Under the guidance of: mr. G. Balamurugan lecturer, the department of psychiatry



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EFFECTIVENESS OF ASSERTIVENESS TRAINING ON SELF ESTEEM AMONG ADOLESCENT GIRLS

M.Sc. Nursing Dissertation protocol submitted to
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Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore.
BY:

Ms. ANU MARIA ALIAS

M. Sc. NURSING 1ST YEAR

YEAR: 2012-2014

UNDER THE GUIDANCE OF:

MR. G.BALAMURUGAN

LECTURER, THE DEPARTMENT OF PSYCHIATRY

M S RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH,

M S RAMAIAH NAGAR, BANGALORE-560054

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

BENGALURU, KARNATAKA.

SYNOPSIS PROFORMA FOR REGISTRATION OF

SUBJECT FOR DISSERTATION

1.

NAME OF THE CANDIDATE AND ADDRESS


MS.ANU MARIA ALIAS

VEEPANATTU HOUSE

PINDIMANA P.O

KOTHAMANGALAM

ERNAKULAM, KERALA.

2.

NAME OF THE INSTITUTION

M.S.RAMAIAH INSTITUTE OF NURSING EDUCATION AND RESEARCH, BANGALORE.

3.

COURSE OF STUDY AND SUBJECT

M.SC NURSING

MENTAL HEALTH NURSING

4.

DATE OF ADMISSION

29-6-2012

5. TITLE OF THE STUDY

EFFECTIVENESS OF ASSERTIVENESS TRAINING ON SELF

ESTEEM AMONG ADOLESCENT GIRLS

BRIEF RESUME OF THE INTENTED STUDY

INTRODUCTION

The only healthy communication style is assertive communication”

Jim Rohn

Human life is divided into five main stages namely infancy, childhood, adolescence, adulthood and old age. In each of these stages an individual find himself in different situations and face different problems1. Adolescence is a crucial period in the development of the self-concept2. Adolescence, the word from Latin: adolescence meaning "to grow up" and is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood (age of majority) but largely characterized as beginning and ending with the teenage stage.3


Adolescent period of transition starts at the age of 10 years and ceases by the age of 19 years. Adolescence is a period of preparation for adulthood during which time several key developmental experiences occur. Besides physical and sexual maturation, developmental experiences include movement toward social and economic independence, and development of identity, the acquisition of skills needed to carry out adult relationships and roles, and the capacity for abstract.4
Adolescents go through many changes. One characteristics feature seen in the adolescents is self hatred. This is a strange emotion, it is outrageously common in teenagers and it can be extremely hard to get out of the rut it creates. The alternative to self hatred is self confidence or self esteem. It is an inevitable part of growth for normal human beings. Lack of self esteem may lead to poor acquirement of the skills and abilities that are needed to achieve objectives and thus it in turn affect one’s successful way of life.5

Low-self-esteem is also associated with feelings of being weak, helpless, hopeless, frightened, fragile, in-complete, worthless and inadequate. They suffer from negative thoughts and fail to recognize their potential, they fear criticism and take compliments negatively and are afraid to take up responsibilities, and afraid of forming their own opinion.5

Almost everyone will experience a lack of self-confidence. So some easy techniques are using to increase self confidence . Assertiveness training is the best way to deal with those situations, both in and out of work, where you feel you lack confidence. It is a way of un-hooking yourself from the learned behaviors of the past and re-programming yourself to be more assertive. 6
Assertiveness is a form of behavior characterized by a confident declaration or affirmation of a statement without need of proof; this affirms the person's rights or point of view without either aggressively threatening the rights of another assuming a position of dominance or submissively permitting another to ignore or deny one's rights or point of view7
6.1NEED FOR THE STUDY

The world population trends 2012 reveals that the world’s adolescent population is 7.06 billion8. Current Population of India in 2012 is estimated to be 1.22 billion. Nearly 90 per cent live in developing countries9. India has the largest population of adolescents in the world being home to 243 million individuals’ aged 10-19 years10. Karnataka is the eighth largest state in India in terms of population. Population of Karnataka in 2012 is 70,201,204 and about 21% of that comprised the adolescent population11.



It is estimated that up to a half of adolescents will struggle with low self esteem, many of these occurrences during the early teen years. One of the most significant periods for increased rates of lower self-esteem is the transition from one stage of education to the next. The most observable of these is the transition from primary (elementary) to junior high or middle school. Research has shown that between the ages of 8 and 13 teens self esteem levels drop markedly, girls more so than boys (Rhodes et al, 2003; Robins et al 2002)12.

Studies have found that one-third to one-half of adolescents struggle with low self esteem, especially in early adolescence. The results of low self-esteem can be temporary, but in serious cases can lead to various problems including depression, anorexia nervosa, delinquency, self-inflicted injuries and even suicide. Self esteem is related to school performance and delinquency. Adolescents with low self-esteem are more likely to do poorly in school, to become pregnant, or to impregnate a partner13.

