Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore

ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. Name of the candidate and address

(in block letters)

DARLY JOHN

I YEAR M. Sc. NURSING

ATHENA COLLEGE OF NURSING

FALNIR ROAD

MANGALORE – 575 001.

2. Name of the Institution ATHENA COLLEGE OF NURSING

FALNIR ROAD

MANGALORE – 575 001.

3. Course of Study,

Subject

M. Sc. NURSING

PAEDIATRIC NURSING

4. Date of Admission to the course 20-05-2011

5. Title of the Topic

EFFECTIVENESS OF PLANNED TEACHING PROGRAMME (PTP)

ON KNOWLEDGE REGARDING TEMPER TANTRUM IN

CHILDREN AMONG MOTHERS IN A SELECTED RURAL

COMMUNITY AT MANGALORE

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6. Brief Resume of the Intended Work

Introduction

“Children are the wealth of tomorrow; take care of them if you wish to have a strong India, ever ready to meet various challenges.”

(Jawaharlal Nehru)

Temper tantrums are the common behaviour problem in pre-school children who

may express their anger by lying on the floor, kicking, screaming and occasionally holding

their breath. Tantrum is natural, especially in children who are not yet able to use words to

express feelings through words. Tantrums typically peak between ages 2 to 3 and start to

decline by 4. Twenty three to 83 percent of all 2-4 year olds have temper tantrums at least

occasionally (2,3,7,8,15 times), last 30 seconds to 2 minutes, most intense at the start.1

Family is the most prominent social group; it prepares its members for the various

roles they have to perform in society. When a child is born in a family the parents are

concerned about many things. One of the main concerns is the socialization of child. It is

the process, of learning the rules and expected behaviours of a society. It includes teaching

behaviour that are expected and appropriate to foster the development of self control.2

The children need assistance from parents and care provides to control impulses

and learn socially acceptable behaviours. Through the daily changes in behaviour of the

toddler the parents will gain knowledge to control them and accept them and to build a

positive attitude towards the toddlers. Parents are responsible for promoting the

development of self control in the child through the appropriate use of discipline and limit

setting. Harsh and rude training develops an aggressive mental makeup and vice versa with

more mild and understanding discipline.3

Parents play an important role in controlling the temper tantrum in children. They

need to have lots of patience with their toddlers. The parents who provide clear concise,

limits, facilitates autonomy development and help the child to gain a sense of order control

and security.4

From the age of 18 months to 3 years, children begin to develop autonomy and

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starts separating from primary caregivers. At this age, they also develop negativism i.e.,

they do things just the opposite of what has been requested or their own desire known as

oppositionalism. When they can’t express their autonomy, they become frustrated and

angry. Some of them show their frustration and defiance with physical aggression such as

biting crying kicking etc., known as temper tantrums. This behaviour reaches its peak point

during the 2nd and 3rd year of life. There are a number of ways to handle the temper

tantrums. Before we manage the child, we must manage our own behaviour. Remain calm,

cool headed, do not argue and reward the child.5

6.1 Need for Study

Temper tantrums are the normal part of child development. However, when

children express anger in out bursts of range: it is a significant challenge for the parents.

Parents may blame their ineffective parenting skills, when the problem may relate to

personality style of children. More than half of young children will have temper tantrums

one or more times per week. At home, there are predictable stimulations that can be

expected to trigger temper tantrums such as bedtime, suppertime, walking, getting dressed,

bathing time, watching T.V etc.6

Temper tantrums typically begin between the ages 18 to 36 months as the child

continues to develop and gain independence from his or her care takers. For example they

won’t be able to decide what to pickup, what to eat, etc. As the child attempts to master

more complex tasks, he or she will become more frustrated. However because of limited

verbal skills they are not able to effectively communicate their frustration. Which leads to

the acting out of undesired behaviours It is estimated that 50-80% of toddlers (2-3 years of

age) experience a tantrum once a week and 20% of them have them daily.7

The common temper tantrums are kicking others, hitting others, throwing objects,

breaking objects, hitting self, head banging, breath holding, biting self, non directed

kicking, stamping feet, hitting the wall, spitting on others, lying on the floor, kicking on

their feet and screaming at the top of their voice.8

A pilot study was conducted on 2007 in Johnson state college southern Illinois

University. Questionnaire data were collected from parents of 33 children of 3 to 5 year

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olds. The small community sample was composed of 15 males and 18 females. Most

parents (n=26; 79%) reported the frequency of tantrums as occurring often, with roughly

half of those (n=12) reporting daily tantrums, and half (n=14) reporting weekly tantrums.

