RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA,

PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

JIMCY.N.M

1ST YEAR M.SC NURSING

MENTAL HEALTH NURSING

YEAR 2010-2012

CAUVERY COLLEGE OF NURSING

TERISIAN COLLEGE CIRCLE

SIDHARTHANAGAR

MYSORE

1

RAJIV GANDI UNIVERSITY OF HEALTH SCIENCESBANGLORE, KARNATAKA

1. NAME OF THE CANDIDATE JIMCY.N.M

CAUVERY COLLEGE OF NURSING

TERISIAN COLLEGE CIRCLE

SIDHARTHANAGAR

MYSORE

2. NAME OF THE INSTITUTION CAUVERY COLLEGE OF NURSING,

MYSORE

3. SUBJECT AND COURSE OF STUDY MASTER OF SCIENCE INNURSING – MENTAL HEALTH NURSING

4. DATE OF ADMISSION TO THE COURSE

01-06-2010

5. TITLE OF THE TOPIC EFFECTIVENESSS OF SELF

INSTRUCTIONAL MODULE ON ELDERLY

AGITATED BEHAVIORS AND ITS

MANAGEMENT AMONG CARETAKERS

IN SELECTED OLD AGE HOME AT

MYSORE DISTRICT KARNATAKA

5.1. STATEMENT OF THE PROBLEM A STUDY TO EVALUVATE THE

EFFECTIVENESSS OF SELF

INSTRUCTIONAL MODULE ON ELDERLY

AGITATED BEHAVIORS AND ITS

MANAGEMENT AMONG CARETAKERS

IN SELECTED OLD AGE HOME AT

MYSORE DISTRICT KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

2

6. BRIEF RESUME OF THE INTENTED STUDY6.1 INTRODUCTION

“Ageing is a development issue. Healthy older persons are a resource for their,

family, their communities and the economy” - WHO

During these recent 11 years the world has changed, there has been significant demographical

change’s in India’s population due globalization and improved medical facility and lifestyle. The fall of

joint family system and rise in nuclear family system has brought new dimension to the care and

welfare of elderly. Population of people above 60yrs. India has today second largest population of

senior citizens1.

WHO defines “Mental health is a state of well-being in which the individual realizes his or her own

abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to

make a contribution to his or her community2”

So, mental wellness is generally viewed as a positive attribute such that a person can reach enhanced

level of mental health even if they do not have diagnosable mental health condition. This definition of

mental health highlights emotional wellbeing, the capacity to live a full and creative life and the

flexibility to deal with life’s inevitable challenges.3,

Mental illness can affect person’s of any age, race,religion or income. It is not the result of personal

weakness, lack of character or poor upbringing. Mental illness occurs when a state of physical, mental,

social and spiritual well-being is disturbed4.

Aging is the normal process of a time related change, begins with birth and continuous

through life. According to Erick Erickson, this stage is a culmination of many previous intrapsychic and

IPR changes. Continued intellectual, social, and physical activities throughout the life cycle are

important for the maintenance of mental health in late life5.

3

The process of aging also tends to create psychological and social problems for the individual

and the society. The degree of adaptation to fact of aging is crucial to one’s happiness. Failure to adapt

can result in depression, anxiety and agitate behavior and other related psychological problems 6.

Agitation has been defined “inappropriate verbal, vocal, or motor activity that is not explained by

needs”. Nurses should be vigilant in how older adults respond to life events, transitions, and challenges

to their physical and mental well-being in order to initiate appropriate intervention in a timely manner 2.

Hence a Nurse should have a behavioral approach to agitated elderly. The behavioral

treatment of agitation centers on identifying and modifying the physiologic, psychosocial, and

environmental factors that are antecedents of the agitated behaviors8.

Psychiatric Nursing has emerged as a specialized branch of Nursing in the recent past in India.

Psychiatric training for Nurses is essential not only to manage the severely mentally ill or psychotic

patients but also to so many other psychological problems which include elderly anxiety and other

neurotic disorder9,10.

6.2 NEED FOR THE STUDY

“Aging gracefully is a widespread self-esteem challenge”

David Leonhard

People aged 60 and over: about 600 million in 2000,1.2 billion in 5052,and 2 billion in 2050.Currently

about two-third of all older persons are living in the developing world; by 2052 that will rise to 75%.In

the developed world, the very old(age80+)is the fastest growing population group. Women outlive men in

virtually all socities; consequently in very old age the ratio of women and men is 2:12.

