A Quasi Experimental Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on Anxiety and Quality of Sleep Among Covid-19 Patients at Selected Covid Care Centre, Coimbatore
Vasanth. G1, Nuziba Begum2, T. Nirmala3
1M.Sc. Nursing, Department of the Mental Health Nursing, College of Nursing,
Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore-641044.
2Associate professor, Department of the Mental Health Nursing, College of Nursing,
Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore-641044.
3M.Sc (N), Ph.D., Principal, College of Nursing,
Sri Ramakrishna Institute of Paramedical Sciences, Coimbatore-641044.
*Corresponding Author Email:
ABSTRACT:
Global prevalence of anxiety and depression increased to 25% during the first year of pandemic. Pandemic is not just a medical phenomenon; it affected individuals, society and caused emotional disruptions, anxiety, stress, stigma and sleep problems. Aim: The present study was undertaken with the aim to assess the effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on anxiety and quality of sleep among COVID-19 patients. Methodology: A quantitative approach with Quasi-Experimental, one group pretest-posttest design was adopted. A purposive sampling technique was used to recruit the study participants, and the sample size was 60. Pretest level of anxiety and quality of sleep were assessed using Hamilton Anxiety Rating Scale and Modified Pittsburgh Sleep Quality Index. Jacobson’s progressive muscle relaxation therapy (JPMR) was administered in individual session for 20 minutes, one session per day for 6 consecutive days. Posttest was conducted by using same questionnaires on the 7th day, after the intervention. Results: ‘z’ test was used to compare the level of anxiety before and after the intervention, the calculated value z=4.85 was greater than the tabulated value 3.29 at 0.001 level of significance. With regard to the quality of sleep before and after intervention, the calculated value z=5.87 was greater than the tabulated value 3.29 at 0.001 level of significance. Conclusion: The study concluded that Jacobson's Progressive Muscle Relaxation Therapy was effective in reducing the anxiety and improving the sleep quality among COVID-19 patients.
INTRODUCTION:
Through clinical observations, many patients developed anxiety and sleep disturbances in isolation treatment2,3. Relaxing the muscles could relax the mind as well. It is a way to help the patients with anxiety and sleep problems by means of tightening one muscle group while keeping the rest of the body relaxed, and then releasing the tension15.
NEED FOR THE STUDY:
Psychologists and mental health professionals speculate that the pandemic (COVID-19) is going to impact on the mental health of the population globally4. The prevalence rates of mental health problems have been reported as 21.90% for anxiety13. Sleep problems in response to the COVID-19 pandemic are high in prevalence (17.4%-57.2%)12. A non drug intervention therapy, progressive muscle relaxation training has the advantages of being economical, east to operate, safe, and comfortable. It significantly improved negative emotion (Anxiety) and sleep problems in COVID-19 patients11.
STATEMENT OF THE PROBLEM:
A Quasi Experimental Study to Assess the Effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on Anxiety and Quality of Sleep among COVID-19 Patients at Selected COVID care centre, Coimbatore.
OBJECTIVES:
1. To assess the level of anxiety and quality of sleep among COVID-19 patients.
2. To evaluate the effectiveness of Jacobson’s Progressive Muscle Relaxation Therapy on anxiety and quality of sleep among COVID-19 patients.
3. To correlate anxiety and quality of sleep among COVID-19 patients.
4. To find out the association between anxiety and quality of sleep with selected demographic variables among COVID-19 patients.
OPERATIONAL DEFINITION:
Effectiveness:
In this study effectiveness refers to the changes in the level of anxiety and quality of sleep after implementation of Jacobson’s progressive muscle relaxation therapy.
Jacobson’s Progressive Muscle Relaxation Therapy:
Jacobson’s Progressive Muscle Relaxation Therapy focuses on slowly tensing and then relaxing each muscle group of body’s psychological response to anxiety provoking thoughts and reduces the physical tension and interrupts the racing thoughts processes that affect sleep in COVID-19 patients5,15.
Anxiety:
Anxiety is the body's natural response to stress; it is a feeling of worry, nervousness or unease about something with an uncertain outcome. In this study anxiety will be assessed by using Hamilton Anxiety Rating Scale8,9,10.
Quality of Sleep:
Quality of sleep is defined as one's satisfaction of the sleep experience, integrating aspects of sleep initiation, sleep maintenance, sleep quantity, and refreshment upon awakening. It will be assessed by using Pittsburgh sleep quality inventory7.
