PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
MS. HENA CHANDRAN A C
I YEAR M. Sc NURSING
PEDIATRIC NURSING
YEAR 2010- 2011
IKON NURSING COLLEGE
BEEMANAHALLI, B.M.MAIN ROAD
RAMANAGARAM DISTRICT BIDADI, BANGALORE - 562109
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATEAND ADDRESS / MS. HENA CHANDRAN A C
I YEAR M. Sc NURSING
IKON COLLEGE OF NURSING
NO.32. BEEMANAHALLI
B. M ROAD, BIDADI
RAMANAGARAM DISTRICT
BANGALORE-562109
2 / NAME OF THE INSTITUTION / IKON NURSING COLLEGE,
BANGALORE.
3 / COURSE OF THE STUDY AND SUBJECT / I Year M.Sc Nursing,
Pediatric Nursing
4 / DATE OF ADMISSION / 10. 05. 2010
5 / TITLE OF THE TOPIC / A Study to Assess the Effectiveness of Structured Teaching Programme on Behavioral Problems among Mothers of 1-12 years of Children in Selected Hospital at Bangalore.
6 BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
Let us put our minds together and see what life we can make for children
- Sitting Bull
Today’s society is complex and ever-changing. As children grow they must learn not only to cope with current demands, but also to prepare for the many unexpected events they will face in their tomorrows. Children are like wet cement; whatever falls on them makes an impression. So children need to adjust with this world to do their best in the future.
Children normal behaviors depend on various natural and environmental circumstances in which a child grow and observes. The ways for his best possible conduct with in his reaches and interact among those who respond his gestures and body talks. Parents are the first to whom a child makes and develops his concerns regarding his needs and wants. Normal behavior developments required normal circumstances and equal participations of parents .1
Infancy and Childhood are of paramount importance in determining and patterning the future behavior and character of the children. Childhood is the period dependency, gradually children learn to adjust in the environment. But when, there is any complexity around them they cannot adjust with those circumstances. Then they are unable to behave in the socially acceptable way and behavioral problems develop with them.2
All children do not react in the same way to the same situation and the children behavior problems could be related to temperament. It can be result when the child’s emotional needs are not being met. When there are emotional aspects to children behavioral problems, the child could hurt himself or another child. This requires careful observation.3
Behavioral problems of children lead to abnormality in their emotions or behavior which is severe and cause distress to the child, family and community. Behavioral disorders are caused by multiple factors like faulty parental attitude, inadequate family environment, mentally and physically sick or handicapped, influence of social relationship, influence of mass media, and influence of social change.4
Temper tantrums are often seen as children’s behavioral problem, but they are a natural part of developing normally. Although many children go through a biting stage, if it is not discontinued, it can develop into a behavioral problem. Not all children’s behavioral problem require professional intervention or medication, they should be closely observed to determine the cause.3
Instead of lashing out with punishment it is important for parents and teachers to know how to deal effectively with children behavioral problems when they arise. The first thing to consider is whether or not the children behavioral problem is just a developmental stage the child is going through. Many childrens’ behavior problems that present themselves in young children are the signal of the onset of another stage in their development as the children start to develop more independence. Giving the children choices is the one way of handling the issues surrounding these childrens’ behavioral problems.3
Management is by treating underlying psychiatric condition if any, family therapy, parental training and liaison with school to investigate possible reasons for refusal and negotiate re-entry. Essential fatty acids may alleviate some symptoms. Hypnotherapy has been found to be benefit in school-age children. Melatonin is sometimes of benefit in sleep disorder.5
Counseling is a useful intervention for many of the behavioral problems. To be of real benefit the change should be learnt and not imposed. Spending 15-30 minutes daily for a positive child-parent interaction is useful. Generally mothers are expected to perform this role.6
6.2 NEED FOR STUDY
Normal children are healthy, happy and well adjusted. This adjustment is developed by providing basic emotional needs along with physical and physiological needs for their mental wellbeing. The emotional needs are considered as emotional food for healthy behavior. The children are dependent on their parents, so parents are responsible for fulfillment of the emotional needs. Every child should have tender loving care and sense of security about protection from parent and family members. Parents especially mothers should be aware about achievements of their children.2
The world wide morbidity due to behavioral problems has been more widely examined in developed countries with an overall prevalence of around 12%. But it is more increased in developing countries due to urbanization and industrialization.7 In general child population the prevalence of behavioral problems has been estimated at between 3% and 6% and higher incidence among pre school children from low-income families that is 30%.8
Parents Report Estimated that 2.7 Million Children are with Emotional and Behavioral Problems.
