CHAPTER 1 INTRODUCTION Background of the study Surgery is an actual or potential action that threatens the integrity of the person

CHAPTER 1
INTRODUCTION
Background of the study
Surgery is an actual or potential action that threatens the integrity of the person, such as bio-psycho-social-spiritual, and may cause discomfort.1
Pain is the most frequent symptom which leads a patient to seek medical help. It is the symptom of a disease, the treatment of which promotes its resolution. In some patients, however, pain is not a symptom, but a sequel of a disease that has already been cured. In these cases, pain control becomes even more important, since it indicates life quality and the possibility of reintegrating the patient to his professional and social activities.2
Pain is defined by each one of us according to our personal experiences and involves a variety of feelings, sensations and situations. The communication of a patient’s painful experience to the health care professionals assisting him is fundamental for the understanding of such condition, implementation of analgesic measures and evaluation of therapeutic efficacy, since pain is an individual and subjective phenomenon.3 It is also considered to be any type of physical damage that is reported to be felt by a patient at the time when he claims to feel it. This conception understands that the only individual who can able to define a person’s pain is the one who is feeling it. Therefore, nurses must believe the patient and try to identify the various behaviors that indicate not only the presence or feeling of pain, but also everything that is experienced by the patient in relation to it. They should also understand that efficient pain treatment requires knowledge concerning the physiological and cultural aspects of each individual. Nursing professionals have made efforts to help individuals in the evaluation and control of their own reactions, for which there are strategies that use physiological, cognitive and behavioral techniques. Among them are the relaxation techniques.

Relaxation must be attempted in order to reduce pain or pain perception, reduce tension, create a pleasant affective condition, reduce anticipating anxiety, reduce anxiety as a response to stress, increase parasympathetic activities, increase knowledge concerning muscle tension and autonomous stimuli, improve concentration, increase the feeling of control, improve the ability to block inner talk, energize and improve sleep, increase suggestibility, decrease the cardiac index, lower pressure, warm or cool body parts, enhance performance of physical activities and help in the relationship with others.4
Some of the relaxation techniques include breathing exercise progressive muscle relaxation autogenic training hypnosis and biofeedback. Relaxation is something people often strive for in the stressful world today but there is also specific relaxation technique that can be used for pain and anxiety relief.

We Will Write a Custom Essay Specifically
For You For Only $13.90/page!


order now

Various relaxation techniques have been used and their effects upon pain and stress have been described in the literature. Florence Nightingale also used form of relaxation by encouraging rest and limiting disturbance and unnecessary noise. The benefits of relaxation technique are improved comfort level of patients, decrease in abdominal muscle tension, reduction of distress caused by painful sensations; reduction in the incidence of psychiatric reactions occurring postoperatively decrease in anxiety and depression levels.5

Among the relaxation techniques, progressive muscle relaxation, in specific Benson Progressive muscle relaxation technique is used in this study. This powerful tool was developed by Dr. Herber Benson. It is mainly based on the premise that anxiety and relaxation are excluding situations. 6The individual retracts a specific set of muscles as much as possible and experiences as tension sensation. The muscles are then relaxed as much as possible and the individual focuses on the relaxation sensations. It is, therefore, a participant exercise in which the individual himself seeks a state of relaxation and physical well-being.

The benefit arising from the practice of Progressive Muscle Relaxation is that it sensitizes individuals to recognize the increase in muscle tension. When Progressive Muscle Relaxation is practiced, and incorporated to the individual’s life style, it can help to neutralize some of the effects of stress reaction. Considering that the progressive muscle relaxation technique can reduce pain, the researcher is planning to evaluate its effectiveness on anxiety and pain among post abdominal surgery patients.
Need for the study
The incidence of abdominal conditions are increasing day by day and majority of the require surgical intervention for example gastrointestinal, biliary, and liver operations, splenectomy, herniorrhaphy, appendectomy, surgery on great vessels of trunk, and so on which are done according to the disease condition of the patient.7
According to the latest data from the National Centre for Health Statistics, 44.9 million inpatient surgical procedures were performed in 2005, followed closely by outpatient surgeries. Other surgical statistics for both in- and outpatient procedures shows that the digestive system surgeries were highest (12 million) followed by musculoskeletal system surgeries (7.4 million), cardiovascular system surgeries (6.8 million), urinary system surgeries (2.36 million) and so on.8
The patients vary greatly in their medical conditions and responses to surgery, responses to pain and interventions, and personal preferences. A descriptive cross-sectional study was conducted to find drug utilization for post-operative pain in 12 Indian hospitals. The subjects were an unselected sample of consecutive patients (n=993) undergoing abdominal surgery. The severity of post-operative pain was assessed during the first day after surgery by means of a six-category (none, mild, moderate, severe, very severe, and unbearable) rating scale and a visual analogue scale. Fifty-nine percent of patients (587) received non-opioid analgesics only, 9% (89) received opioid analgesics only, and 27% (263) received both opioid and no opioid analgesics. Thirty-eight percent (371/967) of patients rated their maximum pain on the first day as severe to unbearable. The percentage of patients in each center who suffered severe to unbearable pain varied from 22 to 67%. The study concluded that many patients still suffer severe pain after abdominal surgery.9
An estimate of global volume of surgery among WHO member states estimate that 20million surgical procedures are performed every year worldwide. In Northern America, it is estimated that the number of appendectomy cases in 2015 was 378,61 .It is estimated that the 25% of male and 2% of females developing inguinal hernia.
The investigator during her daily clinical practice observed that most of post-operative patients are anxious preoperatively and have inadequate pain relief with pharmacological relief measure alone. The difficulty with introducing complimentary therapies such as relaxation into nursing practice is that there is little emphasis of such measures in nursing curricula and little empirical evidence to support the use. It is also observed that published research studies and trails on progressive muscle relaxation in Indian setting are very much limited. Hence this study may have considered importance in providing empirical evidence about efficacy of relaxation technique in reducing post-operative pain and anxiety in patients undergone abdominal surgeries.

Statement of the problem
A study to assess the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam.

Objectives
To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients.

To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients.

To find out the association between pretest anxiety scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

Operational definition
Effectiveness
Effectiveness is defined as the ability of an intervention to produce the desired beneficial effect in actual use.10
In this study effectiveness refers to the extent to which the progressive muscle relaxation exercise has reduced post-operative pain and anxiety among patients who have undergone abdominal surgery.

Progressive muscle relaxation
Progressive muscle relaxation exercise is a technique of mentally focusing major muscle groups and telling them to relax. It involves a repetitive process beginning with the muscles of the feet and working to the muscles of the head and face.
Anxiety
The unpleasant emotional state consisting of psyco physiological response to anticipation of unreal or imagined danger ostensibly resulting from unrecognized intra conflict. In this study anxiety refers to the subjective feeling of uneasiness experienced by patients under gone surgery and is measured using state trait anxiety inventory
Pain
Post-operative pain is the pain experienced after surgery which is an unpleasant sensation associated with actual or potential tissue damage and is mediated by the specific nerve fiber to the brain where its conscious appreciation may be modified by various factors.
In this study post-operative pain refers to unpleasant emotions and sensation experienced out of bed and is measured using Numerical pain scale.

Post abdominal surgery patients
Abdominal surgery is a person who underwent surgical procedure pertaining to abdomen.

In this study patient who has undergone abdominal surgery’s like laparotomy, appendectomy, hernioplasty admitted in the surgical intensive care unit and surgical ward of selected hospitals.

HYPOTHESES
H1- There will be significant difference between mean pretest anxiety scores and posttest anxiety scores among the experimental group.

H2-There will be significant difference between mean pretest pain score and posttest pain scores among the experimental group.
H3 – There will be significant difference between posttest anxiety scores in experimental group and control group.

H4- There will be significance difference between posttest pain scores in experimental and control group.

H5- There will be significant association between pretest anxiety scores with selected demographic variables likes age, gender, education, type of family, marital status and religion.

H6- There will be significant association between pretest pain scores with selected demographic variables likes age, gender education, type of family, marital status and religion.

Conceptual frame work
A conceptual frame work is a theoretical approach to the study of problems that are scientifically based and emphasizes selection, arrangement and classification of concept .A conceptual framework state functional relationship between events and is not limited to statistical relationships.

The present study aim at to evaluating the effect of Benson muscle relation technique on post-operative pain and anxiety among patient who have undergone abdominal surgery .The conceptual frame work of present study is based on Roy’s Adaptation model by sister callista Roy for formulating the conceptual framework. The main concepts in this model includes
System
A system is a set of parts connected to function as a whole for some purpose and that does so by virtue of the interdependence of its parts .In addition to having wholeness and related parts, system also have inputs, outputs, and control and feedback processes
In this study post abdominal surgery patients selected as samples are considered as the human system.

Adaptation level
A person’s adaptation level a constantly changing point, made up of focal ,contextual, and residual stimuli with represent the persons own standard of the range of stimuli to which one can respond with ordinary adaptive responses.

