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   Table of Contents - Current issue
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February 2019
Volume 16 | Issue 2
Page Nos. 55-130

Online since Tuesday, January 21, 2020

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EDITORIAL  

Greetings from ISPN India Highly accessed article p. 55
Sandhya Gupta
DOI:10.4103/IOPN.IOPN_35_19  
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ORIGINAL ARTICLES Top

Effectiveness of progressive muscle relaxation therapy on anxiety and depression: A pre-experimental study on elderly people of old age homes Highly accessed article p. 56
Ajay Kumar Ghodela, Virendra Singh, Narendra Kaushik, Sushil Kumar Maheshwari
DOI:10.4103/IOPN.IOPN_20_19  
Introduction: Old age is the closing period in the life span, and it is characterized by certain physical and psychological changes in human being, including anxiety and depression. These changes often determine personal and social adjustments of the elderly. Aim: This study aimed to assess the effectiveness of progressive muscle relaxation therapy on anxiety and depression among elderly people residing in selected old age homes of Rajasthan. Materials and Methods: Pre-experimental research approach with one group pretest–posttest design was used to conduct the study. Nonprobability convenience sampling technique was adopted to select 50 elderly of selected old age homes of Rajasthan. Hamilton Anxiety Rating Scale and the Geriatric Depression Scale were used to assess anxiety and depression, respectively. Progressive muscle relaxation technique (PMRT) was implemented and continued once a day for 10 days for 20–30 min. Results: The study found that 28.0% elderly had moderate anxiety and 100% had depressive symptoms at baseline. After PMRT, anxiety and depression reduced significantly at P < 0.05.Conclusions: The study concluded that progressive muscle relaxation is effective in reducing level of anxiety and depression among the elderly but need to conduct same study on large sample. Elderly should be taught about progressive muscle relaxation so that they can use to reduce their anxiety and depression.
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Medication adherence and its association with subjective well-being among persons with schizophrenia Highly accessed article p. 61
Angshu Lama, Arunjyoti Baruah
DOI:10.4103/IOPN.IOPN_26_19  
Background: Medication nonadherence has been associated with persistence of psychotic symptoms, relapse, and hospitalization in persons with schizophrenia. Adherence to antipsychotic drug treatment is a key issue for nurses and treatment team members. Aim: The study was conducted with the purpose to assess the medication adherence and its association with subjective well-being among persons with schizophrenia. Method: The study followed a quantitative nonexperimental descriptive design. Participants of this study included 85 persons diagnosed with schizophrenia according to ICD-0 taking treatment at LGB Regional Institute of Mental Health, Tezpur. Data were collected using the self-structured sociodemographic datasheet, The Medication Adherence Rating Scale, and The WHO Subjective Well-Being Inventory. Results: 34.1% patients were not adherent to medication. Significant association was found between the medication adherence and subjective well-being (χ2= 6.58 P < 0.05). Significant association was also found between the medication adherence and factor 8, i.e., inadequate mental mastery factor of subjective well-being of the patient (χ2= 10.82 P < 0.05). Pearson correlation coefficient between the medication adherence and subjective well-being was 0.343, so there was positive correlation between the patient's medication adherence and their subjective well-being. Conclusion: The findings of this study reveal that there is a significant association of adherence with the subjective well-being of the patient and that there is a significant positive correlation present between the medication adherence and subjective well-being. Proper psychoedu and support can help clients to improve their medication adherence.