Aging scenario of India repots that in the beginning of the last century 12 millions Indian where age

60 years or more. The number of the aged is doubled in the next 60 years to 24 millions. Since then

there has been a large increase in the number of the elderly, to about 56 millions in 1991. The projected

figures for the years 2001 and 2025 are 70 millions and 177 millions respectively 11, 12.

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An epidemiological studies and community surveys on the elderly in India indicate a varied

prevalence rate of mental illness or psychiatric morbidity ranging from 2.2 percent to 3.7 percent. Most

of these surveys were conducted in Gero-psychiatric clinics; mental health centre located in South India

Towers, Calcutta and Agra and also covered the older people from villages and slum areas 13.

It has, however, been observed that there is a general tendency of psychiatric morbidity to

rise with advancing years. Moreover, for most of the elderly population, these problems can be

subsumed within a general problem of poverty. Although less in number and restricted in scope, such

surveys of the mental health problems of the elderly, nevertheless, brought into focus the need for

conducting interdisciplinary studies14.

Many studies conducted in India and other developing countries reveal that a majority of elderly

people are socially and economically dependent on their family members. They cannot afford to seek

health care themselves. In India although physical, social and psychological health are separated out for

convenience, each impinges can affect psychological health, especially the environment in which they

live13,14.

The Indian subcontinent boasts of our ‘Great Joint Family’ ‘The Traditional family’ system where

we used to respect, care and love our elders, our parents. Due to Globalization and New lifestyle there

is increasing number of abuse. Neglect and abandon case with regards to senior citizens. The gradual

urbanization of rural India is also a new trend to worry. Therefore psycho and social problems of the

elderly needs to be attended urgently1.

The nonspecific neuropsychiatry symptoms of agitation can generate felling of frustration, fear and

helplessness in both the patients and their caregivers. Coping mechanisms may fail and give way to

intolerance as family member try to deal with these problems day after day,. Therefore elderly people

are forced out of their homes and they are made to depend on federally funded services like old age

homes. In old age homes Caring and concern can quickly turn to annoyance, outright anger and even

elder abuse. Caregiver’s lack of understanding and unrealistic expectations compound the problem

some caregivers may see the affected elderly people as manipulative rather than as victims of

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unavoidable central nerves system changes. Professionals working with the elderly are also not immune

to these feeling 14.

Thus it was evidently felt by the researcher the need to identify 5 the agitation in elderly and select

caretaker of old age homes to educate regarding elderly agitated behaviors and its management.

Growing older cannot be prevented. We begin aging at the time of conception and continue aging

one day at a time12. However, some of the effects of aging can be slowed and even prevented 13.

Prevention in later years requires participating in health education and health promotion activities

designed to reduce the risk of disease

Taking into consideration all the above facts, the researcher felt to develop a self-instructional module

on elderly agitated behaviors and its management among caretakers of old age homes, to suggest the steps

to be taken in order to prevent and minimize some of the adverse behavioral feature of agitation, may be

avoided or diminished.

Hence the following section discusses issues to be considered, the need to develop a research study on

elderly agitated behaviors and its management among caretaker in a selected old age homes at Mysore

district Karnataka.

6.3 STATEMENT OF THE PROBLEM

A Study to Evaluate The Effectiveness Of Self Instructional Module On Elderly Agitated Behaviors

And Its Management Among Caretakers In Selected Old Age Home At Mysore District Karnataka.

6.4 OBJECTIVES

To assess and identify agitation in elderly people.

To assess the knowledge level of caretakers regarding elderly agitated behaviors and its

management.

To develop a self instructional module on elderly agitated behaviors and its management for

caretakers in old age home.

To evaluate the effectiveness of self instructional module on agitated behaviors and its

management among caretakers in old age home.

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To determine the association between the knowledge regarding elderly agitated behaviors and its

management among caretakers in old age home with selected demographical variables such as

age, sex,locality,education status, qualification etc

6.5. HYPOTHESIS

H0: There is no association between the knowledge level of caretakers in old age home and selected

variables such as age, sex, education status and qualification

H1: The mean post-test knowledge of caretakers in old age home will be higher than the pre-test

knowledge score after administrating the Self instruction module.

6.6. OPERATIONAL DEFENITIONS

Effectiveness

Effectiveness is a measure of the match between stated goals and their achievement15.

In this study ‘effectiveness’ refers to the extent to which self-instructional module has achieved

the effect in the management of elderly agitated behavior as measured by gain in knowledge score.

Self-instructional module

A self contained instructional unit that includes one more learning objectives, appropriate

learning materials and methods necessary learning of specific unit or topic16.