Focal stimuli
The focal stimulus is the internal or external stimuli most immediately confronting the human system. In this research study abdominal surgery is considered as a focal stimulus.

Contextual stimulus
They are all other stimuli present in the situation that contribute to the effect of the focal stimuli. In this research study age, gender, education, marital status, family history ,religion were considered as contextual stimulus that affect the anxiety and pain regarding post abdominal surgery patients
Residual stimulus
Residual stimuli are environmental factors within or without the human system with effects in the current situation that are unclear. In this research study lack of knowledge regarding self-control of pain considered as a residual stimuli
-230588296186FOCAL STIMULUS
Abdominal surgery
00FOCAL STIMULUS
Abdominal surgery
6329237320040Decreased pain and anxiety in experimental group
0Decreased pain and anxiety in experimental group
INPUTTHROUHG PUTOUT PUT
2846567190445PMR for Experimental group
0PMR for Experimental group

1502327140059
6090672289146-31780410795CONTEXTUAL
STIMULUS
Age
Gender
Education
Marital status
Type of family
Religion
M
00CONTEXTUAL
STIMULUS
Age
Gender
Education
Marital status
Type of family
Religion
M

392733712702846567128740001454785128270Pretest for Both experimental and control group
00Pretest for Both experimental and control group
4244975214878Posttest for both Experimental and Control group after 7 days
Posttest for both Experimental and Control group after 7 days

103322813004069327369000No significant reduction of pain and anxiety scores in control group
No significant reduction of pain and anxiety scores in control group

60906992101024030842273713
8916323277218843042825828927825709525002846567277633No PMR for Control group
0No PMR for Control group

1454757222637
-561278258786RESIDUAL
STIMULUS
Lack of knowledge about self-control of pain
0RESIDUAL
STIMULUS
Lack of knowledge about self-control of pain

169940423352400FEED BACK
Fig 1:Schematic representation of conceptual framework based on Roy’s Adaptation Model
CHAPTER 2
REVIEW OF LITERATURE
The literature review in a research report is a summary of recent knowledge about a particular practice problem and includes what is known and not known about the problem. A review of research and non research literature relevant to the study was undertaken, which helped the investigator to develop an insight into the problem and again information on what has been done in the past. Review of literature has provided the researcher an in depth knowledge and insight into the given problem.

This chapter dealt with selected quantitative and qualitative studies and supporting literatures from written textbooks, published articles in journals and online databases.

The review of literature in this study was done under following headings
1.The review of literature related to progressive muscle relaxation exercise
2. The review of literature related to effectiveness of progressive muscle relaxation exercise on anxiety among postoperative patients.

3. The review of literature related to effectiveness of progressive muscle relaxation exercise on pain among postoperative patients.

The review of literature related to progressive muscle relaxation exercise

A quasi experimental study was conducted to assess the effect of Benson Relaxation on Quality of Life of Patients with Irritable Bowel Syndrome. Total 46 sample were collected using simple random sampling technique . The results indicated the mean total quality of life score in test group after intervention was changed from 93.13 to 57.61 while the control group was changed from 105.65 to 96.43 (P?0.001). There was a significant difference in six dimensions of quality of life including dysphoria (P ? 0.001), social reaction (P ? 0.001), health worry (P ? 0.001), body image (P ? 0.001), interpersonal relation (P = 0.004) and activities interference (P = 0.001) between the two groups, but no significant difference was found in food abstinence (P = 0.244) and sexual worry (P = 0.830). The findings showed that Benson relaxation training might be an effective therapy for improving quality of life in patients with IBS14
A quasi experimental study was conducted to assess use of the “progressive muscle relaxation” technique for pain relief in gynecology and obstetrics . Total 61 sample were collected using purposive random sampling technique. Among which 52.5% had gynecological nature and 47.5% obstetrical. The result shows that 85.3% of patients were got pain relief by the use of this technique and 14.7% of people has no effect on pain15
A quasi experimental study was conducted to assess the effect of progressive muscle relaxation technique on pain relief during labor in Fatemieh hospital .Total 62 samples were collected using convenience sampling technique. The statistical analysis of data showed significant difference in intensity of pain between the experimental and control groups (P = 0.0001). Also there was a significant difference in behavioral reactions between the two groups (P ; 0.0001)16
A quasi experimental study was conducted to evaluating the effectiveness of using Progressive Muscle Relaxation Technique in Reducing the Pain of Multiple Sclerosis Patients. Total 70 sample were collected using purposing sampling technique .The independent t test indicated that there was no significant difference in the amount of subjective pain perceived by experimental and control groups before the intervention p?;?0.05, while the same test showed a significant difference in the pain experienced following the intervention p?=?0.001. The paired t test within groups also showed a significant reduction in the pain perceived by the patients in the experimental group 3?months after the intervention p?=?0.001, while no significant difference was seen in the amount of pain experienced by patients in the control group p?;?0.05.17
A quasi experimental study was conducted to assess the effects of Progressive Muscle Relaxation Training on Anxiety and Depression in Patients enrolled in an Outpatient Pulmonary Rehabilitation Program .Total 83 sample were collected using purposing sampling technique . There was an overall significant improvement within each group over time (p ; 0.0001). There was no statistically significant group-time interaction (p = 0.17) and no statistically significant difference between the groups (p = 0.22), despite lower scores for every time point in the PMR group. For depression, there was an overall significant improvement within each group over time (p ; 0.0001). Although the difference between the groups (p = 0.09) and group-time interaction (p = 0.07) did not reach statistical significance, the results again favored the PMR group for weeks 5–8. Depression scores were lower for the PMR throughout weeks 1–8. PR is effective in reducing anxiety and depressive level in chronic lung patients.18
A quasi experimental study was conducted to assess efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia. Total 18 sample were collected using simple random sampling technique. The degree of anxiety improvement was significantly higher in the progressive muscle relaxation training group than in the control group after progressive muscle relaxation training intervention (p?;?0·0001) and at follow?up (p=0·0446); the mean BAI score fell from 16·4 pretest to ?5·8 post?test.. This study demonstrated that progressive muscle relaxation training can effectively alleviate anxiety in patients with schizophrenia. 19
A quasi experimental study was conducted to assess the effect of Benson’s relaxation method on hemodialysis patients’ anxiety, Total 105 sample were collected using purposing sampling technique. The mean of hidden and obvious anxiety marks changes showed a significant difference after intervention in relaxation group (P=0.001) but it was not significant in control group. The mean of total anxiety marks also did not show a significant difference after the intervention than before it in relaxation group based on paired sample t-test (P=0.001). Results of the study exhibited that using Bensons relaxation can be effective for declining and controlling hemodialysis patients’ anxiety.20
A quasi experimental study was conducted to assess the effect of Benson relaxation technique on the preoperative anxiety and hemodynamic status., Total 166 sample were collected using purposing sampling technique. The baseline clinical characteristics of the patients in the intervention and control groups were nearly the same. The mean systolic and diastolic blood pressure, pulse pressure, the average number of heart rates and respiratory rates declined significantly in the intervention group compared to the control group (P < 0.001). The mean score of hospital anxiety was significantly lower in the intervention group than in the control group (P < 0.001).21