• Boys were more likely than girls to have definite or severe emotional and behavioral difficulties.
• Children ages 8 and over were more likely than younger children to have emotional or behavioral difficulties.
• Children from poor families were more likely to have emotional or behavioral difficulties .9
The total prevalence of sleep disorders was 21.2%. Disorders included parasomnia symptoms bruxism [6.5%], sleep talking [4.9%], and sleep walking [0.6%]), restless legs or periodic limb movement symptoms (restless sleep [5.0%] and leg movements [1.9%]); and symptoms of sleep-disordered breathing (frequent snoring [5.6%], mouth breathing [4.1%], choking or gasping [0.9%], and breathing pauses [0.2%]). 10
The prevalence of bruxism was significantly higher in the preschool (8.5%) and in the toddler (3.5%) and middle-school (3.7%).The prevalence of restless sleep ranged from 9.6% among 2-year-olds down to 3.4% among 12-year-olds.The nail biting 40% prevalence in 10 years old children. One and half times higher in girls than boys.10
A non-clinical based English literature search for epidemiological studies in the past 12-18 months from 51 Asian countries were showed the general prevalence of behavioral and mental disorders range from 10-20%.11
A study conducted in National Institute of Mental Health and Neurosciences, Bangalore resulted that all behavioral emergencies in the state of Gujarat and Andhra Pradesh which together accounts for more than 15% of India’s population. A total of 40,541 cases of behavioral emergencies were recorded, in which most victims from poor socioeconomic status (93%), rural area (74%) and backward caste (43%).12
A prevalence study conducted in 12 districts of the Karnataka state were showed that current incidence of behavioral problems in children were 4.9% and from 13-15 year old children tobacco chewing is more prevalent and include nearly 8.25%.13
An exploratory study was carried out during the year 2006-07 in Dharwad city, to know the prevalence of behavioral problems among pre adolescents and revealed 18 percent of children were found with a difficult behavior. Further study revealed that boys had significantly more externalizing problems while girls had significantly more of internalizing problems.14
In today’s busy life, parents are not able to take care and give love and affection to their beloved one. Children are deprived from parental affection and these children develop various habit disorders, changes in behavior to overcome the situation13. A Nations most important and precious resource is its children who constitute its hope for continued achievement and productivity. Today we are passing through a stage where the behavioral patterns of youngsters are a matter of much concern for the educationists, psychologists, and sociologists. Early prevention and interventions is better than later remediation.15
Based on above findings, the investigator found it is desirable to assess the knowledge of the mothers of 1-12 years of children regarding behavioral problems. Educating the mothers and creating awareness about behavioral problems helps to prevent the incidence of behavioral disorders in their children.
6.3 STATEMENT OF THE PROBLEM
A Study to Assess the Effectiveness of Structured Teaching Programme on Behavioral Problems among Mothers of 1-12 years of Children in Selected Hospital at Bangalore.
6.4 OBJECTIVES
· To assess the knowledge level regarding behavioral problems among mothers of 1-12 years of children in selected hospital, Bangalore.
· To evaluate the effectiveness of structured teaching programme on knowledge
regarding behavioral problems among mothers of 1-12 years of children in
selected hospital, Bangalore
· To find out the association between knowledge regarding behavioral problems among mothers of 1-12 years of children with selected socio demographic variables.
6.5 OPERATIONAL DEFINITION
Assess: In this study it refers to the organized, systematic and continuous process of collecting data from the mothers of 1-12 years of children regarding behavioural problems.
Effectiveness: In this study it refers to the extent to which the structured teaching programme on behavioral problems has improved the knowledge of mothers after the implementation of the structured teaching programme as evidenced by the differences during the pretest and post test.
Structured Teaching Programme: It refers to systematically developed
instruction designed to provide information regarding behavioral problems in
children.