COVID-19 Patients:
COVID-19 Patients are the people, those who are all admitted in the COVID-19 ward at Sri Ramakrishna Hospital and undergoing treatment for COVID-19 infection with Mild symptoms6.
Hypothesis:
H1 -There is a significant difference in the level of Anxiety among COVID-19 patients in experimental group before and after implementation of Jacobson’s Progressive Muscle Relaxation Therapy.
H2 -There is a significant difference in the quality of sleep among COVID-19 patients in experimental group before and after implementation of Jacobson’s Progressive Muscle Relaxation Therapy.
H3 -There is a significant correlation between anxiety and quality of sleep among COVID-19 patients.
H4 -There is a significant association between the level of anxiety and quality of sleep and selected demographic variables among COVID-19 patients.
METHODOLOGY:
Research Approach: Quantitative approach
Research Design: Quasi- Experimental, one group pre test-post test design
Setting: Sri Ramakrishna Hospital Covid-19 ward, Coimbatore
Target Population: COVID-19 Patients
Accessible Population: COVID-19 Patients at Sri Ramakrishna Hospital
Sampling Technique: A Purposive sampling
Sample Size: 60 COVID-19 Patients
VARIABLES:
Independent: Jacobson’s Progressive Muscle Relaxation Therapy
Dependent: Anxiety and Quality of sleep
Criteria for sample collection:
Inclusion Criteria
1. Patient diagnosed as COVID‐19 positive with mild symptoms.
2. Both male and female COVID-19 patients at Sri Ramakrishna Hospital.
3. COVID-19 patients who were willing to participate.
Exclusion Criteria:
1. COVID-19 patients who were under Anti anxiety drugs and Sleep inducing drugs.
2. COVID-19 patients with visual and hearing impairments.
Validity: The tools were validated by five subject experts in the field of Mental Health Nursing department. Suggestions and recommendations given by the experts were accepted and necessary corrections were done14.
Reliabity: The reliability coefficient obtained for Hamilton Anxiety Rating Scale and Modified Pittsburgh Sleep Quality Index were 0.85 and 0.96 respectively.
Ethical Consideration: The proposed study was approved by IEC of Sri Ramakrishna Hospital, Coimbatore. A written permission was issued to proceed with the study. Informed consent was obtained from each study participant.
Data Collection Procedure: The study was conducted in Covid-19 ward at Sri Ramakrishna Hospital, Coimbatore. During the data collection period 60 participants were selected through purposive sampling technique. Pretest data were collected from the study participants using questionnaires such as Hamilton Anxiety Rating Scale and Modified Pittsburgh Sleep Quality Index. Jacobson’s progressive muscle relaxation therapy was administered as individual session for 20 minutes, one session per day for 6 consecutive days. Posttest was conducted by using same questionnaires on 7th day, after the intervention (JPMR).
Table 1: Data analysis and interpretation: demographic variables of covid-19 patients (n=60)
S. No |
Demographic variables |
Category |
Frequency |
(%) |
1. |
Age
|
15-30 21-45 46-60 >60 |
11 10 18 21 |
18.33 16.67 30 35 |
2. |
Sex
|
Female Male |
25 35 |
41.67 58.33 |
3. |
Marital status
|
Married Unmarried |
53 7 |
88.33 11.67 |
4. |
Residence
|
Urban Rural |
38 22 |
63.33 36.67 |
5. |
Education
|
Illiterate Primary education Secondary education Graduate |
17 7
17
19 |
28.33 11.67
28.33
31.67 |
6. |
Occupation
|
Government Private Business Daily wages Unemployed |
8 16 9 5 22 |
13.33 26.67 15 8.33 36.67 |
7. |
History of previous hospitalization |
No Yes |
32 28 |
53.33 46.67 |
8. |
Chronic illness |
No Yes |
39 21 |
65 35 |
9. |
Habit of smoking |
No Yes |
40 20 |
66.67 33.33 |
10. |
Habit of drinking |
No Yes |
39 21 |
65 35 |
11. |
Exercise Regularly |
No Yes |
35 25 |
58.33 41.67 |
Table 2: Assessment on level of anxiety among COVID-19 patients before and after the intervention (n=60)
S. No |
Level of Anxiety |
Pre-test |
Post-test |
||
Frequency |
(%) |
Frequency |
(%) |
||
1. 2. 3. |
Mild Moderate Severe |
49 9 2 |
81.67 15 3.33 |
58 2 0 |
96.67 3.33 0 |
The above table 2 depicts that before the intervention (JPMR), majority of 49 (81.67%) COVID-19 patients had mild anxiety, 9 (15%) had moderate anxiety, and 2 (3.33%) had severe anxiety. After the intervention (JPMR), majority of 58 (96.67%) COVID-19 patients had mild anxiety and 2 (3.33%) COVID-19 patients had moderate anxiety.