A true experimental study was conducted to assess Benson’s relaxation effect in comparing to systematic desensitization on anxiety of female nurses. The Total 72 sample were collected using purposing sampling technique The result indicated that there was no significance difference in pretrait and prestate anxiety among the participate scores. In addition, the education level was no significant in three groups (P = 0.594). Therefore, the randomization method was adequate for random allocation of recruited individuals in three groups. The ANOVA was conducted to compare the posttrait and poststate anxiety among three groups. The F-test showed that a significant difference among three groups regarding scores of posttrait and poststate anxiety (P; 0.05). Moreover, the changes of scores in trait and state anxiety were statistically significant (P; 0.05). The Tukey post hoc test was used to compare groups one by one, and the results showed that Benson’s relaxation method was similar to systematic desensitization method in decreasing the trait and state anxiety score (P = 0.903). Therefore, both Benson’s relaxation and systematic desensitization intervention methods were effective in decreasing of the anxiety score of nurses.22
A quasi experimental study was conducted to assess efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients simple randomization technique was used to select the sample. Total 138sample were collected using purposing sampling technique. Out of 88 patients, 80 completed at least 55 sessions and were included in analysis. The samples comprised 44 male (55%) and 36 females (45%) and age mean was 47.98 ± 12.53. There was no significant difference in demographic characters between two groups. The comparison of two mean scores before and after intervention in terms of pain, stress, and anxiety showed a significant difference (P ; 0.001). Amongst the control group, there was no significant difference in two time frame scores (P ; 028, P ; 0.11, and P ; 0.18) . There was a correlation between pain and stress (r = 0.563), anxiety and pain (r = 0.489), age and pain (r = 0.268), anxiety and stress (r = 0.919), anxiety and age (r = 0.505), anxiety and dialysis duration (r = ?279), anxiety and income (r = ?0.299), stress and age (r = 0.393), stress and dialysis duration (r = ?198. 23
A study was done to assess the prevalence and course of postoperative pain in the early post operative period after ambulatory surgery. Over period of 4 months ,648 patients who underwent day-case surgery were included in the study. Data were collected with interviews and questionnaires. Pain intensity was measured using a visual analogue scale (VAS) during 4 days after surgery .On the day of operation 26 % of the patients had moderate to severe pain (defined as mean VAS;40).Mean VAS – score were greater than 40 mm in 21 % on postoperative day 1, in 13 % on POD 2 in 10% on POD 3 and in 9 % on POD 4.Operations of nose and pharynx, abdominal operations, plastic surgery of the breast and orthopedic operations were the most painful procedures during the first 48 hours .The study shows that an important number of patients still experience moderate to severe pain in post postoperative period after day case surgery even after a 4 day period24
Progressive muscle relaxation technique and anxiety in post-operative patients
A quasi experimental study was conducted to assess the effectiveness of progressive muscle relaxation therapy in reducing stress among patients with abdominal surgery for cancer treatment from selected hospital in Chennai. 60 samples were collected on basis of purposive sample technique .The mean level of stress (82.04) after the use of PMRT was lower than the mean level of stress (112.43) before the use of PMRT. The findings imply that the PMRT had a significant effect in reducing the stress of patients with cancer. The mean posttest level of stress in experimental group (82.04 ) was lower than the mean posttest level of stress in control group. The study found that there was no association between decrease in the level of stress and selected demographic variables.25
A quasi experimental study was conducted to assess effect of progressive muscle relaxation technique on stress, anxiety, and depression after hysterectomy in selected hospitals. Sample size was 80. Purposive sampling technique was used. The study revealed that as much as 42.5% of the study ; 40% of the control groups had very severe stress before the intervention. After intervention, the study group has attained nearly 50% decrease in the stress mean score (8.200± 3.568) as with the control group (14.575 ± 3.889). Before the intervention, almost equal proportions (37% and 35%) of the study and control groups respectively, had very severe total score of anxiety. After intervention, such difference between both groups was found to be statistically significant (p ; .0000). Where, 35% of the control group still had severe anxiety in comparison with 5% of the study group, it can be concluded that women who received progressive muscle relaxation technique after hysterectomy demonstrated lower stress, anxiety and depression levels than those who received only the routine nursing care.26
A quasi experimental study was conducted to assess study the effect of progressive muscle relaxation training of patients after stoma surgery, Total 10 sample were collected using purposing sampling technique. There was a significant decrease in both the C?STAI score (F = 4.66, P ; 0.05) and the WHOQoL score (F = 4.74, P ; 0.05) in the experimental group. Among the domains of WHOQoL, a significant difference was shown in physical health/independence and general perception of QoL, with the experimental group demonstrating better functioning there was no significant difference between the control and experimental groups. The results suggest that the use of PMRT could enhance quality of life and decrease state anxiety in patients after stoma surgery.27
A quasi experimental study was conducted to assess the effect of Benson relaxation technique on the anxiety of patient undergoing coronary angiography, Total 70 sample were collected using purposing sampling technique. Use of Benson relaxation technique significantly decreased anxiety in the intervention group ( p=0.001) However no significant difference was in systolic blood pressure, respiratory rate and heart beat parameter between the study group( p=0.0001). According to the result of the study use Benson’s relaxation technique before coronary angiography reduced the level of anxiety in the patient ,Therefore this complimentary approach could be used as an effective health care measures without any side effect to provide mental support for patient before invasive procedures.28
A quasi experimental study was to conducted to assess effects of Progressive Muscle Relaxation Intervention in extremity fracture surgery Patients. Total 84 sample were collected using simple random sampling technique. Progressive muscle relaxation is effective in reducing state anxiety and enhancing the self efficacy of patients with extremity fracture undergoing an elective surgery. The average age of participants was 36.71 years (SD = 13.41) in control group and 3There were 25 participants who scored between 41 and 47 points on the measure of state anxiety, accounting for 29.8%; 23 participants scored >47 points, accounting for 27.4% in this study. A sample t test in the present study indicated that the state anxiety levels of patients scheduled for an elective extremity fracture surgery were higher than the general population (t = 6.061, p = .000) This study was on the basis of the fracture patients’ inpatient stay. PMRT was applied in PMRT group within 48 hr of admission into the hospital until dis-charge from the hospital. The PMRT group and the control group showed significant improvement in state anxiety at discharge compared with at admission (p ; .05). The PMRT group also showed 10 Western Journal of Nursing Research significant improvement in self-efficacy at discharge (p ; .01); by contrast, the control group showed no statistically significant improvement in self-efficacy at discharge (p ;.05)29
A quasi experimental study was conduct to assess the effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients. Total 59 sample were collected using simple random sampling technique. The State Trait Anxiety Inventory and two Quality of Life Scales were used to collect the data of interest in three occasions, namely during hospitalization, at week 5 and at week 10 post?surgery. The use of PMRT significantly decreased state anxiety and improved generic quality of life in the experimental group (P;0.05), especially in the domains of physical health, psychological health, social concerns and environment. This may be a cost?effective intervention that needs minimal training and could easily be offered to those patients that they would like to use it as part of the specialist care provided to stoma patients.30
Progressive muscle relaxation and pain in post-operative patients
A Cross sectional study was conducted to assess the effect of Relaxation Exercises on controlling postoperative pain. Total 60 sample were collected using cross over technique in patient underwent upper abdominal surgery. Pain levels were found to be reduced after the relaxation exercises compared with the levels before the relaxation exercises (z = -5.497; p ; .001) Relaxation exercises, a non pharmacologic method, are effective in reducing postoperative pain and should therefore be included in a regimen to control postoperative pain in patients who have undergone upper abdominal surgery31
A quasi experiment study to assess the effect of Benson Relaxation Technique in reducing pain intensity in women after cesarean section. Simple randomized technique was used to select the sample. The total sampling size was 60. The mean of pain score before intervention at CG was 4.43 cm. It was decreased to 4.40 cm (1 min), 4.27 cm (12 h), 4.10 cm (24 h), 4.00 cm (36 h), 3.93 cm (48 h), 3.83 cm (60 h), 3.67 cm (72 h) and 3.51 cm (84 h). Meanwhile, the IG was 4.97 cm. It was decreased to 4.90 cm (1 min), 4.23 cm (12 h), 3.57 cm (24 h), 3.03 cm (36 h), 2.77 cm (48 h), 2.73 cm (60 h), 2.67 cm (72 h) and 2.63 cm (84 h). The study results found that significant difference comparing pain intensity before and after the intervention in CG and IG (P = 0.001), but pain reduced in IG more than CG the Benson relaxation could reduce pain intensity in women after cesarean section.32
A quasi experimental study was conducted to effect of the Benson’s relaxation technique on the pain severity after laminectomy surgery in AJA hospitals. Total 62 sample were collected using simple random sampling technique was used to select the sample. The study showed that the mean pain intensity after the first stage of the intervention was 37.5±76.1 in the experimental group and 77.6±17.1 in the control group, after the second stage of the intervention 80.4 ± 25.1 in the experimental group and 5.77±1.47 in the control group and after the third stage of the intervention was 67.3±14.1 in the experimental group and 06.5±92.0 in the control group. The Benson’s relaxation technique had a positive and significant effect on pain severity in this group of patients after all three intervention stages33.
A quasi experimental study to assess the progressive muscle relaxation and pain perception in abdominal surgery patients. Total 21 sample were collected using convenient sampling technique was used. Mean age of the entire sample was 38.23 years (SD = 11.27 range 23-64 years). The mean age of the experimental group was 39.00 (SD = 12.12; range 25-64 years). Th e mean age of the control group was 37.40 (SD = 10.85; range 23-54 years). There was no significant age difference in the experimental and control groups (t = 0.32, p = 0.75). referA true experimental study was conducted to evaluate the effectiveness of pain and stress among post caesarean mother admitted at selected hospital, pudukkottai. Simple random sampling technique was used. Sample size was 60. Among the experimental group of post caesarean mothers in the pretest majority about 73.33% of the post caesarean mothers had severe pain, 26.66% of the post caesarean mothers had moderate pain. Where as in control group about 76.66% of the post caesarean mothers had severe pain, 23.33% of the post caesarean mothers had moderate pain. In pretest among the experimental group the mean pain score was 7.56+ 1.56 and mean percentage was75.6. Where as in control group mean pain score was 7.68+ 1.48 and mean percentage was 76.8.In posttest among experimental group, the mean pain score was 1.73+0.81 and mean percentage was 17.3. where as in control group the mean pain score was 3.13+2.16 and mean percentage was 31.3.