A survey conducted at the annual convention of the American Association for health education reported teenage girls today are more independent and see greater opportunities available to them than their baby boomer parents did at their age. These same girls also have less self-confidence and weaker self-images than their parents’ generation14.

A National Report on the State of Self-Esteem, commissioned by the Self Esteem Fund, in United States reveals that there is a self-esteem crisis in this country that pervades every aspect of a girl’s life including her looks, performance in school and relationships with friends and family members. 62% of all girls feel insecure or not sure of themselves. 75% of girls with low self-esteem reported engaging in negative activities such as disordered eating, cutting, bullying, smoking, or drinking when feeling badly about themselves. 25% of teen girls with low self-esteem resort to injuring themselves on purpose or cutting when feeling badly about them. 25% of teen girls with low self-esteem practice disordered eating, such as refusing to eat, or over-eating and throwing up when feeling badly about themselves15.

The student researcher personally experienced many adolescent girls having problems of low self esteem. So, for this reason, student researcher conducts this study among adolescents and implement assertiveness training module for improving the knowledge regarding assertive behavior and self esteem.
6.2 REVIEW OF LITERATURE
Review of Literature is an ongoing process and covers the entire planning stage-A good research does not exist in vacuum. An intensive Review of Literature was done by the investigator to lay a broad foundation for the study.

The literature was reviewed and presented under the following heading:-



  1. Literature related to self esteem .

  2. Literature related to assertiveness training.

  3. Literature related to Assertiveness Training Programme on self esteem among Adolescent girls.




  1. Review of literature related to self esteem on Adolescence

A study on self-esteem on 112 adolescent girls was conducted in Kangra District of Himachal Pradesh. A total sample of 112 school going girls in the age range of14 to 19 years were selected from five villages of Kangra district. Self esteem was measured through self esteem scale and the means and percentages were calculated. The scores of the adolescent girls were mostly in the range of 81 to 106, which means they were in an average category, although about 33% of them had low self-esteem. A positive correlation was found 1.34 between self-esteem and family type and 0.231 between education of girls and self esteem16.

2. Review of literature related to effectiveness of assertiveness training among nurses
A study was formulated to evaluate an assertiveness training program on nursing and medical students' Nursing Department, Tri-Service General Hospital, Taiwan on assertiveness, self-esteem, and interpersonal communication satisfaction. Using a longitudinal research design, 69 participants whose scores on the Assertive Scale were < or = 50% (i.e., low assertiveness) and who were willing to participate were included and assigned to an experimental group (33 subjects) or comparison group (36 participants; participants were matched with the experimental group by grade and sex).Participants in the experimental group received eight 2-h sessions of assertiveness training once a week. The assertiveness and self-esteem of the experimental group were significantly improved in nursing and medical students after assertiveness training, although interpersonal communication satisfaction of the experimental group was not significantly improved after the training program17.

A study was conducted to assess the self esteem and assertiveness on 372 final year Turkish university students. The research population was a total of 372 students who were in their final year of university in different programs. Total response rate was 77.9%. The data were collected using a "Personal Information Form," Stanley Coppersmith Self Esteem Inventory (SEI) and Rathus Assertiveness Schedule (RAS). The results of the study were that the nursing students had the highest scores from SEI (80.64+/-15.83). Similarly the nursing students had the highest scores on the RAS (36.29+/-25.33) 18.




  1. Review of literature related to effectiveness of Assertiveness Training Methods on Self-Esteem Among Adolescent girls

A study was conducted in Islamic Azad University, Iran on 2012 determining of efficacy assertiveness training on increasing self-esteem and general self efficacy girls’ students. Study method was two experiment groups and control group with pretest and posttest. 40 people were selected that they have lower scores on self-esteem and self-efficacy and were conducted in two groups of 20 people in training programs, assertiveness training in 90 minutes to 8 sessions of group practices. According final findings of research effect of training in combined variable self-efficiency n=0/36 partial Wilks lambda=0/724, p≤ 0/001, F (4, 78) have significant effect. Means that assertiveness training was effective in increasing self-efficacy and self-esteem19.


A study to assess the Effects of Assertive Training on the Performance Self-Esteem of Adolescent Girls on 1982 . Assertiveness training was provided for 148 girls in 10 high school business and homemaking classes in six senior high schools. Training sessions were co-led by an experienced leader and the students" own high school teacher. Significant changes in performance self-esteem scores were found between pretesting and a three-month follow-up (p < 0.001) for the 103 subjects available at follow-up; low self-esteem subjects showed greater increases than high self-esteem subjects (p < 0.001). Changes in self-esteem were related to the girls" perceptions of teacher reactions to their assertive behavior (p < 0.01) 20.
STATEMENT OF THE PROBLEM:

A Quasi experimental study to assess the effectiveness of assertiveness training on self esteem among adolescent girls in selected schools , Bangalore.