The remainder of the sample (n=7) reported tantrum frequency as less common, ranging

from monthly to less than monthly to never (n=1).Cumulative score for tantrum frequency

was calculated using two Likert items from the tantrum questionnaire. scores ranged from 2

to 15 (possible range =16), with an average score of 8.5 (SD=3.6), translating to “about

once every few days”.9

A pilot study was conducted on 2007 to find the prevalence and a aetiology of

temper tantrum in a non- referral outpatient setting of united kingdom among 800 children

(2-3 years) attending a paediatric outpatient department, 182(22.8%) were found to be

having temper tantrums. Temper tantrums found to be most common at 3-5 years (75.3%)

less common 6-8 years (20.8%) least common at 12 years (3.9%), children aged 2-3 years

were more likely to be a lower social class(p<0.01) where as in other groups 6-8 years and

9-12 years were upper social class. The ratio of boys to girls was 3.1:1 children showed

higher incidence of history of post natal trauma and seizure disorders compared with the

controlled group (p <0.05)10

The investigator has been many children in the neighbourhood with temper

tantrums and the parents were punishing the child by beating, scolding and thus there was

no reduction in the temper tantrums. So, the investigator thought to educate the care gives

on how to manage the temper tantrum of children.

6.2 Review of Literature

A study was conducted among 2000 mothers of 2 year old children living in New

Zealand 2007, to determine the prevalence of behavioural problems among them. In this

study interview method was used. Child behaviour checklist of 1028 obtained from the

mothers. 1028 questionnaire mostly completed by biological mother (96.9%, n=996), 3%

(n=30) by adoptive mothers and 2.8% (n=29) by other care givers of the 1028 samples. In

this study findings highlight the way in which preschool behavioural problem may vary

with in specific cultural settings maternal education and the years lived in New Zealand.11

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A study was conducted on 279 preschool children (3 to 6 years old) in Duke

University Medical Centre Washington 2003, regarding common tantrum behaviour

included behaviours such as crying and hitting and occurred once a day on average with

median duration of 3 minutes and with 75% of tantrums lasting between 1.5 and 5 minutes.

Researchers have also found that 70% of 18-24 months old children have tantrum, other

authors have noted that the highest incidence of tantrums occur in the 3 to 5 years of age

range (75.3% of children). A study of children exhibiting severs tantrums; found that 52%

of these children had other non-tantrum related behavioural emotional problems.12

A study was conducted on 2003 in University of Wisconsin Madison Health center,

regarding Temper Tantrums in Young Children; Behavioral composition among parents of

335 children aged 18 to 60 months. The interviewed parents of children reveals that

changes in tantrum characteristics with age. Tantrum prevalence was found to increase

from 87% at 18 to 24 months to 91% at 30 to 36 months and then decrease to 59% at 42 to

48 months, paralleling results from the longitudinal study of MacFarlane et al. of 991

packets mailed to parents. Of this, 335 narratives (178 boys and 157 girls) were usable.

The mother was the informant in 325 cases and the father in 10 cases. The median interval

between the telephone interview and writing of the narrative was 30 days. The correlation

between the frequency estimates was r(332=.61 and p<.001.The co relation between our

reconstruction of the duration of the tantrum in the narrative and the parents’ estimate of

mean tantrum duration in the preceding month was r(331)=.55 and P<.001.13

A study was conducted in University of Mohaghegh Ardebili, Iran, June 22, 2008.

The sample consisted of 600 preschoolers using the child behaviour checklist, among 288

girls and 312 boys aged 4 to 6 years attending day care centres affiliated with a Welfare

Organization in Tabriz, Iran. 66% children were aged 48 to 60 months and 24% 62 to 72

months. 56% children had working mothers while the remaining 44% had mothers who

were housewives. All subjects completed a general information questionnaire about the

child and the mother. Results showed that behaviour problems were seen in 12% of

preschoolers. Temper tantrums were reported in 72%, food fads in 58%, and conflicts with

siblings in 46 % of the children.14

An exploratory study was conducted in 2008 on the temperamental traits of breath

holding (BHS) among 114 children of age 1-4 years referred to child guidance clinic in

Chennai comparing with healthy children. 40% had onset of breath holding spells within

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first 6 months of life. 40% experienced spells weekly and 33.3% monthly. The breath

holders found to be angry, annoyed and irritable by scoring low in the variables mood than

the control group. The energy diversion score was high for the breath holders on the

activity level. High score in the energy dimension (2=5.255, P<0.001) and the intensity of

reaction (2=5.749, P<0.001) were highly significant.15

A study was conducted in United states on 2003 over 1200 parents about their

children’s tantrums .The result of the study found that the child aged 18 to 24 months 87%

of children who throw temper tantrums and tantrums lasted for 2 to 4 minutes and occurred

8 to 9 times a week. The child 30 to 36 months aged 91% of children who throw temper

tantrum, lasted for 2 to 3 minutes and occurred for 6 times a week. The child 42 to 48

months aged 59% of children who throw temper tantrum, lasted for 5 minutes and occurred