A quasi experimental study was conduct to the effect of Benson Relaxation on reduction of pain level among post caesarean section mother at Cibabat Hospital, Indonesia. Total 60 samples were collected using quota sampling technique. The mean of pain before intervention was 4.97 cm. It was decreased to 2.63 cm. The study found a significantly different comparing of pain intensity before and after intervention (p = 0,000). The Benson relaxation can reduce the pain intensity state among client with cesarean section.

A quasi experimental study was conducted to assess the Effect of Benson’s Relaxation Technique on night pain and sleep quality among adults and elderly patients Undergoing Joints Replacement Surgery. Total 100 samples were collected using simple random sampling technique. The study results stated that there was an improvement in pain scores among the study group subjects at one day postoperative while there was a statistical significant difference was existed between study and control groups regarding pain intensity at 3rd postoperative day after implementation of Benson’s relaxation Technique.

CHAPTER 3
METHODOLOGY
Research methodology is the systematic way of doing a research to solve problem and it provides fundamental base of a research on intervention. A well structured methodology gives the research process a way to proceed appropriately.

This chapter deals with the method adopted for the present study, the research approach, research design, setting of the study, description of the population, sampling technique, development of the tool, pilot study, procedure for the data collection and plan for data analysis.

Research approach
Research approach indicates the basic procedure for conducting research. The choice of the appropriate approach depends on the purpose of the study.

The present study aimed to determine the effectiveness of progressive muscle relaxation therapy on anxiety and pain among abdominal surgery patients in selected hospital, Kollam. Quantitative approach was considered to be most appropriate approach to find out the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam.

Research Design
Research design is the overall plan for addressing a research question, including specifications for enhancing the study’s integrity. The research design used in this study was quasi experimental pretest posttest control group research design.

Non-randomized pretest posttest control group design
E O1 X O2
C O1 – O2
Key
E-Experimental group
C-Control group
X-Progressive muscle relaxation exercise (Benson muscle relaxation technique)
O1-Pretest
O2-posttest
Variables
A variable is an attribute that varies, that is, takes on different values. Variables are the central building blocks of quantitative studies.

In this study three types of variables were identified, they are
1. Independent variable
2. Dependent Variable
3. Demographic variables
Independent variables
Independent variable is the variable that is believed to cause or influence the dependent variable; in experimental research, the manipulated (treatment) variable.

In this study independent variable is progressive muscle relaxation
Dependent variables
The variable hypothesized to depend on or be caused by another variable (the independent variable). It is otherwise called as the outcome variable of interest.

In this study dependent variable is anxiety and pain.
Demographic variables
Characteristics or attributes of subjects that are collected to describe the sample are called as demographic variables.
In this study it refers to the base line variables of the subjects such as age in years, gender, education, marital status, type of family, religion.

Settings of the study
Setting is the physical location and conditions in which data collection takes place in a study. The setting of the present study is the selected hospitals in Kollam, under Bishop Benziger Hospital, Kollam as experimental group and Upasana hospital Kollam as control group. The researcher selected the setting based on the familiarity of the place, easy of getting permission for conducting the study, feasibility and availability of the study participants.

Population
A population is the entire aggregation of cases in which a researcher is interested. It is the entire set of individuals or objects having some common characteristics; sometimes called universe. The term population refers to the aggregate or totality of those conforming to a set of specifications
In the present study the population were the post abdominal surgery patients..Sample and sampling techniques
Sample
A sample is a subset of a population, selected to participate in a study and the members of the samples are subjects.

In this study sample consists of 60 post abdominal surgery patients in hospital out of this 30 in experimental group and 30 in control group.
Sampling technique
Sampling is the process of selecting a portion of the population to represent the entire population so that the inference about the entire population is made.

In this research study purposive sampling technique was used for sample selection
Purposive sampling technique is the method of non probability sampling, in which subjects are choosen to be part of the sample with a specific purpose in mind.

Criteria for selection of samples
The sample selection is based up on the inclusion criteria and exclusion criteria
Inclusion criteria
All post abdominal surgery patients like laparotomy, appendectomy, hernioplasty.

Patients who can follow its instruction and practice the relaxation technique.

Exclusion criteria
Patients who received or practice any other relaxation therapy.

Patients who are having any medical contra indications for performing relaxation technique.

Those patients who have any complication.

Tool/Instruments
Tool or instrument is a device used to collect data to observe or measure the key variables in the research problem.

Development of baseline proformaBased on the objectives, demographic and clinical proforma State Anxiety scale of Spiel Berg’s Trait Anxiety Inventory and Numerical pain scale were prepared administered to patients who have undergone abdominal surgery. The baseline proforma used was a structured interview schedule and the following steps were involved in the development of the tool.

Review of literature
Preparation of first draft
Personal consultation and discussion with nursing experts and guide
preparation of criteria check list
Content validation of tool
Translation of tool to Malayalam
Retranslation of tool to English
Reliability testing of the tool
preparation of final draft
Selection of standardized tool for pain and anxiety
Various standardized scales on anxiety were reviewed, specific to surgical population and pain scale specific to post operative ambulation. After review state anxiety scale of State Trait Anxiety Inventory and Numerical pain scale were selected and obtain permission to use. Both scales met the requirements objective of study and found to be relevant to the population under study.

Description of tool
Tool used in study were
Part 1: Consisted of baseline profoma, which was a structured interview schedule to collect information regarding the patient who has undergone abdominal surgery. The demographic variables included were age, gender, education, type of family, marital status, religion whereas the clinical variables were previous major surgery, number of previous hospitalization ,use of analgesics.

Part II: Consisted of tool to assess the anxiety among the patient undergone abdominal surgery. The tool used was State anxiety scale of Spiel Berg Trait anxiety Inventory it was developed by spielberger, Gorsuch and Lushene(1970) to provide reliable ,relative brief ,self report scale for assessing both strait and trait anxiety.
In present study 20 item S –Anxiety scale was used .In responding to S anxiety scale, samples were instruct to respond how you feel right now, that is at this moment by rating the intensity of their feeling on A four point pain scale which include (1) not at all,(2)mild somewhat(3) moderately so (4) very much so. For each S Anxiety items, samples were asked to circle the number that best describes the intensity of their pretest feelings .Maximum score is 80 and minimum score is 20.

Content validity
Content validity refers to the degree to which the items in an instrument adequately represent the universe of content for the concept being measured. Content validity assures that the content area covered in the tool are appropriate complete and useful for the particular phenomenon being studied. Along with research synopsis, progressive muscle relaxation and the prepared tool containing the demographic information, Spel anxiety scale and Numerical pain scale to assess practice were given to experts for content validation. The experts included are 2 surgeon, 1psychologist, 4 nursing experts and 2 language expert for language validation. The evaluators are requested to go through each item and give the necessary corrections and their valuable suggestions to improve the content validity of the tool. Based on the suggestions and opinions from the experts one question is added and the necessary corrections are done in the tool. Majority of items got 100 percent agreement from the experts, and certain questions got 85.71%, and 71.42%.After content validity suggestions, corrections and modifications done in the items was found to be valid.

Reliability
Reliability refers to the degree of consistency or dependability with which an instrument measures an attribute.

Reliability is the ability of an instrument to create reproducible results. After obtaining permission from Sree Narayana medical trust the tool was administered among post abdominal surgery patients. Reliability was established by test retest method .The anxiety reliability is 0.71.The pain reliability is 0.74.

Pilot study
Pilot study is gathering of information to address a research problem. The research study synopsis, tool, informed consent for the study were presented before the medical officers of Sree Narayana Trust Medical Mission Hospital and Holy cross Hospital, Kollam along with the permission seeking letter. Pilot study was done in Sree Narayana Trust Medical Mission Hospital and Holy cross Hospital from 6/11/17 to 12/11/17. The experimental group included 3samples from Sree Narayan Trust Mission and 3 samples from Holy cross hospital were included under the control group the samples were selected based on inclusion and exclusion criteria on the 2nd postoperative day total of 6 samples were taken. Informed consent was taken from the samples prior to the pretest after giving proper instruction regarding Benson muscle relaxation technique the researcher help the patient is to perform this relaxation technique for 20 minutes in a day and this was continued for consecutive 7 days. The pretest includes the anxiety and pain of the experimental and control group were analyzed using Spielberg’s trait anxiety inventory and numerical pain scale. The post test was done on the 7th postoperative day for both experimental and control group the data were analyzed using description (mean, mediam, standard deviation and inferential statistics (chi-square).

The study was found to be feasible and practicable with few modifications. The investigator then proceeds for the main study.

Data collection process
Data collection is the process of acquiring and collecting information needed for the study from the subjects.