In this study ‘self-instructional module’ refers to the educational material (booklet) prepared for

caretaker of old age homes regarding management of elderly agitated behaviors. This includes the

following aspects: concept of agitated behaviors, identification and management of behaviors

during the initial stage, management of the patient during and after agitated behaviors.

Elderly

The 65 years and older population who is often viewed as an important long term care target

group6.

Agitated behavior

Inappropriate verbal, vocal, or motor activity that is not explained by needs2.

Old Age Home

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Old age home are meant for senior citizens who are unable to stay with their families or

destitute.2.

In this study old age home is a setting where elderly people are forced by their family member.

Elderly will be taken care only by the caretaker employed in the old age homes.

Care Taker

One who is employed to look after or take charge of goods, property, or a person, a custodian2.

In this study caretaker is meant for those who trained to take care (giving bath, dressing- up, feeding

and severing food etc.) of elderly in old age homes who can’t perform their basic needs.

6.8. CONCEPTUAL FRAME WORK

Theory of Ida Jean Orlando.

Orlando describes her theory as revolving around five major interrelated concepts.

1. Patient behavior

Professional nursing function-organizing principle.

The patient’s presenting behavior- problematic situation.

2. Nurse reaction

The immediate reaction or internal response of the nurse.

3. Nursing action

Nursing process discipline (Deliberative nursing process).

4. Improvement

This theory will be modified and used as conceptual frame work for this study.

6.9. DELIMINATIONS

The study is delimited to elderly people aged above 65yrs who are living in old age home.

The data collection period is limited to 6 weeks only.

6.10. REVIEW OF LITRATURE

Review of literature is an important step in the development of any research project. It helps the

investigators to analyze what is known about the topic and describe methods of inquiry used in earlier

world including their success and shortcomings.

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Literature refers to the activities involved in searching for information on a

topic as well as the actual written report that summarizes the state of the existing

knowledge on research problems It gives a broad understanding of the problems, keeping those aspects

in mind the investigators probed into the available resource of document,informations and studies on

agitation in elderly and its management.

Review of literature helps in selecting appropriate methodology, developing

tool, analyzing data and relating the findings from one study to another so as to

establish knowledge in a professional discipline from which valid and pertinent

theories may be developed.

Review of literature has been grouped into the following categories based on Agitation and use of

therapy as managements

Prevalence of Agitation in elderly.

Agitation and use of music therapy.

Agitation and use of family presences stimulated therapy.

Agitation and use of bright light therapy.

Agitation and use of Activity therapy.

Prevalence of agitation in elderly.

D Saldanha conducted the study and its aim is to determine the prevalence of dementia and

agitation in elderly of an urban center of Pune and to evaluate the corresponding socio-demographic

correlates along with psychiatric morbidity in the study sample. The number of people over 65 years

numbered 6721 and 2145 of them were randomly selected for a door-to-door survey. They were

initially administered household questionnaire and then subjected to a screening tool . the result findings

revealed that prevalence of dementia and agitation in the sample population of elderly aged above 65

years was 4.1%. Burden of care was associated with caring for elderly with dementia with increasing

severity of agitation behaviours.Aging in Indian culture though a disability is much stressful today in

Indian culture as in others17.

Agitation and use music therapy

9

Gerdner L.A conducted a study to asses the effect of individualized versus classical relaxation music

on the frequency of agitation in elderly persons. The sample for this study consisted of 30 women and 9

men with sever cognitive impairment .Baseline data were collected for 3 weeks. Music intervention were

presented for 30 minutes, two time per week. the modified Cohen Mansfield Agitation Inventory

measured the dependent variables. A repeated measures analysis of variance with Bonferroni post hoc test

showed a significant reduction during and following individual music compared to classical music18.

Jan Goddaer conducted a Study on effects of relaxing music on agitation among nursing home

residents with sever cognitive impairment. 29 nursing home residents with sever cognitive deficits

participated in a 4- week protocol in which, following baseline observations (week1), relaxing music

was introduced (week2), removed (week3), and reintroduced (week4). Subjects were observed in terms

of total number of behaviors of the cohen-Mansfield Agitation Inventory present during a given week,

and the number of behaviors present on the subscales of aggressive, physically nonaggressive, verbally

agitated and significant reduction were observed on the cumulative incidence of agitation 19.

Agitation and use of family presence stimulated therapy.