5 times a week.16

An experimental study was conducted to evaluate the effect of intervention on

temperament of rural infants. A sample size of 110 infants both male and female of age

birth to eighteen months at the time of pre-test were selected and grouped into

experimental and control groups with the interaction being given to the experimental group

for a period of one and a half years after which infants and children from both groups were

tested. The temperament of infants and children were tested consecutively at regular

intervals through a modified scale. Results were revealed that the mean scores of

temperament of infants and children from birth to 6 months were (83.7 %.), 6 to 12 months

were 985.3%), and 12 to 18 months were (80.4%).17

6.3 Problem Statement

Effectiveness of planned teaching programme (PTP) on knowledge regarding

temper tantrum in children among mothers in a selected rural community at Mangalore.

6.4 Objectives of the Study

1. To determine the knowledge level of mothers regarding temper tantrum in children

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as measured by structured interview schedule.

2. To evaluate the effectiveness of planned teaching programme on knowledge

regarding temper tantrum in children in terms of gain in the mean post test

knowledge score.

3. To find out the association between mean pre test knowledge score and selected

demographic variables ( age of the mother, education of mother, occupation of the

mother, number of children, type of family, income, previous knowledge regarding

temper tantrum.)

6.5 Operational Definitions

1. Knowledge: In this study, knowledge refers to the correct responses obtained from

mothers to the knowledge items on temper tantrum as measured by a structured

knowledge questionnaire.

2. Effectiveness: In this study, effectiveness refers to the extent to which the planned

teaching programme on temper tantrum in children have achieved the desired effect

in improving the knowledge of the mothers as evidenced by gain in mean post test

knowledge score.

3. Planned teaching programme: In this study, planned teaching programme refers

to a systematically developed instructional programme designed for mothers to

provide information regarding meaning types and management of temper tantrum.

4. Temper tantrum: In this study, temper tantrum refers to one of the behavioural

disorders which involve display of bad temper in which the child performs

uncontrolled action (such as rigid body, biting, kicking, throwing objects, hitting,

crying, rolling on floor, screaming loudly, banging limbs, stiffness, breath holding

spells) in a state of emotional stress.

5. Children: In this study, children refer to those belonging to the age group of 0-5

years in a selected rural community at Mangalore.

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6. Mothers: In this study, mothers refer to the women who have children between 0-5

years.

Variables under study

1. Dependent variable: knowledge of mother regarding temper tantrum.

2. Independent variable: Planned teaching programme on temper tantrum.

3. Extraneous variables: Education of mother, age of mother, occupation of mother,

numbers of children, type of family, previous knowledge on temper tantrum.

6.6 Assumptions

The study assumes that-

1. Mothers will have some knowledge about temper tantrum.

1. Mothers will be interested and willing to cooperate in the study.

2. Planned teaching programme is an accepted teaching strategy in improving the

knowledge.

6.7 Delimitations

The study will be delimited to the mothers:

whose children are between the age group 0-5 years.

who are willing to participate in the study.

who can understand English or Kannada.

who are available during the period of data collection.

6.8 Projected outcome (Hypothesis)

The hypotheses will be tested at 0.05 level of significance

H1: The mean post-test knowledge score of mother regarding Temper tantrum will be

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significantly higher than their mean pre test knowledge score.

H2: There will be significant association between mean pre-test knowledge score of

mothers, regarding temper tantrum and selected demographic variables.

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA

Data will be collected from mothers of 0-5 year’s children of a selected rural

community at Mangalore.

7.1.1 Research Design

Pre-experimental one group pre-test post-test design will be used for the study.

O1 X O2

O1 – Pre-test

X – planned teaching programme

O2 – Post-test

7.1.2 Setting

The study will be conducted in a selected rural community at Mangalore.

Vamanjoor is the selected rural area which comes under Kudupu PHC which is 12km.

away from the Mangalore City and under the governance of Mangalore City Corporation.

Kudupu PHC has 6 sub- centres and the population is around 26817.

7.1.3 Population

In this study population will consist of mothers of children residing in selected area.

Approximately 5000 people are residing in the area and around 100 mothers have under

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five children.

7.2 METHOD OF DATA COLLECTION

7.2.1 Sampling Procedure

Purposive sampling technique will be used to select the rural community and

simple random sampling will be used to select the sample size.

7.2.2 Sample Size

The sample for the present study will consist of 60 mothers of under five children

in a selected rural community at Mangalore.

7.2.3 Inclusion criteria for sampling

Mothers who are:

residing in rural community.

having children <5 years of age.

who can speak or understand Kannada or English

7.2.4 Exclusion Criteria for sampling

Mothers who are not:

willing to participate in the study.

in the house at the time of data collection.

able to speak or understand Kannada /English.