The data was collected after obtaining prior administrative permission and informed consent from the patients. The data collection period extended from 04/12/17 to 30/12/17. A total of 60 were taken (30 samples in experimental group from Bishop Benziger hospital, Kollam and 30 samples in control group from Upasana hospital, Kollam). Samples were taken by purposive sampling method based on inclusion criteria. Informed consent was taken from the samples and pretest is administered. Immediately after the pretest progressive muscle relaxation of 20 minutes was given samples in experimental group. For control group progressive muscle relaxation was not given. On the 7th day posttest was done in both experimental and control group.

Plan for data analysis
Data analysis is the technique used to reduce, organize and give meaning to. Data collecting will be entered into the master sheet. The data analysis will be done by using descriptive and inferential statistical method based on the hypothesis of the research study. For presenting the analysed data, figures, graphs, tables will be used. The analysis will be conducted as follows,
Using frequency distribution and percentage demographic data will be analysed.

Evaluation of mean pretest and posttest anxiety scores among post abdominal surgery patients in experimental group were using paired t test.

Evaluation of mean pretest and posttest pain scores among post abdominal surgery patients in experimental group were using paired t test.

Evaluation of mean posttest anxiety scores in the experimental and control group were analysed using unpaired t test.

Evaluation of mean posttest pain scores in the experimental and control group were analysed using unpaired t test.

Significant association between pretest anxiety scores with selected demographic variables likes age, gender, education, type of family, marital status and religion were analysed using chi-square.

Significant association between pretest pain scores with selected demographic variables likes age, gender, education, type of family, marital status and religion were analysed using chi-square.

.

CHAPTER IV
Analysis
Statement of the problem
A study to assess the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam.

Objectives
•To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients.

•To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients.

•To find out the association between pretest anxiety scores with selected demographic variable such as age, gender, education, type of family, marital status and religion.

•To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

HYPOTHESIS
•H1- There will be significant difference between mean pretest anxiety scores and posttest anxiety scores among the experimental group.

•H2-There will be significant difference between mean pretest pain score and posttest pain scores among the experimental group.
•H3 – There will be significant difference between posttest anxiety scores in experimental group and control group.

•H4- There will be significance difference between posttest pain scores in experimental and control group.

•H5- There will be significant association between pretest anxiety scores with selected demographic variables likes age, gender, education, type of family, marital status and religion.

•H6- There will be significant association between pretest pain scores with selected demographic variables likes age, gender education, type of family, marital status and religion.

Organization of findings
The collected information has organized and present as follows
Section A
Part I: Demographic perfoma will be analyzed using frequency and percentage distribution.

Section B: Paired t test will be used to determine the difference between the mean pretest and posttest anxiety and pain scores in experimental group.

Section C: Unpaired t test will be used to determine the difference in the mean pretest and posttest anxiety and pain scores in experimental and control group.

Section D: Chi-square will be used to determine the association between pretest anxiety and pretest pain score with selected demographic variables such as age, gender, education, type of family marital status and religion.

Analysis
Analysis include percentage and frequency distribution of demographic variables pretest and posttest anxiety scores of experimental group ,pretest and posttest pain scores.

Section A
This section deals with the frequency and percentage distribution of sample characteristics of 60 post abdominal surgery patients from sere Bishop benziger hospital and Upasana hospital ,Kollam according to age, gender, education, marital status, religion.

Table 1
Frequency and percentage distribution of demographic variables of samples
Category Experimental group Percentage
(%) Control group Percentage
(%)
Age group 20-30 5 16.66% 1 3.33%
31-40 10 33.33% 11 36.66%
41-50 3 10% 9 30%
51-60 7 23.33% 7 23.33%
61-70 5 16.66% 2 6.66%
Sex Male 14 46.66% 13 43.33%
Female 16 53.33% 17 56.66%
Education Illiterate Primary school 5 16.66% 5 16.66%
High school 5 16.66% 8 26.66%
Higher secondary school 10 33.33% 11 36.66%
Intermediate/Diploma 5 16.66% 5 16.66%
Graduate 4 13.33% 0 0
Post graduate 1 3.33% 1 3.33%
Type of family Nuclear family 17 56.66% 18 60%
Joint family 13 43.33% 12 40%
Religion Hindu 8 26.66% 4 13.33%
Christian 12 40% 13 43.33%
Muslim 10 33.33% 13 43.33%
Marital status Married 25 83.33% 27 90%
Unmarried 5 16.66% 3 10%
Widow/widower 0 0 0 0
N=60

Figure 1: Percentage distribution of Age among samples.

The data in figure 1 shows that in experimental group 16.66% of samples belong to 20-30 years, 33.33% belong to 31-40 years, 10% belong to 41-50 years, 23.33% belong to 51-60 years 16.66% belongs to 61-70 years. In control group 33.33% of samples belong to 20-30 years, 36.66% belong to 31-40 years, 30% belong to 41-50 years, 23.33% belong to 51-60 years and 6.66% belong to 61-70 years.

N=60

Figure 2: Percentage distribution of samples according to gender .

The data in figure 2 shows that in experimental group 46.66% of samples belong to male, 53.33% belong to female,. In control group 43.33% of samples belong to male, 56.66% belong to female.

Figure 3: Percentage distribution of education among samples.

The data in figure 3 shows that in experimental group 0% of samples belong to illiterate, 16.66% belong to primary school, 16.66% belong to 41-50 years, 23.33% belong to 51-60 years 16.66% belongs to 61-70 years. In control group 33.33% of samples belong to 20-30 years, 36.66% belong to 31-40 years, 30% belong to 41-50 years, 23.33% belong to 51-60 years and 6.66% belong to 61-70 years.

N=60

Figure 4 : Percentage distribution of type of family among samples.

Figure shows that 56.66% belongs to nuclear family and 43.33% in joint family in experimental group.40% belongs to joined family and 60% nuclear family in control group.

N=60

Figure shows that 26.66% belongs to Hindu in experimental group and 13.33% in control group 40% Christian in experimental group and 43.33% in control group, 33.33% Muslim in experimental group and 43.33% in control group.
N=60
Figure shows that 83.33% belongs to married in experimental group and 90% in control group.16.66% un married in experimental group and 10%% belongs to control group.

Section A
Part 2:Frequency and percentage distribution of anxiety score
Table 2: Frequency and percentage distribution of anxiety score in experimental group
Level of
anxiety Pretest Posttest
Frequency Percentage Frequency Percentage
Mild 1 3.33% 20 66%
Moderate 13 43% 6 20%
Sever 16 53% 4 13%
Data is the table 2 shows that pretest 3.33% had mild level anxiety,43% had moderate level anxiety,53% had sever level anxiety.In post test 66% had mild level anxiety,20% had moderate level anxiety,13% had sever level anxiety
Table 3: Frequency and percentage distribution of anxiety score in control group
n= 30
Level of
Anxiety Pretest Posttest

Frequency Percentage Frequency Percentage
Mild
1 3.33% 1 3.33%
Moderate
7 23% 6 20%
Severe 23 77% 23 76%
Data is the table 3 shows that pretest 3.33% had mild level anxiety,23% had moderate level anxiety,77% had sever level anxiety. In posttest 3.33% had mild level anxiety,20% had moderate level anxiety,76% had sever level anxiety.

Part 2:Frequency and percentage distribution of pain score
Table 4: Frequency and percentage distribution of pain score in experimental group
n= 30
Level of
Pain Pretest Posttest
Frequency
Percentage Frequency Percentage
Mild
0
0 9 30%
Moderate
3 10% 21 70%
Severe 27 90% 0 0
Data is the table 4 shows that pretest no mild level pain,10% had moderate level pain ,90% had sever level pain . In posttest 30% had mild level pain ,70% had moderate level pain, no sever level pain
Table 5: Frequency and percentage distribution of pain score in control group
n=30
Level of pain Pretest Posttest
Frequency
Percentage Frequency Percentage
Mild
0 0 0 0
Moderate
12 40% 11 37%
Severe
17 57% 18 60%
Data is the table 5 shows that pretest no mild level pain,40% had moderate level pain ,57% had sever level pain . In post test no mild level pain ,37% had moderate level pain,60% hsad sever level pain
Section B
Mean,standard deviation and t value of pretest and posttest anxiety score in experimental group
Mean Standard deviation T value
Pre-test 62.645 9.870 6.615
Posttest
40.517 15.649 Tabulated value at 0.05 significant level is 2.05 since the calculated value is greater than table value. There is significant difference between mean pretest anxiety scores and posttest anxiety scores among the experimental group. Hence H1 is accepted.