Figure 1: Level of anxiety among COVID-19 patients before and after the intervention
Table 3: Analysis on effect of Jacobson’s Progressive Muscle Relaxation Therapy on anxiety among COVID-19 patients (n=60)
Group |
Mean |
Standard deviation |
Mean difference |
Calculated Value |
Table value |
Pre-test Post-test |
14.73 11.38 |
4.16 3.25 |
3.35 |
4.85*** |
3.29 |
***Significance at 0.001 level
The above table 2 inferred that there was a reduction in the anxiety level among experimental group, which was significant to the administration of Jacobson’s Progressive Muscle Relaxation Therapy (p<0.001).
Table 4: Assessment on quality of sleep among COVID-19 patients before and after the intervention (n=60)
S. No |
Quality of sleep |
Pre-test |
Post-test |
||
Frequency |
(%) |
Frequency |
(%) |
||
1. 2. |
Good Poor |
35 25 |
58.33 41.67 |
51 9 |
85 15 |
The above table 4 depicts that before the intervention (JPMR) 35 (58.33%) COVID-19 patients had good quality of sleep and 25 (41.67%) COVID-19 patients had poor quality of sleep. After the intervention (JPMR) majority of 51 (85%) COVID-19 patients had good quality of sleep and 9 (15%) COVID-19 patients had poor quality of sleep.
Figure 2: Quality of sleep among COVID-19 patients before and after the intervention
Table 5: Analysis on effect of Jacobson’s Progressive Muscle Relaxation Therapy on quality of sleep among COVID-19 patients (n=60)
Group |
Mean |
Standard deviation |
Mean difference |
Calculated Value |
Table value |
Pre-test Post-test |
5.73 3.97 |
2.004 1.04 |
1.76 |
5.87*** |
3.29 |
***Significance at 0.001 level
The above table 5 was inferred that there was an improvement in the sleep quality among experimental group, which was significant to the administration of Jacobson’s Progressive Muscle Relaxation Therapy (p<0.001).
Table 6: Correlation between anxiety and quality of sleep among COVID-19 patients (n=60)
Group |
Mean |
Standard Deviation |
‘r’ Value |
Table Value |
|
|
|
|
|
Pre-test (Anxiety) Pre-test (Quality of sleep) |
14.73
5.73 |
4.16 2.004 |
0.45*** |
0.408 |
***Significance at 0.001 level
The above table 6 reveals that there was a strong positive correlation (r = 0.45) between anxiety and quality of sleep among COVID-19 patients (p<0.001)
Table 7: Association between anxiety and selected demographic variables among COVID-19 patients (n=60)
S. No |
Demographic variables |
Frequency |
Level of Anxiety |
χ2value |
Degree of freedom (r-1) (c-1) |
χ2table value |
|
≤Mean |
>Mean |
||||||
1. |
Age 20-25 56-90 |
32 18 |
23 13 |
9 15 |
4.03* |
1 |
3.841 |
2. |
Sex Female Male |
25 35 |
17 20 |
8 15 |
0.73 |
1 |
3.841 |
3. |
Residence Urban Rural |
38 22 |
25 12 |
13 10 |
0.75 |
1 |
3.841 |
4. |
Education Illiterate Literate |
15 45 |
7 30 |
8 15 |
1.9 |
1 |
3.841 |
5. |
Occupation Employed Unemployed |
36 24 |
25 12 |
11 12 |
2.3 |
1 |
3.841 |
6. |
History of previous hospitalization No Yes |
28 32 |
19 18 |
9 14 |
0.85 |
1 |
3.841 |
7. |
Chronic illness No Yes |
36 24 |
27 10 |
9 14 |
6.8** |
1 |
6.635 |
8. |
Habit of smoking No Yes |
40 20 |
25 12 |
15 8 |
0.04 |
1 |
3.841 |
9. |
Habit of drinking No Yes |
42 18 |
27 10 |
15 8 |
0.4 |
1 |
3.841 |
10. |
Exercise regularly No Yes |
35 25 |
21 16 |
14 9 |
0.098 |
1 |
3.841 |
* Significance at 0.05 level ** Significance at 0.01 level
The above table 7 reveals that Chi Square value for the age (χ2=4.9) and chronic illness (χ2=6.8) had association with the anxiety at 0.05 and 0.01 level of significance respectively. Other demographic variables had no association with the level of anxiety among COVID-19 patients