7.2.5 Instrument intended to be Used

The tool will consist of two sections:

Section I: Demographic Proforma

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Section II: Structured interview schedule to assess the knowledge of mothers of children

regarding temper tantrum.

7.2.6 Data collection method

Permission will be obtained from the concerned authority. The purpose of the study

will be explained to the subjects and informed consent will be taken. Pre-test will be

conducted with structured knowledge questionnaire using interview schedule; this will be

followed by administration of planned teaching programme on temper tantrum. The post-

test will be conducted with the same structured knowledge questionnaire using interview

schedule after seven days.

7.2.7 Data Analysis Plan

Based on the objectives, data analysis will be done using descriptive and inferential

statistics. Findings will be presented in the form of tables and figures.

1. Demographic data will be analysed using frequency, percentage, mean and standard

deviation.

2. Effectiveness of planned teaching programme will be analyzed by using paired ‘ t’

test.

3. Association between pre-test mean knowledge score and selected demographic

variables will be analyzed using chi-square test.

7.3 Does the study require any investigations or interventions to be conducted on

patients or other humans or animals? If so, please describe briefly.

No, investigation or intervention will be conducted on sample. However, the investigator will be

administering the structured knowledge questionnaire and a planned teaching programme on

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temper tantrum will be given to the mothers of under five children.

7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, ethical clearance will be obtained from the ethical committee of college of

nursing prior to the conduction of the study. Administrative permission will be obtained

from the concerned authorities. Written consent will be obtained from the study sample

and confidentiality will be maintained.

List of References

1. Fetsch RJ, Jacobson B. Children’s anger and tantrum. [online]. Available from:

URL:http://www.ext.colostate.edu [accessed on 2001 Sep 4].

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2. Potts NL Mandelco BL. Paediatric Nursing care for children and their families.

New York: Delmar Publishers; 2002.

3. Jackson DB, Sunder RB. Child health nursing. Philadelphia: J. B. Lippincott

Company; 1993.

4. English statements for temper tantrum. [online]. Available from:

URL:http://www.CPS.ca/ English/statement/pp/pp04-01htm. [accessed on 2011

Sep 4].

5. Kuriakose KR. Dealing with temper tantrums in children. Health Action 2011

Sep;22-6.

6. Temper tantrum. [online]. Available from:

URL:http://www.wikipedia.tempertantrum.co.in. [accessed on 4 Sep 2011].

7. Behrman RE, Kliegman RM, Jenson HD. Nelson’s textbook of paediatrics. 17th ed.

Philadelphia: 2004.

8. Huckleberry MJ, Wilson D, Winkelstein ML. Wong’s essentials of paediatric

nursing. 7th ed. Missouri: 2005.

9. Mireault G, Trahan J. Tantrum and anxiety in early childhood. Early Childhood

Educational Journal 2007;9(2):1-10.

10. Bhatia MS, Dhar NK, Singal PK. Temper tantrum; prevalence and aetiology in a

non referral outpatient setting. Clinical Paediatrics 1990;29(6):311-5.

11. Paterson J, Carter S. Behavioural problems among two year old pacific children

living in New Zealand. Journal of Child Psychology and Psychiatry

2007;48(5):514-22.

12. Potegal M, Davidson, Richard J. Temper tantrums in young children: behavioural

composition. Developmental Behaviour Paediatrics 2003;24(3):140-7.

13. Belden AC, Thomson NR, Luby JL. Temper tantrums in healthy versus depressed

and disruptive preschoolers: defining tantrum behaviours associated with clinical

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problems. Journal of Paediatrics 2008;152:117-22.

14. Barahmand U. Temperament, parenting and behaviour problems. [online].

Available from: URL:http://www.children.wedmed.com

15. Ganeshan B, Anbumani J. Mental traits of breath holding children: a case control

study. Indian Journal of Psychiatry 2008;15(3):1992-5.

16. The statement of the temper tantrum. [online]. Available from:

URL:http://raisingchildren.net.au/articles/temper tantrums.html [accessed on 2011

Sep 5].

17. Sharma S, Nagar S. Effect of intervention of child’s temperament in Kangra district

of Himachalpradesh. Indian Psychological Review 2006;66(3):115-20.

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8. Signature of the Candidate

9. Remarks of the Guide

10. Name and Designation of (in block letters)

10.1 Guide MRS. JTOTHI PRAMEELA MARTISASSISTANT PROFESSORATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE.575001

10.2 Signature

10.3 Co-guide (if any)

10.4 Signature

11. 11.1 Head of the Department MRS. JTOTHI PRAMEELA MARTISASSISTANT PROFESSORATHENA COLLEGE OF NURSINGFALNIR ROADMANGALORE.575001

11.2 Signature

12. 12.1 Remarks of the Chairman and Principal

12.2 Signature

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