Mean, standard deviation and t value of pretest and posttest pain score in experimental group
Mean Standard deviation t value
Pre-test
7.607 0.916 14.21
Posttest 4.11 1.012 Tabulated t= 2.05, p<0.05
Tabulated value at 0.05 significant level is 2.05.Since the calculated value is greater than table value, there is significant difference between mean pretest pain scores and posttest pain scores among the experimental group. Hence H2 is accepted
Section c
Mean standard deviation and t value of mean posttest anxiety score in experimental and control group
Mean Standard deviation t test
Experimental group 40.517
15.649 2.26
Control group 54.625 6.350 Tabulated value at 0.05 significant level is 2.05 since the calculated value is greater than table value. There is no significant difference between posttest anxiety scores in experimental group and control group. Hence H3 is not accepted .Section c
Mean standard deviation and t value of mean posttest pain score in experimental and control group
Mean Standard deviation t test
Experimental group 3.96 1.0080 8.68
Control group 6.66 1.3729 Tabulated value at 0.05 significant levels is 2.05 since the calculated value greater than table value. There is no significant difference between posttest pain scores in experimental group and control group.H4 is not accepted.

Section D
Chi square value showing association between pretest anxiety scores with selected demographic variables likes age, gender, education, type of family, marital status and religion
Slno Demographic
variables No anxiety Mild anxiety Moderate anxiety Sever anxiety dfChi-square Table
Value Significance
1 Age
20-30 0 0 1 5 31-40 0 2 2 18 8 12.649 15.51 NS
41-50 0 0 3 10 51-60 0 0 6 5 61-70 0 0 4 5 2 Gender Male 0 1 5 22 2 0.450 5.99 NS
Female 0 1 8 23 3 Type of family Nuclear family 0 1 8 30 2 11.293 5.99 S
Joint family 0 1 6 14 Others 0 0 0 4 Marital status Married 0 2 12 40 4 3.207 9.49 NS
Unmarried 0 0 1 5 5 Religion Hindu 0 1 6 6 Christian 0 1 5 18 4 7.468 9.49 NS
Muslim 3 20 Others Table shows that age chi square value is 12.649 table value greater than calculated value so significance. sex chi-square value is 0.450 table value less than calculated value so no significance education chi square value is 11.736 table value greater than calculated value so there is significance marital status chi square value is 3.207 table value greater than calculated value so there is significance religion 7.368 table value is greater than calculated value so there is significant. Type of family chi-square value is 11.293 table value greater than calculated value so there is significant.

Chi square value showing association between pretest pain scores with selected demographic variables likes age, gender education, type of family, marital status and religion
Slno Demographic
variables No pain Mild pain Moderate pain Sever pain dfChi-square Table
Value Significance
1 Age
20-30 0 0 1 5 31-40 0 1 2 19 8 6.572 15.51 NS
41-50 0 0 4 7 51-60 0 1 5 8 61-70 0 0 2 5 2 Gender Male 0 1 4 21 2 0.626 5.99 NS
Female 0 1 8 25 3 Type of family Nuclear family 0 1 10 24 2 0.571 5.99 NS
Joint family 0 1 5 19 Others 0 0 0 0 4 Marital status Married 0 1 10 39 1 0.091 3.84 NS
Unmarried 0 1 1 4 5 Religion Hindu 0 0 1 12 Christian 0 0 9 16 4 3.71 9.49 NS
Muslim 0 0 6 17 Others 0 0 0 0 Table shows that age chi-square value is 6.572 table value is greater than calculated value so there is significance. Sex chi-square value is not compute .education chi-square value is 52.372 table value is greater than calculated value so there is significance. Type of family chi square value is not compute marital status chi square value is not compute religion chi-square value is3.71 table value greater than calculated value so there is significance.

CHAPTER 5
RESULT
This study was conducted to assess the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam. This chapter discusses major results and findings of the research study.

Objectives
•To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients.

•To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients
•To find out the association between pretest anxiety scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

•To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

Hypotheses
All hypothesis were tested at a 0.05 level of significance
H1- There will be significant difference between mean pretest anxiety scores and posttest anxiety scores among the experimental group.

H2-There will be significant difference between mean pretest pain score and posttest pain scores among the experimental group.
H3 – There will be significant difference between posttest anxiety scores in experimental group and control group.

H4- There will be significance difference between posttest pain scores in experimental and control group.

H5- There will be significant association between pretest anxiety scores with selected demographic variables likes age, gender, education, type of family, marital status and religion.

H6- There will be significant association between pretest pain scores with selected demographic variables likes age, gender education, type of family, marital status and religion.

Major findings of the study
Section A: Sample characteristics: Description of demographic variables under study
This section dealt with the results and findings of the sample characteristics of the present study. The sample characteristics include the demographic variables like age, gender, educational status, occupation, , Type of family, and available source of knowledge regarding the prevention of stroke.

Demographic data
The data shows that majority 69.99% belongs to 20-30 yrs group
Majority 109.99% belongs to females group
Majority 36.66% belongs to higher secondary education in control group .16.66% belongs to primary school in experimental group and 16.66% belongs in intermediate education in experimental group
Majority 116.66% belongs to nuclear family members
Majority 83.33% belongs to christens cartegory .

Majority 173.33%% belongs to married group
Section B: Evaluation of effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients
1 Comparison of the pre-test and post-test anxiety score of experimental group
The mean post-test anxiety score of experimental group (40.517±2.05) was higher than the mean pre-test scoring (62.645±3.21). The calculated ‘t’ value was greater than the table value at 0.05 level of significance. Hence the null hypothesis was rejected and research hypothesis was accepted. So there was statistically significant difference between the pre-test and post-test anxiety score of experimental group before and after progressive muscle relaxation technique. This shows that progressive muscle relaxation technique was effective in decrease among post abdominal surgery patient. The findings of the study revealed that there was significant difference in the anxiety score among abdominal surgery before and after progressive muscle relaxation technique in the experimental group. This suggests that progressive muscle relaxation was effective in decreasing anxiety regarding anxiety among post abdominal surgery patients.

2 Comparison of the pre-test and post-test pain score of experimental group
The mean post-test practice score of experimental group (4.11±4.35) was higher than the mean pre-test scoring (7.607±5.008). The calculated„t? value was greater than the table value at 0.05 level of significance. Hence the null hypothesis was rejected and research hypothesis was accepted. So there was statistically significant difference between the pre-test and post-test practice score of experimental group before and after progressive muscle relaxation technique. This shows that progressive muscle relaxation technique was effective in decreasing pain among post abdominal surgery patients .The findings of the study revealed that there was significant difference in the pre-test and post-test practice score among post abdominal surgery patients before and after progressive muscle relaxation technique in the experimental group. This suggests that progressive muscle relaxation was effective in decreasing pain among post abdominal surgery patients.

3 Comparisons of the post-test anxiety scores of experimental and control group
The mean post-test anxiety score of experimental group was (62.645±2.05) and the mean post-test anxiety score of control group was (54.625±4.71). The calculated unpaired’t’ value was greater than table value at 0.05 level of significance hence the null hypothesis was rejected, and research hypothesis was accepted. Hence there is a statistically significant difference in posttest anxiety score of experimental and control group. The findings show that there was a statistically significant difference in the mean post-test anxiety score of experimental group after progressive muscle relaxation when compared to the post-test anxiety score of control group.

4 Comparison of post-test pain scores of experimental and control group.

The mean post-test pain score of experimental group was (4.11±4.35) and the mean post-test pain score of control group was (1.391±5.33). The calculated unpaired’t’ value was greater than table value at 0.05 level of significance. Hence the null hypothesis was rejected and research hypothesis was accepted. So there is a statistically significant difference in posttest pain score of experimental and control group. The findings shows that there was a statistically significant difference in the mean post-test pain score of experimental group after progressive muscle relaxation technique when compared to the post-test pain score of control group.

Section C: Association between pretest anxiety score of sample with selected demographic variables like age, gender, educational, type of family , marital status , and religion
Association of anxiety and selected demographic variables
The association of anxiety and selected demographic variables like age, gender, type of family, marital status and religion, and anxiety among were computed by Chi-square. The Chi-square for age (12.649), gender (0.450), type of family (11.293) marital status (3.207), religion (7.368). Since the calculated chi-square value are greater than table value for age, gender, marital status ,type of family, and religion anxiety among post abdominal surgery patients there was a statistically significant association was found between these demographic variables and pre-test knowledge scores. So accepts the research hypothesis for these demographic variables.

Since the calculated chi-square value is lesser than table value for age, gender, marital status, religion, but type of family chi square value is greater than table value so null hypothesis is not accepted for these demographic variables. The findings of the study revealed that there is statistically significant association found between pre-test pain score with selected demographic variables like type of family.

Association between pretest pain score with selected demographic variables like age, gender, educational, , type of family , marital status , and religion
Association of pain and selected demographic variables
Association between pretest pain score with selected demographic variables like age, gender, education, type of family, marital status, and religion pain among post abdominal surgery were computed by chi-square. The calculated chi-square for age (6.572), gender (0.626), marital status (0.091), type of family (0.571), religion (3.71). Since the calculated chi-square value is greater than table value for type of family, the null hypothesis is rejected and research hypothesis was accepted for this demographic variable. So there is a significant association found between pre-test practice score with selected demographic variable type of family.

