found that when their parents first met them the vast majority of adoptees were delayed in all four areas of development7.
Therefore, the longer those children had been institutionalized the more likely such institutionalization had an impact on intellectual development. It is important to note, however, that there was wide variability in IQ scores within each group of children, with some orphanage children scoring in the superior range for IQ (Ames 1997). Rutter and his colleagues compared Romanian adoptees' intellectual development to a group of within-country adoptees (Rutter et al. 1998). Rutter and his colleagues (1998) found that by the age of four, the Romanian adoptees who had been adopted before six months of age did not differ in terms of IQ from the sample of within-country adoptees. For those children adopted after six months of age, their mean IQ scores were only slightly below 100 but they did score significantly lower than either the within-country adoptees or the early-adopted Romanian children.
These findings are consistent with findings from a study comparing orphanage and home-reared children in Russia. Vladimir Sloutsky (1997) assessed differences in IQ scores between six- and seven-year-old children reared in an orphanage with home-reared children and found that the orphanage children scored significantly lower in IQ than home-reared children.
An orphanage is an institution dedicated to the care and upbringing of children who have lost their parent(s). Historically, such institutions were quite prevalent in western societies in the past. An upsurge in such institutions was observed during mid 1700's, mid 1800's and immediately Post World War I. Despite the rising role of foster care for orphans in western society, orphanages continue to play a key role in the war torn third world countries, where their number is ever increasing, they have no means of survival, and foster care is culturally unacceptable 8.
More than 50 years of research provides convincing evidence that the type of institutional care provided in western countries had a detrimental effect on cognition, behavioral, emotional and social development of young children.
But in some poverty stricken countries it has been observed that the children in orphanages had better chances of cognitive development, when the children were encouraged to participate along with the staff in the decisions that influenced them in the institution. It is possible that when managerial skills are fuelled by education and understanding, orphanages can provide a humane social environment one that offers of a close and stable relationship between members.
With regards to growing up in an orphanage, recent studies from Africa suggest that the children who grow into adults in orphanages have remarkably good long-term life adaptations. Most recent studies on children in conflict zones have stressed that children can survive traumatic situations if they feel cared for.
Psychological well being in large measures depends upon the emergence of social support system and social network around vulnerable children. Countries that spend less on community health and social services are more likely to have a higher proportion of institutionalized children.
An Orphanage is often examined through problematic psycho-social functioning of children. There is general agreement among researchers that children placed in orphanage settings at a young age and for long periods of time are at greatly increased risks for development of serious psychopathology later in life.
From this agreement, has emerged a general notion that orphanages are breeding grounds for many psychiatric problems. However, this concept loses its relevance at places affected with long term conflicts, poverty or countries devastated by various disasters, as orphanages are often the only viable option of survival for these children.
This is more relevant in third world countries which suffer more frequent disasters and are also among the most conflict torn areas of world with thousands of orphans Unlike the West adoption and foster care at such places are often culturally unacceptable and logistically unrealistic solutions.
Anna Freud concluded from several case studies that institutionalized children are doomed to fail psychologically because of maternal deprivation. This was despite good physical and social care. Another psycho-analytically trained psychiatrist, John Bowlby also reported that maternal – deprivation was the central issue, causing psychological damage to orphanage children. Goodwin argues that any amount of orphanage experience is harmful; the damage is greatest during first year of life and increases dramatically with length of stay in an institution.
Results of some other studies from Eastern Europe also suggest that there is major developmental impairment in children who suffer profound institutional privation at infancy or early childhood and that such children show good developmental catch-up, following adoption in well functioning families.
Children who grow up in orphanages or foster care usually have no social connections, and these children are at a disadvantage for completing high school, going to college, or getting job opportunities all of which may be contributing factors in predisposing a child to psychopathology.
Studies have shown that institutionalized children have high rates of psychiatric symptoms. Duration of institutionalization, physical structure, and age at abandonment differentially relate to psychiatric symptoms. A positive social orientation and clear standards of behavior are protective factors a family provides against the development of psychiatric symptoms.
Children in institutional care are extremely vulnerable to psychological problems, and institutionalization in long term, in early childhood increases the likelihood that they will grow into psychologically impaired and economically unproductive adults. It has also been observed that in an orphanage setting children’s emotional and behavioral status worsens and even in well run institutions children develop a range of negative behaviors’, including aggression and indiscriminate affection towards adults9.
Individuals placed in orphanages early in their lives are at greater risk when they reach adulthood of living in poverty, developing psychiatric disorders, having difficulties in interpersonal relationships, and having serious problems parenting their own children10.
The overall high prevalence of psychiatric morbidity in orphan children population could be attributed to the serious social implications of the turmoil to the Kashmiri Families. Thousands of children got orphaned and their families broken. There is hardly a family in the valley that has not been affected. More than 50,000 families are
Rendered homeless and as such have lost their initiative to protect themselves or their children.
One in every three malnourished children in the world lives in India. The country also has the dubious distinction of having the world’s largest number of sexually abused children; an estimated 600,000 to 700,000 children are sexually abused every year. A child below 16 years is raped every 155th minute; a child below 10 every 13th hour; and one in every 10 children is sexually abused at any point of time. Orphaned and abandoned children, who live on the streets, are more at risk for being abused. The situation appears to be quite grim, but we are determined to contribute as much as we can to eradicate the problem.