Clive Ballard conducted a study to assess the effectiveness of brief psychosocial therapy on agitated

elderly with Alzheimer disease. 318 patients with Alzheimer disease (AD) with clinically significant

agitated behavior were taken as samples and treated in an open design with a psychological intervention

(brief psychosocial therapy [BPST]) for 4 weeks. The therapy involved social interaction, family

presences stimulated therapy, or removal of environmental triggers. The study resulted with an

improvement of 5.6 points on total Cohen-Mansfield Agitation Inventory (CMAI; mean [SD], 63.3 [16.0]

to 57.7 [18.4], t = 4.8, df = 317, p < 0.0001). Overall, 43% of participants achieved a 30% improvement

in their level of agitation20.

Garland conducted a study the effectiveness of individualized psychosocial treatment in reducing the

frequency of physically and verbally agitated behaviors in nursing home elderly. 30 nursing home

residents with frequent, severe behavioral disturbances were observed by research staff before, during,

and after multiple, randomized, single-blind exposures to 15-minute audiotapes of simulated family

presence (a conversation prepared by a family member about positive experiences from the past). The

study result was that Simulated presence proved effective in reducing counts of physically agitated

behaviors. And also showed significantly reduced counts of verbally agitated behaviors21.

10

Agitation and use of bright light therapy

A Saltlin conducted a study to test that evening bright light pulses would improve sleep-wake

patterns and reduce agitation in elderly and sleep disorders. 10 inpatients on a research ward of a veterans'

hospital were studied in an open clinical trial. All patients had agitated behavior and sleep disturbances.

After a week of baseline measurements, patients received 2 hours/day of exposure to bright light between

7:00 p.m. and 9:00 p.m. for 1 week. During the baseline week, the treatment week, and a post treatment

week, patients were rated by nurses for agitation sleep-wake patterns, use of restraints, and use of

prescribed-as-needed medication monitors. The study result showed Clinical ratings of sleep-wakefulness

on the evening nursing shift improved with light treatment in eight of the 10 patients. The proportion of

total agitated behavior occurring during the nighttime decreased during the light -treatment week. The

relative amplitude of the circadian locomotor activity rhythm, a measure of its stability, increased during

the light-treatment week22,23.

C.G. Lyketos conducted a study to test the efficacy of bright light therapy in a randomized,

controlled, crossover clinical trial. 15 patients with dementia and agitated behaviors residing in a

chronic care facility were randomized in a crossover design to morning bright light therapy for 1 hour

per day or to a control condition with dim light exposure. Patients were treated in either condition for 4

weeks, followed by 1 week on no treatment, prior to being crossed over to the other condition. The

study result showed that, Patients with dementia in chronic care who exhibit agitated behaviors sleep

more hours at night when administered morning bright light therapy24.

Agitation and use of Activity therapy

Buettner conducted a research to evaluate the responses to 30 handmade recreational tools and

assessed their effect on the conduct of nursing home residents with agitated behaviors. The objects used

were stuffed butterfly, cart for wandering, fishing box, flowers for arranging, laundry for hanging, home

decorator books, muffs, picture dominoes squeezies and tetherball game. These objects were placed on an

open cart. Residents could freely choose from the selection of items on the cart. The preferred objects for

all residents in this study was a tetherball game, which held residents attention for as for long as 20

minutes. The result showed that the warmth of these objects may serve to provide both pleasure and

decreased chilling, with a resulting decrease in agitation25.

11

Mary Lucero, Kijek, Malone, Santos, Hendrix. Developed specific play products as a means of

enhancing the quality of life of individuals with disturbed behaviors. Her products and potential

interactions included a busy box, abacus, stacking cups, Reader’s Digests.spinng board, pat mat, and

curves and waves. The interaction with these objects were varied; The residents could thumb, page, fold,

hold, read. Look, and touch a Reader’sDigest;This approach to play therapy included providing the object

to the resident, demonstrating its use, and guiding the play activity by moving the resident’s hands. Result

of this study indicated that using an effective method of product introducing significantly improved the

resident’s ability to engage in activities with the stimulus object with reduction in disturbed behaviors like

agitation26.

7. MATERIALS AND METHODS OF STUDY7.1 SIGNIFICANCE OF THE STUDY

The study implies to find the level of knowledge regarding elderly agitated behaviors and its

management and to evaluating the effectiveness of self instruction module on elderly agitated behaviors

and its management among caretakers in old age home.

7.2. SOURCE OF DATA

The data will be collected from the caretakers in selected old age home at Mysore district.

7.3. RESEARCH DESIGN

Quasi experimental one group pretest –post test design.

KEYS

01– Pre-test regarding elderly agitated behaviors and its management.