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Factors associated with postnatal depression among primi mothers p. 67
D Jija
DOI:10.4103/IOPN.IOPN_28_19  
Introduction: Postnatal depression poses a heavy burden to the society because of its significant impact on the health of the baby, mother, and its negative effect on the family. During the postnatal period, the emotional status and social support of women has to be assessed. The present study aimed at identifying the factors associated with postnatal depression. Materials and Methods: A descriptive cross-sectional study was conducted in two hospitals in Thiruvananthapuram Corporation, Kerala. Primi mothers (n = 610) at 6 weeks after delivery attending the immunization clinic were included in the study. Consecutive sampling technique was used. The research tool used were sociodemographic data sheet, life events inventory, questionnaire on social support, and Edinburgh Postnatal Depression Scale. Results: The proportion of postnatal depression among the primi mothers was 9.5% (95% confidence interval [CI] 7.2–11.8). The factors associated with postnatal depression among primi mothers included alcoholism of husband (OR 3.01; 95% CI, 1.1–8.24), unplanned pregnancy (OR 2.32; 95% CI, 1.16–4.64), conflict with parents (OR 4.19; 95% CI, 0.9–19.63), conflict with in-laws (OR 5.16; 95% CI, 1.01–26.23), and lack of support from husband (OR 3.33; 95% CI, 1.26–8.81), mother (OR 15.02; 95% CI, 5.66–39.87), mother-in-law (OR 2.38; 95% CI, 1.06–5.34), and friends and neighbors (OR 2.01; 95%CI, 1–4.04). Conclusion: Health professionals at the periphery level of health care should be educated about the risk factors of postnatal depression.
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Assessing the risk factors of suicide among adolescents and evaluating the knowledge on suicide prevention at Goalpara, Assam p. 72
Rita Moni Sharma, Tarulata Kakati Majhi
DOI:10.4103/IOPN.IOPN_24_19  
Background of the Study: A study was conducted to assess the risk factors of suicide among adolescents and evaluate the knowledge on suicide prevention in selected colleges of Goalpara district, Assam. Aims: Aims of the study were to reduce suicide rate among adolescents by creating awareness, provide knowledge on risk factors of suicide and suicide prevention. Objectives: 1.To assess the risk factors of suicide among adolescents in control and experimental group before intervention. 2.To assess the knowledge on suicide prevention among adolescents in control and experimental group before and after intervention. 3.To evaluate the effectiveness of structured teaching programme on increasing knowledge suicide prevention among adolescents of experimental group. Materials and Methods: It was a quantitative approach, quasi experimental study with pre test-post test and control group design. Purposive non random sampling technique was used to select the sample. The study was conducted in two colleges with 80 students, 40 in each control and experimental group. Adolescents selected for the study were the students between the age group of 16-19 years and were studying higher secondary standard. Self administered structured questionnaire was used which consist of three part related to socio-demographic data, risk factors of suicide and knowledge on suicide prevention. Structured teaching programme was conducted to the experimental group which included knowledge on suicide prevention. Results: There was significant difference ('t'=14.607, p=0.000) between control and experimental group in the post test of knowledge on suicide prevention. The overall post test knowledge score on suicide prevention showed that majority of the respondents acquired good knowledge in experimental group. The results indicated that adolescents suicide can be prevented by increasing knowledge, awareness and developing positive attitude.
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Effectiveness of guideline on knowledge and attitude of trainee school teachers towards identification and management of children with specific learning disabilities p. 77
Kalyani Moharana
DOI:10.4103/IOPN.IOPN_27_19  
Background: An effective education is vital not only for individual advancement but also to provide a capable workforce and citizenry for our country. Initial teacher training is regarded as a cornerstone of the development of inclusive education. Learning disabilities (LDs) are present in at least 10% of the population. In India, prevalence rate of LD ranges from 9% to 39% and incidence of dyslexia in primary school children has been reported to be 2%–18%. Aim and Objective: Present study aimed to evaluate the effectiveness of the guidelines on knowledge and attitude of trainee school teachers toward identification and management of children with specific LDs (SPLDs) by conducting pretest before intervention and posttests after intervention on 7th and 60th day. Materials and Methods: From each Zone (East, West, North, and South) of Odisha, one district was selected. A total of 269 trainee school teachers sample were selected. Qualitative study approach was used in this study with pretested and predesigned questionnaire. The data were analyzed using repeated measures analysis of variance (RMANOVA) to compare pretest and posttest knowledge questionnaire and attitude scale score over the time period; the “P” value was significant at 0.001. Results: Findings revealed that the data were analyzed using RMANOVA to compare pretest and posttest knowledge questionnaire and attitude scale score over the time period; the “P” value was significant at 0.001. This indicated that the guidelines for trainee school teachers toward identification and management of children with SPLD was effective in improving the knowledge and attitude significantly over the time period of the trainee school teachers. Conclusion: Guideline (self-instructional module) is effective for trainee school teachers to improve their knowledge and attitude toward identification and management of children with SPLDs over the time period.