6.3 OBJECTIVES OF THE STUDY:

  • To assess the pretest level of self esteem among adolescent girls

  • To assess the effectiveness of assertiveness training by comparing the pre test and post test scores of self esteem in experimental and control group

  • To assess the effectiveness of assertiveness training on self esteem by comparing the post test scores of self esteem in experimental and control group

  • To determine the association between pre test level of self esteem and selected socio demographic variables


6.4 HYPOTHESES:-

  • H01: There is no statistically significant difference between pre-test and post-test scores of self esteem in experimental group

  • H02: There is no statistically significant difference between post-test scores of self esteem in experimental group and control group

  • H03: There is no statistically significant association between pre-test levels of self esteem and selected socio demographic variables


6.5 OPERATIONAL DEFINITIONS:

  • Effectiveness

It refers to extent to which Assertiveness training improves the level of self esteem as experienced by Adolescent girls which is measured by using Rosenberg self esteem scale.

  • Assertiveness Training

In this study it refers to structured training programme developed by the student researcher which consist of 5 session includes Introduction, rapport formation , Ice breaking , group discussion , Role play , Modeling, Evaluation and Conclusion. Each session lasts for 90mn/day once /twice in a week for consecutive 3 week.

  • Self – esteem

It refers to overall evaluation of one’s own worth, self respect and independence which is measured by using Rosenberg self esteem scale



  • Adolescent girls

In this study it refers to Adolescent girls of age group 13-16 years.

6.6 ASSUMPTIONS

1. Adolescent girls may have varying levels of self esteem

2. Assertiveness training may improve the self esteem of Adolescent girls
6.7 DELIMITATIONS

The study is delimited to

1. Adolescent girls those who are studying in 8th and 9th standard.

2. Adolescent girls of selected schools at Bangalore
7. MATERIAL AND METHODS

7.1.1 SOURCES OF DATA:

Data will be collected from adolescent girls of selected schools at Bangalore.



7.2 METHOD OF DATA COLLECTION

7.2.1 RESEARCH APPROACH:

Research approach of the present study is an evaluative research approach.



7.2.2 RESEARCH DESIGN:

Non equivalent control group pre test-post test design



7.2.3 VARIABLES:

INDEPENDENT VARIABLE: Assertiveness training

DEPENDENT VARIABLE: Self esteem

SOCIO DEMOGRAPHIC VARIABLE:

It includes the base line information of adolescent girls such as



  • Age

  • Religion

  • Level of education

  • School performance

  • Type of family

  • Number of children in the family

  • Family income

  • Residential area

  • Co-curricular participation

  • Father and mother education


7.2.4 SAMPLING TECHNIQUE:

Simple Random sampling technique.



7.2.5 SAMPLE SIZE

Total Sample size = 30: (15 experimental and 15 control group)



7.2.6 SAMPLE CRITERIA:

Inclusion criteria

Exclusion criteria.

    • Adolescent girls who were major ill at the time of data collection.

    • Adolescent girls who undergone Assertiveness Training Programme (ATP) previously.


7.2.7 FOLLOW UP

No follow up is done in the study



7.2.8 COMPARISON PARAMETER

  • Pre test and post test of self esteem will be compared in experimental and control group.

  • Post test level of self esteem will be compared between experimental and control group

7.2.9 DURATION OF STUDY

Four weeks of data collection



      1. TOOLS FOR THE RESEARCH

  1. Tools for data collection

Section A: Sociodemographic Performa of adolescents

Section B: Rosenberg Self-Esteem Scale

7.2.11 DATA COLLECTION PROCEDURE:

A prior permission will be taken from the head of the institution from the selected schools before collecting the data.Informed consent will be taken then assent should be taken from selected participants. Pre test on self esteem is done on adolescent girls of both experimental and control group using Rosenberg self esteem scale. Assertiveness training is given to the experimental group. Itconsist of 5 session includes Introduction, rapport formation, Ice breaking, group discussion, Role play, Modeling and Evaluation and Conclusion. Each session lasts for 90min/day, once /twice in a week for consecutive 3 week. Post test will be obtained from experimental and control groupafter 1 week using same scale.




      1. PLAN FOR DATA ANALYSIS

The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics

Frequency, percentage, Mean, Standard Deviation, Mean Percentage to describe level of self esteem between experimental and control group.



Inferential statistics

1. Paired t-test to compare pre test and post test scores of self esteem between experimental and control group.

2. Independent t-test to compare post test scores of self esteem between experimental and control group

3. Chi-square test to check association between pretest scores of self esteem and selected socio demographic variables of experimental and control group



7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN OR ANIMALS, IF SO PLEASE DESCRIBE BRIEFLY:

Yes, Assertiveness training will be given to the Adolescent girls.


7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?

Yes, Ethical clearance will be obtained from the concerned authority. Confidentially and anonymity of the subject will be maintained.



8.REFERENCE

1. The problem of old age in India [Online].2010 [cited 2012 Dec]; Available from: URL:http://azadindia.org/social-issues/problem-of-old-age-in-india.html



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