X – Application of Self Instructional Module on elderly agitated behaviors and its management.

02 –Post test knowledge regarding elderly agitated behaviors and its management.

7.4. METHOD OF DATA COLLECTION

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Pre-test 01 Post-test 02X

Modified Cohen-Mansfield Agitation Inventory scale is used to screen elderly agitated behaviors those

who are living in selected old age home of Mysore districts. And data collection is planned through using

a self developed structured questionnaires to identify pre-test knowledge level among caretakers

regarding elderly agitated behaviors and its management. Self instructional module will be administered

and afer week post test knowledge will be assessed.

Part A : Demographical variables include age, sex, locality, education status, qualification, etc.

Part B : Modified Cohen-Mansfield Agitated Inventory scale to assess and identify elderly

agitated behaviors.

Part C : Self developed structured questionnaire on knowledge regarding elderly agitated

behaviors and its management.

Part D : Self Instruction Module on elderly agitated behaviors and its management.

7.5. SAMPLING PROCEDURE

7.5.1. Criteria for Sampling Selection

Inclusive criteria

Caretakers of elderly agitated people in old age home.

Elderly people above 65years of age.

Exclusive criteria

Caretakers of elders in old age home who are not willing to participate.

7.5.2 Population

The target population selected for this study is caretakers of elders in old age home.

7.5.3 Samples

Caretakers of elderly in selected old age home at Mysore.

7.5.4 Sample size

Sample size consists of 60 samples of caretakers in selected old age home at Mysore.

7.5.5 Sampling technique

Convenient Sampling technique which is a type of non probability sampling.

7.5.6 Setting

The setting for the study is selected old age home at Mysore.

7.5.7 Pilot study

10% of the population size is planned for the pilot study.

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7.6 VARIABLES

Independent Variables

Self Instructional Module on elderly agitated behaviors and its management.

Dependent Variables

Knowledge on elderly agitated behaviors and its management among caretakers in old age

homes.

7.7 PLAN FOR DATA ANALYSIS

Descriptive statistics

Demographical variables and knowledge of caretakers of old age home will be analyzed using

frequency, percentage, mean and standard deviation.

INFERENTIAL STATISTICS

o The pre-test and post test scores would be analyzed by paired t-test.

o Chi-square test will be used to find out the association between the knowledge on elderly

agitated behaviors and its management among caretakers in selected old age home with

selected demographical variables such as age, sex, educational status, qualification etc.

7.8 PROJECTED OUTCOME

The study will enable to identify the knowledge on elderly agitated behaviors and its

management among caretakers of old age home.

The study will help the caretakers of old age home to gain knowledge about elderly agitated

behaviors and its management.

7.9 ETHICAL CONSIDERATION

Yes, Ethical clearance is obtained from the institutions and authorities concerned to the particular

setting and also from ethical committee.

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8.1 LIST OF REFERANCE

1. Chalo (March to) azad maidan Mumbai on 16h august 2010. [online]. 2010 aug 4 [cited 2010,aug3];

An article available from: URL:http://www.silverinning.com.

2. Karen Devereaux Melilio, Susan Crocker Houd. Geropsychiatric and mental health nursing. 1st

edition . Canada : Jones and Barlett publishers; 2005.

3. Mental Health. [online] 2010 June 4 [cited 2010 14]; An article available from: URL:

http://www.wikipedia.org/

4. Mental Health. and illness. [online] 2010 July 1[cited 2010,10]; An article available from: URL:

hhtp://www.mental health about.com.

5. Sankar N, Sathiyavathy N, Sandanlakshmy N. Study on anxiety in the elderly. Nightingale nursing

times. 2009; P. 24-5

6. Elsa Sanatombi Devi,Neenu A, Anu P, Rosemary J. Elderly and depression. The nursing journal of

India. 2007; P. 222-23

7. Cohen-Mansfield J & Billing N. Agitated behaviors in the elderly.A conceptual review. Journal of

the American geriatric society.1986; P. 711-21

8. Lindenmayer J. The pathophysiology of agitation. Journal of clinical psychiatry.2000; P. 5-10

9. Niraj Ahuja. A short textbook of psychiatry. 6th ed . New Delhi: Jaypee publishers; 2006.

10. Nambi. Psychiatry for nurse. 1st edition. New Delhi: Jaypee publishers; 2008.

11. Ageing scenario of India. [online] 1999 Aug 2 [cited 2010]. An article available from: URL:

http://www.slideshare.com

12. Prakash IJ. Ageing. An Indian perspective. Bangalore University ; 2001.

15

13. Michael Zal H. Agitation in the elderly. Psychiatric times. 2006 aug. 16:1.

14. Edwards H. Chapman. Contemplating,caring,coping,conversing.A model for promoting mental

wellness in later life. Journal of gerentological nursing.2004 .P.16-21.