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Contributing factors which led to relapse of tobacco-seeking behaviour among stroke survivors, in a selected tertiary care hospital, New Delhi p. 84
Neetu Kataria, Sandhya Gupta, MV Padma Srivastava, Sonali Jhanjee
DOI:10.4103/IOPN.IOPN_32_19  
Background: The outcome of treatment of stroke depends on removal of modifiable risk factors, such as stopping tobacco seeking behavior which is important factor to prevent reoccurrence of stroke. Aim: To identify contributory factors and relapse of tobacco seeking behavior among tobacco users recovering from stroke. Methodology: An exploratory, cross sectional study on 164 tobacco user post-stroke patients seeking treatment from AIIMS, New Delhi, India. Tools: A demographic data sheet, Pattern of Tobacco Use semi-structured proforma, MFTS, MF-ST Version scale, Checklist to assess factors contributing relapse of tobacco seeking behavior and NIHS scale were used for the study. Results: Mean age of post-stroke patients was 50.56±1.27 years. Slightly less than half (45%) of the patients relapsed to tobacco use post-stroke attack after initial abstinence whereas 54.87% (n=90) of the patients did not relapse to tobacco use. Most of the subjects gave some reasons of relapse like craving or uncontrollable desire. A little over one third of the patients reported symptoms such as irritability, sadness, poor concentration, constipation and non availability of tobacco cessation treatment which they reported led to their relapse of tobacco use. Most of the subjects reported that they were still not ready for enrolling in Tobacco Cessation treatment Programme (60.3%). A significant difference was found between relapse of tobacco seeking behavior with MF-ST (smokeless) scale (p<0.001) than MF-TS (smoking) scale (p<0.05). Conclusion: The prevalence of tobacco users getting attack of stroke is four times higher than non-tobacco users. Even though patients are warned by doctor to stop smoking, they continue to use tobacco and to be under risk of reoccurrence of stroke and other complications.
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Resilience, psychological well-being, and coping strategies in medical students p. 92
Sonika , Shalini , Rajesh Kumar
DOI:10.4103/IOPN.IOPN_22_19  
Introduction: The period of transition from school to medical education is critical and students faced many challenges and have a stressful life. Coping and resilience level of a student determine psychological well-being for higher professional competence and learning. The study aims to determine impacts of coping, and resilience on psychological well-being among medical students. Materials and Methods: A cross-sectional descriptive survey was conducted by randomly enrolling 151 MBBS students at All India Institute of Medical Sciences, Rishikesh, Uttarakhand. The information on personal and professional domains, coping, resilience and psychological well-being was sought by using sociodemographic profile sheet, resiliency scale for adult, BREF-COPE (Coping Orientation to Problems Experienced), and Ryff's psychological well-being scale. Appropriate descriptive and inferential statistics was applied to formulate results. Results: Resilience did not show significant relationship with psychological well-being in medical students. However, it was found that high level of resilience enables to predict more autonomy (P < 0.05), personal growth (P < 0.05), help in findings meaning in life (P < 0.05) and develop strong structural aspects (P < 0.05) in physical structure. Further, higher resilience enables to more use of self-distraction (P < 0.05). Likewise, it was also evident that better level of psychological well-being enables students to use more active coping (P < 0.05), positive reframing (P < 0.05), and acceptance coping strategies (P < 0.05). Conclusion: Higher level of resilience will help the medical graduates to buffer day to day stressors and enalbles to use more positive coping strategies. Discussion and Recommendation: Improvement in social and personal life of the health sciences students should be kept in mind along with clinical competency. Development of resilience to tolerate day to day life hassles is a healthy practice to have a positive augmentation of psychological well-being. The study recommended to implicit educational training centered on resilience and positive coping strategies in future.