Behavioral Problems: It refers to an abnormality of emotions, behavior or
relationship which is sufficiently severe and persistent to handicap the child in
his social or personal functioning and to cause distress to the child, their care
givers and to the people in the community. Common behavioral problems are
Psychosocial behaviors, habit disorders, disruptive behavior, sleeping
problems and educational difficulties.
6.6 ASSUMPTION
It is assumed that:
1. Most of the mothers may have some knowledge regarding behavioral problems.
2. There will be enhancement in the knowledge of the mothers after
administration of Structured Teaching Programme.
6.7 HYPOTHESIS
H1 There will be significant difference between pretest and post test knowledge score regarding behavioural problems among mothers of 1-12 years of children.
H2 There will be significant association between the knowledge of the mothers of 1-12 years of children with selected demographic variables regarding behavioral problems.
6.8 REVIEW OF LITERATURE
Literature review is a critical summary of research on a topic of interest, often. prepared to put a research problem in context.16
In this chapter the review of literature is presented under the following headings;
1. Studies related to knowledge regarding behavioral problems.
2. Studies related to causes of behavioral problems
3. Studies related to management of behavioral problems
1. Studies related to knowledge regarding behavioural problems
A study was conducted regarding childrens’ delayed development and behavioral problems and its impact on mothers’ perceived physical health across early childhood in United States. The researchers examined the associations between developmental delay and behavior problems at 3 years of age and mothers' self-perceived physical health at ages of 3, 4, and 5, in families of 218 children with and without developmental delays. The study sample comprised 218 families. The study resulted that mothers of children with both delayed development and high behavior problems are a particular risk group that may be especially in need of early intervention.17
A study was conducted regarding whether maternal knowledge mediated the relation between overt marital conflict and preadolescent behavioral competence. Four years of self-report data were collected from 133 mothers and their preadolescents, beginning when the preadolescents were in 4th grade. Marital conflict, maternal knowledge, and preadolescent behavioral competence were assessed at all 4 time points. The results indicated that maternal knowledge mediated the relation between marital conflict and preadolescent behavioral competence.18
2. Studies related to causes of behavioral problems
A study was conducted regarding maternal folic acid supplement use in early pregnancy and child behavioral problems. An adequate folate nutritional status is also important for normal fetal growth and brain development. Child behavioral and emotional problems were assessed with the Child Behavior Checklist at the age of 18 months in 4214 toddlers. Results showed that children of mothers who did not use folic acid supplements in the first trimester had a higher risk of total problems. In conclusion, inadequate use of folic acid supplements during early pregnancy may be associated with a higher risk of behavioral problems in the offspring.19
A study was conducted on teacher’s assumptions regarding the severity, causes and outcomes of behavioral problems in preschoolers. 91 female and 9 male preschool teachers (average age 34 yrs) rated severity, need for referral, long-term outcome, stability, and importance of constitutional and environmental determinants for case vignettes describing 3 syndromes in children: aggression, hyperactivity, and withdrawal. Sex and age (3½ and 5½ yrs) of the described child were systematically varied. Results indicated little evidence of sex bias in evaluations of the behavior problems and showed that behavioral problems as more transient in younger children20.
A study was conducted on the relationship of maternal smoking to psychological problems in the offspring. There is strong evidence for an association between maternal smoking in pregnancy and psychological problem in offspring. The problems most frequently associated are attention problems, hyperactivity and conduct problems, although there is some evidence for an association with substance use problems as well. Finally the study resulted that maternal prenatal smoking may induce psychological problems in the mother that are inherited by offspring and which lead to conduct problems in future.21
A study was conducted on behavior problems among very low-birth weight (VLBW) children in Netherlands. Very low-birth weight children had more depressed behavior and more internalizing problems by parent report, and also scored significantly more often within the clinical range on total problem scores. Neither neonatal cerebral ultrasound nor neurological examinations were directly associated with behavioral outcome. Cerebral damage was related to cognitive development. The researchers suggested that depressed behavior of very low-birth weight preschool children might be associated with parental reactions to the birth of a very low-birth weight child, and that their attention problems might be linked indirectly to brain damage via cognitive impairments.22