15. Fraser. Effectiveness. [Online]. 1994 [Online] available from: URL:

http://www.qualityresearchinternational.com/glossary/effectiveness.htm

16. Elsa Sanatombi Devi. Manipal manual of nursing education.1st edition.CBS publishers. New

Delhi:2006.P.131

17. Saldanha D, Mani MR, Srivasstav k, Goyal S, Bhattacharya D. An epidemiological study of

dememtia under the age of mental health program. Maharashtra. Pune. Indian J psychiatry[serial

online] 2010[cited 2010 Nov 8);52:131-9. Available from: URL:

http://www.indianjpsychiatry.org/text.asp?

18. Gerdner LA. Effects of individual versus classical relaxation music on the frequency of agitation

in elderly person. International psychogeriatric. 2000 ; P. 49-62

19. Goddaer J. Effect of relaxing music on agitation among nursing home elderly with severe cognitive

impairment. Archives of psychiatric nursing. 1994 ; P.150-58

20. Clive Ballard, Richard Brown, Jane Fossey, Simon Douglas, Paul Bradley, Judith Harcork. et.al.

Brief psycholosial therapy for the treatment of agitation in Alzheimer disease.

American.J.Geriatropsychiatry [serial online] 2009 [cited 2010 Sep17] ; 9:726-33.Available from:

URL:http://lib.bioinfo.pl/Journal.

21. Garland. A study to compare the effectiveness of two individual psychological treatment in

reducing the frequency of physically& verbally agitated behaviors in nursing home elderly.

American Journal of geriatric psychiatry. 2007; P.514-21

22. Evan LK. Sundown syndrome in institutionalized elderly. Journal of the American geriatric society.

1987; P.101-8

23. Satlin A,Volicer L, Ross V, Camphell S. Bright light treatment of behavioral and sleep disturbance

in patients with Azhemer’s diseases. American J. psychiatry [serial online] 1992 [cited 2010 Aug

14].P.1028-33.Avialable from: URL: http://www.ncbi.nlm.nih.gov/pubmed/1353313.

24. Lytesos CG, Lindell Veiel L, Baker A, Steele. A study to test the efficiency of bright light therapy

in a randomnized,cotrolled,crossover clinical trial. Int.J.geriatropsychiatry [serial online] 1999

[cited 2010 Jul].7: P.520-25. Avialable from: URL: http://www.ncbi.nlm.nih.gov/pubmed/1353315.

25. Buettner. A study to evaluate the responses to 30 handmade recreational tools and assessed their

effect on the conduct of nursing home elderly with agitated behaviors. Play therapy with adults. 1st

edition [online] 1999. Philadelphia: British catalog publishers; 2003 [cited 2010].Available from:

URL: http://www.google.co.in/plttf

16

26. Mary Lucero, Kijek, Malone, Santos, Hendix. A study to develop specific play products as a means

of enhancing the quality of life of individuals with agitation.Play therapy with adults.1st

edition[online] 1999.Available from: Philadelphia:British catalog publishers; 2003 [cited 2010].

Available from. URL: http://www.google.co.in/playspecified/ppr

8.2. BIBLIOGRAGHY

1. Denise F, Polit, Cherly Tatano Beck. Nursing research.7th ed. New Delhi :Jaypee

publishers(p)Ltd;2003.

2. Basavanthappa BT. Nursing research.1st ed. New Delhi :Jaypee publishers(p)LTD;2003.

3. Carol L, Macnee . Understanding nursing research, reading and using research in practice.1st edition

.Philadelphia: Lippincott company;2004.

4. Basavanthappa BT. Nursing theories.1st edition. New Delhi: Jaypee brothers medical

publishers;2007.

5. Mary C Townsend. Essentials of Psychiatric/Mental health nursing. 1st edition. Canada: F.A. Davis

Company publishers;1999.

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9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF THE GUIDE (IN BLOCK LETTERS)

11.1. SIGNATURE

11.2. CO-GUIDE (IF ANY)

11.3. SIGNATURE

11.4. HEAD OF THE DEPARTMENT

11.5. SIGNATURE

12. REMARKS OF THE CHAIRMAN AND PRINCIPAL

12.1. SIGNATURE

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