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Restraints practices among psychiatric nurses in state mental health-care setting, Karnataka, India p. 98
Sreevani Rentala, Sunanda Govinder Thimmajja, Raveesh Bevinahalli Nanjegowda, Prasanth Bevoor
DOI:10.4103/IOPN.IOPN_25_19  
Background: Using physical restraints are a highly preferred practice in psychiatric wards. The main reason to use physical restraints in psychiatric wards is to prevent injury to patient and others and reduce violent behavior among mentally ill patients. Purposes: The purpose of the study is to determine the use of physical restraints and ongoing practices among nurses working at psychiatric wards. Methods: This was a descriptive, cross-sectional study done involving fifty psychiatric nurses. Nurses who agreed to participate in the study filled out structured self-report questionnaire prepared by the investigators. Results: The mean number of patients cared by each nurse per month was 52.88 and mean number of patients restrained by nurse per month was 7.74. Twenty percent of nurses reported that they use alternatives before employing restraint practices. Ninety percent of nurses reported using roll of gauze as a restraint material. A good number of nurses (68%) reported that the restraint procedure is limited to <2 h. Only 4% nurses reported receipt of written orders for use of restraints. There was a significant association between age of the nurses with number of patients cared. Conclusion: For a better nursing care, it is very important to develop a restraint practice protocol.
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Effects of group psychoeducation on knowledge of caregivers of people with schizophrenia p. 105
Raviteja Innamuri, Karunakaran Palani, Margaret Silas, Reema Samuel, Donae Elizabeth George, Visalakshi Peravali, Deepa Ramaswamy
DOI:10.4103/IOPN.IOPN_2_19  
Background: Several studies have documented poor knowledge of schizophrenia among caregivers and its negative influence on clinical outcomes such as treatment response and prognosis. The benefits of group psychoeducation of caregivers of patients suffering from schizophrenia have been well established. However, very few studies have explored the effectiveness of the group psychoeducation program in the Indian setting. Aims: This study aims to evaluate the effects of a group psychoeducation program on the knowledge of schizophrenia among caregivers. Settings and Design: The study was conducted at the department of psychiatry at a tertiary care hospital. The study design is a quasi-experimental, two-group pretest posttest design. Methods: Sixty-eight caregivers fulfilling the inclusion criteria were recruited consecutively from the inpatient wards. Their knowledge was assessed with a Knowledge About Schizophrenia Interview (KASI) questionnaire, within 1 week of admission and again during the week of discharge. Controls were caregivers who received psychoeducation through “standard care” alone. Cases were caregivers who received the “group psychoeducation program” in addition to the “standard care” during the course of their stay at the hospital. Their pretest and posttest scores were compared. Results: Fifty caregivers successfully completed the study. There was statistical difference between cases and controls in education (P = 0.007) and duration of stay (P ≤ 0.001). Comparing pretest and posttest scores of all the participants showed that psychoeducation received through various sources (standard care or standard care with group psychoeducation) from admission until discharge produced a significant change in knowledge (P = 0.001). On controlling for education and duration of inpatient stay using multivariate analysis, group psychoeducation further produced a significant improvement in KASI scores in subsections of management (B = 0.839, confidence interval [CI] = 0.301–1.377, P = 0.002) and course and prognosis (B = 1.366, CI = 0.095–2.637, P = 0.035). Conclusions: Group psychoeducation in the Indian setting is an effective and feasible option to improve the knowledge of schizophrenia among caregivers, especially with regard to management, course, and prognosis.