Table 8: Association between quality of sleep and selected demographic variables among COVID-19 patients (n=60)
S. No |
Demographic variable |
Frequency |
Quality of sleep |
χ2 Value |
Degree of freedom (r-1) (c-1) |
χ2 table value |
|
≤Mean |
>Mean |
||||||
1. |
Age 20-25 56-90 |
30 30 |
21 14 |
9 16 |
3.36 |
1 |
3.841 |
2. |
Sex Female Male |
25 35 |
13 22 |
12 13 |
0.7 |
1 |
3.841 |
3. |
Residence Urban Rural |
38 22 |
21 14 |
17 8 |
0.4 |
1 |
3.841 |
4. |
Education Illiterate Literate |
17 43 |
9 25 |
8 18 |
0.13 |
1 |
3.841 |
5. |
Occupation Employed Unemployed |
37 23 |
25 10 |
12 13 |
3.39* |
1 |
3.841 |
6. |
History of previous hospitalization No Yes |
28 32 |
16 19 |
12 13 |
0.02 |
1 |
3.841 |
7. |
Chronic illness No Yes |
37 23 |
23 12 |
14 11 |
0.6 |
1 |
3.841 |
8. |
Habit of smoking No Yes |
40 20 |
22 12 |
18 8 |
0.14 |
1 |
3.841 |
9. |
Habit of drinking No Yes |
42 18 |
22 12 |
20 6 |
1.05 |
1 |
3.841 |
10. |
Exercise regularly No Yes |
35 25 |
19 15 |
16 10 |
0.19 |
1 |
3.841 |
* Significance at 0.05 level
The above table 8 reveals that Chi Square value for the occupation (χ2=3.39) had association with the quality of sleep at 0.05 level of significance. Other demographic variables had no association with the quality of sleep among COVID-19 patients.
LIMITATIONS:
1. Sample size of the study was small which limits the generalization of the study findings.
2. Sleep quality was assessed after 7 days and long term effect could not be studied.
RECOMMENDATIONS:
1. A similar study can be conducted among the people in various settings.
2. The study can be replicated with large number of samples which would facilitate the generalization of findings.
3. All the staff nurses have to be trained to implement Jacobson’s Progressive Muscle Relaxation Therapy
4. A qualitative study can be carried out to examine the lived in experience of people among Covid -19 pandemic.
NURSING IMPLICATION:
Nursing Education:
To deliver the nursing care effectively, nursing educators must focus on alternative and complementary therapies to reduce anxiety and improve sleep quality in practice.
Nursing Administration:
The nurse administrator has a responsibility to provide nurses with substantive continuing nursing education opportunities and can draw written policies from the patients regarding application of JPMR.
Nursing Practice:
Nurses also can train the patients and help them to practice Jacobson’s Progressive Muscle Relaxation Therapy during hospitalization and to follow the same in day to day life.
Nursing Research:
The study findings would be help to expand the scientific body of professional knowledge and promote evidence based practice for reducing the level of anxiety and improving the quality of sleep.
CONCLUSION:
The present study established a simple, safe, and non-pharmacological intervention, Jacobson’s Progressive Muscle Relaxation Therapy and its effect on anxiety and quality of sleep among COVID-19 patients. The study found that Jacobson's Progressive Muscle Relaxation Therapy reduced anxiety and improved sleep quality among COVID-19 patients. Hence, the researcher suggests that nurses should adopt this intervention in their clinical practice as routine care to reduce the level of anxiety and improve the quality of sleep. This will improve the patients’ comfort and well-being in psychiatric wards.
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Received on 04.04.2024 Modified on 19.06.2024
Accepted on 23.07.2024 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2024;14(3):211-216.
DOI: 10.52711/2349-2996.2024.00042