Since the calculated chi-square value is less than table value for age, gender, marital status, religion, null hypothesis is accepted for these demographic variables. The findings of the study revealed that there is no statistically significant association found between pre-test pain score with selected demographic variables like age, gender, marital status, religion.

CHAPTER 6
DISCUSSION, SUMMARY AND CONCLUSION
This chapter presents with the major findings of the study, discusses it with other similar studies conducted by various investigators which is followed by summarization, and conclusion of the findings. Implications of the study in nursing profession were discussed, along with that limitations are acknowledged and the recommendations for further research were included.

Discussion
The present study was conducted to assess the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam. To achieve the objectives of the study quasi experimental pre-test post-test research design was adopted. The sample size comprised of 60, where 30 samples in experimental group and 30 samples in control group. The findings of the study have been discussed in relation to the objectives and with other similar studies.

The objectives of the study were,
To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients.

To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients
To find out the association between pretest anxiety scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.
To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients.

A quasi experimental study was conducted to assess effect of progressive muscle relaxation technique on stress, anxiety, and depression after hysterectomy in selected hospitals. Sample size was 80. Purposive sampling technique was used. The study revealed that as much as 42.5% of the study & 40% of the control groups had very severe stress before the intervention. In the present study 76% of the control group had very sever anxiety before the intervention. After intervention, the study group has attained nearly 50% decrease in the stress mean score (8.200± 3.568) as with the control group (14.575 ± 3.889). After the intervention present study group attained 20% decrease in the anxiety mean (40.517±2.05) as with the control group (54.625±4.71). Before the intervention, almost equal proportions (37% and 35%) of the study and control groups respectively, had very severe total score of anxiety. After intervention, such difference between both groups was found to be statistically significant (p < .0000). Where, 35% of the control group still had severe anxiety in comparison with 5% of the study group, it can be concluded that women who received progressive muscle relaxation technique after hysterectomy demonstrated lower stress, anxiety and depression levels than those who received only the routine nursing care.

To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients
A Cross sectional study was conducted to assess the effect of Relaxation Exercises on controlling postoperative pain. In this study 60 sample were collected using cross over technique in patient underwent upper abdominal surgery. Pain levels were found to be reduced after the relaxation exercises compared with the levels before the relaxation exercises (z = -5.497; p < .001) .Present study also pain level were found to be reduced before the intervention90% sample had sever pain during the second postoperative day.After administration of progressive muscle relaxation exercise for 5 days the percentage of patient with the sever pain level reached zero.

To find out the association between pretest anxiety scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

A quasi experimental study was conducted to assess the effect of Benson’s relaxation method on hemodialysis patients’ anxiety, Total 105 sample were collected using purposing sampling technique. The mean of hidden and obvious anxiety marks changes showed a significant difference after intervention in relaxation group (P=0.001) but it was not significant in control group. The mean of total anxiety marks also did not show a significant difference after the intervention than before it in relaxation group based on paired sample t-test (P=0.001). Results of the study exhibited that using Bensons relaxation can be effective for declining and controlling hemodialysis patients’ anxiety.Mean age of research units was 42.73 ± 12.16 which were in age range from 20 to 60. Results of one sided variance showed that there is not a significant statistical difference between two groups regarding age (P;0.05). 59 men (56.19%) and 43 women (43.8%) were in two groups. Number of men and women were almost the same in relaxation group but in control group men (68.57%) comprised the majority of research units. 81 persons (77.14%) of research units were married so that married persons frequency per cent was (74.3%) in relaxation group and (80%) in control group. Considering the first purpose of this study according to even t-test, mean of obvious anxiety changes point did not show a significant difference after intervention than before the intervention in two relaxation groups (P=0.001) but it is not significant in control group. Bensons relaxation can be effective for declining and controlling hemodialysis patients’ anxiety. The researcher recommends the nurses to pay more attention to Banson’s relaxation method as a simple, cheap and effective one while taking care of the patients.
To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion.

The finding of the present study was supported by a quantitative study was conducted regarding to assess efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients simple randomization technique was used to select the sample. Total 138sample were collected using purposing sampling technique Out of 88 patients, 80 completed at least 55 sessions and were included in analysis. The samples comprised 44 male (55%) and 36 females (45%) and age mean was 47.98 ± 12.53. There was no significant difference in demographic characters between two groups for selecting samples .In present study also no significant difference in demographic characters male 14 (46.65) and 16 female (53.33%) . The comparison of two mean scores before and after intervention in terms of pain, stress, and anxiety showed a significant difference (P ; 0.001) for this study and present study
Summary
The present study was done to evaluate the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam. The objectives of the study were. To determine the effect of progressive muscle relaxation exercise on anxiety among post abdominal surgery patients. To determine the effect of progressive muscle relaxation exercise on pain among post abdominal surgery patients. To find out the association between pretest anxiety scores with selected demographic variables such as age, gender, education, type of family, marital status and religion. To find out the association between pretest pain scores with selected demographic variables such as age, gender, education, type of family, marital status and religion
The conceptual frame work of the study was based on the Roy?s adaptation model by Sister Callista Roy. The study made use of quantitative research approach with true experimental pre-test post-test research design to determine the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam.

The population includes post abdomen surgery patients in selected hospital Kollam who are meeting the inclusion criteria. Simple random sampling was used to select 60 samples for the study. The tools used were progressive muscle relaxation anxiety and pain scale including demographic data.

The pilot study was conducted on 10 samples with post abdominal surgery patients to confirm the feasibility of the study. The main study was done on 60 samples with post abdominal surgery patients in selected hospitals Kollam. Pretest was conducted for both experimental and control group followed by implementing progressive muscle relaxation for about 20 minutes for experimental group only and posttest done for both experimental and control group on the 7th day with the same tool.

Conclusion
The present study aimed to find the effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam. The findings of the study shows that the mean difference of the post-test anxiety score of experimental group ( 40.51 )was greater than the control group( 54.62) at 0.05 level of significance after progressive muscle relaxation to the experimental group
The mean difference of the post-test pain score of experimental group (3.36± 1.0080) was greater than the control group (6.66±1.3729) at 0.05 level of significance after progressive muscle relaxation to the experimental group. So the progressive muscle relaxation is effective in decreasing pain and anxiety among post abdominal surgery patients in selected hospitals Kollam.

Nursing Implications
The present study has various implication in the field of nursing practice, nursing education, nursing administration and nursing research.

Implications for nursing practice
Nursing personnel as a member of health care team have an important role in improving general health, wellbeing and quality of life of patients by various measures.

In order to reduce pain and anxiety among abdominal surgery patients, nurses should put an effort towards promoting muscle relaxation technique in wards.

The nurse should advise abdominal surgery patients to do progressive muscle relaxation regarding reduction of pain and anxiety.

Implications for nursing education
The nursing professionals are expected to provide high quality care for patients in hospital settings which are the backbone of nursing, in order to improve the health status of the society.

The nurse educator should prepare the student nurse to apply their knowledge and skill in caring post abdominal surgery patients to reduce anxiety and pain practicing progressive muscle relaxation.

Along with the education to students, nurse educator should take initiative in imparting progressive muscle relaxation technique to newly appointed staff nurses.

Implications for nursing administration
The nurse administrator can take the initiative in imparting information about the result of the study by individual and group teaching in the hospitals.

The nurse administrator in the hospitals shall make arrangements for organizing programmes regarding importance of progressive muscle relaxation.

Nurse administrator should be aware of the counseling programmes and can suggests their subordinates to practice these muscle relaxation which will help the post abdominal surgery patients to reduce their anxiety and pain among post abdominal surgery
Implications for nursing research
There is a great scope for the nurses to conduct research to identify the progressive muscle relaxation and practice among post abdominal surgery patients regarding reduction of pain and anxiety and to understand the various interventions that helps to reduce the progressive muscle relaxation and practice among post abdominal surgery patients for the reduction of pain and anxiety.

Based on the results of the study nurse researchers can undertake similar studies among patients with other diseases, on different settings in the hospital.

Dissemination of research findings through presentation and publication will add to the body of progressive muscle relaxation technique and help in nursing practice.

The study was done on a small group of samples in selected hospitals Kollam. So generalization cannot be done.

REFERANCE
1 The Efect of Benson Relaxation on Reduction of Pain Level Among Post Caesarean Section Mother atCibabat ?os!ital” #ndonesia https://www.scribd.com/document/262038484/Document
2 Rev Latino-am Enfermagem the use of progressive muscle relaxation technique foor pain relive in gynecology and obstrics http://br.123dok.com//document/qmjr3g9q-rev-latinoam-enfermagem-vol-10-numero5-1.html
3 Pimenta CAM Aspectos culturais afetivos terapeuticos relacionados do no cancerescola de Emfermagem/USP’1995
4 Burnner L S,Suddarth DS Enfermagem medico cirurgica 3rd edition rio de Jniero (RJ) interamericana 1995
5 Flahert GG Fitzpatrick JJ relaxation to increase comfort level of post-operative patients a preliminary study nursing research 1978
6 Jacobson E progressive relaxations a physiological and clinical intervention of muscular state and investigation of muscular state and their significance in psychological and medical practice 3rd edition Chicago university.