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REVIEW ARTICLES Top

Mental Healthcare Act 2017 – Role of nurse in enabling person with mental illness p. 114
James Paul, Radhakrishnan Govindan, Narayana Manjunatha, C Naveen Kumar, Suresh Bada Math
DOI:10.4103/IOPN.IOPN_29_19  
The Mental Healthcare Act (MHCA) 2017 has come up with some major changes in the mental healthcare by introducing the concept of advance directives and nominated representatives and aims at strengthening the human rights of person with mental illness (PMI) and clearly emphasized the responsibility of the government. The objective of this article is to give a brief overview of the MHCA-2017 and specify the role of mental health nurses in enabling PMI and protects their rights, as they are also included in the mental health professionals.
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Prevalence of attention-deficit hyperactivity disorder in India: A systematic review and meta-analysis p. 118
Johny Kutty Joseph, Babitha K Devu
DOI:10.4103/IOPN.IOPN_31_19  
Attention-deficit hyperactivity disorder (ADHD) is one of the popular neurological developmental disorders among children, adolescents, and even in adults. It is manifested by difficulty in attention, hyperactivity, and impulsiveness. ADHD and impulsivity can hinder in the school life, attaining goals, different abilities, and competitions of the student. There is ample literature reporting the prevalence of ADHD in the most part of the world. However, the prevalence of ADHD is not clearly understood in India. Many studies have been conducted in India to estimate the prevalence of ADHD in different parts of the country, but no attempt has yet been done to draw a conclusion on the pooled prevalence of ADHD in India. The goal of this study is to review all the available observational studies on the estimation of prevalence of ADHD among children and adolescents from different parts of the country to calculate the pooled prevalence of ADHD in India (among children and adolescents). The search also was limited to studies conducted from 2009 to 2019. All the epidemiological survey related to ADHD prevalence was included in the study after considering the inclusion criteria. Articles were reviewed using Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Each individual study was assessed for risk bias using the “Quality assessment checklist for prevalence studies” extracted from Hoy et al. Pooled Prevalence estimates was calculated with random effect model. The point prevalence of ADHD among children and adolescents in the included studies ranges from 1.30% to 28.9%. The pooled prevalence of ADHD among children and adolescents is 7.1% (95% confidence interval [CI]: 5.1%–9.8%). The summarized prevalence of ADHD is 9.40% (95% CI 6.50%–13.30%; I2 = 96.07% P < 0.001) among male children and 5.20% (95% CI 3.40%–7.70%; I2 = 94.17% P < 0.001) among female children with a range of 7.6%–15% in 8–15 years of children. The prevalence of ADHD among children in India is consistent with the worldwide prevalence. According to the ADHD Institute, Japan the world prevalence of ADHD ranges from 0.1% to 8.1%. This explains that ADHD affects quite a large number of children in India. As India is known for stigma related to mental disorders understanding the prevalence of ADHD in Indian Population helps to gain an insight into morbidity burden of the country and helps the parents and teachers to take care of the persons suffering from ADHD.
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CONCEPT ARTICLE Top

Chatbot in mental health care p. 126
M Vijayarani, G Balamurugan
DOI:10.4103/IOPN.IOPN_34_19  
In India, the prevalence of mental disorders is in increasing over the year, at the same time the mental healthcare professionals shortage also in the rising trend. Smart technologies such as Artificial Intelligence (AI) play an important role in filling this Mental Health delivery gap. In this paper let us know about how the chatbot is one such technology used in mental healthcare delivery. Interestingly, chatbots are initially used mainly to deliver the mental health services such as psychotherapy, later is used in other industries also. The reviews show that Chatbots are widely used to manage anxiety, depression, stress and also to provide psychoeducation. However, it has its own limitation such as, it cannot think like a human with wisdom and empathy; and also the confidentiality of the data is very much serious concern. At the same time, these Chatbots will become an integral part of our lives in the coming years. And we need Chatbots that match our culture. In order, to benefit from this technological advancement, we should have a regulatory and assessment process in place.
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LETTER TO EDITOR Top

Online learning – Are Indian nurses ready? p. 129
G Balamurugan
DOI:10.4103/IOPN.IOPN_36_19  
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