7 .Abdominal surgery. online. Available from: URL:http://en.wikipedia.org/wiki/Abdominal_surgery
8 .Statistics on surgical procedures in the US. online. Available from: URL:http://www.ncbi.nlm.gov/
9 Vallano A, Aguilera C, Arnau JM. Management of postoperative pain in abdominal surgery. British Journal of Clinical Pharmacology 1999 Jun 47(6);667-73.

10 .Graffam S, Johnson A. A comparison of two relaxation strategies for the relief of pain and its distress. Journal of Pain and Symptom Management 2010 Mar;2(4):229-31.

11
12
13
14 Masoomeh Asad The Effect of Benson Relaxation on Quality of Life of Patients with Irritable Bowel Syndrome file:///C:/Users/Jeevan/Downloads/jjcdc-05-04-31068.pdf.

15 d paul aa The use of the “progressive muscle relaxation” technique for pain relief in gynecology and obstetrics https://www.ncbi.nlm.nih.gov/pubmed/1264105116 M. Bagharpoosh, G. Sangestani M. Goodarzi EFFECT OF PROGRESSIVE MUSCLE RELAXATION TECHNIQUE ON PAIN RELIEF DURING LABOR http://acta.tums.ac.ir/index.php/acta/article/view/317817 Maark p Jensen A Comparison of Self-Hypnosis Versus Progressive Muscle Relaxation in Patients With Multiple Sclerosis and Chronic Pain https://www.tandfonline.com/doi/abs/10.1080/00207140802665476.

18 progressive muscle relaxation and pain perception in abdominal surgery patients HYPERLINK “http://www.dtic.mil/dtic/tr/fulltext/u2/a218267.pdf” http://www.dtic.mil/dtic/tr/fulltext/u2/a218267.pdf
19 wen-chun chen, Efficacy of progressive muscle relaxation training in reducing anxiety in patients with acute schizophrenia https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2702.2008.02773.x20 Fatemeh Kiani effect of Benson’s relaxation method on hemodialysis patients’ anxiety 2) http://www.alliedacademies.org/articles/the-effect-of-bensons-relaxation-method-on-hemodialysis-patients-anxiety.21 jala poorolagal Effect of Benson relaxation technique on the preoperative anxiety and hemodynamic status: https://www.sciencedirect.com/science/article/pii/S187293121630088622 mahebobh sajadi Benson’s relaxation effect in comparing to systematic desensitization on anxiety of female nurses: http://www.ijmpo.org/article.asp?issn=09715851;year=2017;volume=38;issue=2;spage=111;epage=115;aulast=Sajadi23 M a hidhraji gorji The efficacy of relaxation training on stress, anxiety, and pain perception in hemodialysis patients https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4244714/24 Gramke H F de Rijke JM Van kleef M Raps Kessels A G peTER M L Sommer the prevalence and course of postoperative pain in the early post operative period after ambulatory surgery in a university hospital clin. J .pain 2007 jul-Aug.25 Ajithakumari.G, Prof.V.Hemavathy Effectiveness of Progressive Muscle Relaxation Therapy in Reducing Stress among Patients with Abdominal Surgery for Cancer Treatment https://www.ijirset.com/upload/2015/june/29A_24.pdf26 Rasha Mohamed Essa Effect of progressive muscle relaxation technique on stress, anxiety, and depression after hysterectomhttp://www.sciedu.ca/journal/index.php/jnep/article/viewFile/9987/6783
27 Y. L Cheung R N the effect of progressive muscle relaxation training of patients after stoma surgeryhttps://onlinelibrary.wiley.com/doi/abs/1 0.1046/j.1365-2354.2001.00256.x
28 Tahmasbi1 H the effect of benzon relaxation technique on the anxiety of patient undergoing coronary angiography , http://jnms.mazums.ac.ir/files/site1/user_files_d258bd/eng/telehealth-A-10-422-31-89944d9.pdf29 Yen Long Dung Effects of Progressive Muscle Relaxation Intervention in Extremity Fracture Surgery Patients http://journals.sagepub.com/doi/abs/10.1177/0193945914551509?journalCode=wjna30 Cheung Y L The effect of progressive muscle relaxation training on anxiety and quality of life after stoma surgery in colorectal cancer patients https://www.ncbi.nlm.nih.gov/pubmed/1267380931 Ummu yildiz Findik Effect of Relaxation Exercises on Controlling Postoperative Pain https://www.researchgate.net/publication/221838718_Effect_of_Relaxation_Exercises_on_Controlling_Postoperative_Pain32 Tetti solehati Benson Relaxation Technique in Re ducing Pain Intensity in Women After Cesarean Section. http://europepmc.org/articles/PMC4493735 Appendix A
Institutional Ethical Clearance Certificate

Appendix B
Benson muscle relaxation exerciseTraining certificate

Appebdix C
Letter Seeking Permission to conduct pilot study in selected hospital,kollam
Appendix D
Letter Seeking Permission to conduct pilot study in selected hospital,kollam

Appendix E
Letter Granding Permission to conduct pilot study in selected hospital,kollam

Appendix F
Letter Seeking Permission to conduct the research study in selected hospital,kollam
lefttop00

Appendix G
Letter Seeking Permission to conduct the research study in selected hospital,kollam

Appendix F
Letter Requesting Expert’s opinion to establish to content validity
From
Ms. Bincy Babu, Ist year MSc nursing
Bishop Benziger College Of nursing Kollam
To
Respected madam/sir
Subject: request for opinions and suggestions of experts for establishing content validity for research tool
I am a master of nursing student in bishop Benziger College of nursing, Kollam in the specialty of medical surgical nursing. As per the requirement for the partial fulfillment of the master of nursing degree under KUHAS, I have selected the following topic for synopsis proposal Effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospital, Kollam.

Enclosure
1.Synopsis of the study
2.Demographic data
3.State Trait Anxiety S
I request you sir/madam, to kindly go through the comment of tool and validate against the criteria given. Anticipating a favorable response at the earliest. Thanking you
Kollam Yours sincerely
Date Bincy Babu

Appendix G
CONTENT VALIDITY CERTIFICATE
I……………………………………………………………here by certify that I have validated the tool of Ms Bincy babu Ist year M SC nursing student, Bishop Benziger college of nursing , Kollam who is undertaking the study Effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospitals,Kollam.

Signature of the expert
Designation and address

Date
Place
Language validation certificate
This is to certify that I have done the validation of research tool (Malayalam version) of Ms. Bincy Babu, II year M.Sc. Nursing student of Bishop Benziger College of Nursing, who had undertaken the research study titled “Effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospitals, Kollam. “.” I hereby solemnly affirm that meanings of all the concepts in Malayalam version are exactly the same as English version.

1Signature of the expert
Place: Date: Designation and address

CRITERIA CHECK LIST FOR THE VALIDATION OF THE TOOL
Kindly put tick mark against your suggestion
DEMOGRAPHIC PERFOMA
SlNo ITEMS AGREE DISAGREE REMARKS
1 Age 2 Sex 3 Education 4 Type of family 5 Marital status 6 Religion 7 Occupation 8 Monthly income CLINICAL DATA
SL
NO ITEMS AGREE DISAGREE REMARKS
1 Type of surgery done 2 Previous major surgery 3 Type of anesthesia 4 Co morbidities PAIN SCALE

SL
NO ITEMS AGREE DISAGREE REMARKS
1 0 no pain 2 1-3 mild pain 3 4-7 moderate pain 4 8-10 severe pain 4.STATE TRAIT ANXIETY INVENTORY
SL
NO ITEMS AGREE DISAGREE REMARKS
1 I feel calm 2 I feel secure 3 I feel tense 4 I feel strained 5 I feel ease 6 I feel upset 7 I am presently worrying over possible misfortunes 8 I feel satisfied 9 I feel frightened 10 I feel uncomfortable 11 I feel self-confident 12 I feel nervous 13 I feel jittery 14 I feel indecisive 15 I am relaxed 16 I feel content 17 I am worried 18 I feel confused 19 I feel steady 20 I feel pleasant ANXIETY SCALE
SL
NO ITEMS AGREE DISAGREE REMARKS
1 1-20 No anxiety 2 21-40 Mild anxiety 3 41-60 Moderate anxiety 4 61-80 Sever anxiety List of validators who validate the tool
1Dr.G.Mohan
Senior Consultant Surgeon
Bishop Benziger Hospital
Kollam
2Dr.Sudheer saludeenSenior Surgeon
Sree Narayana Trust Medical Mission
Kollam
3Mrs.Vijayan.v
Assossiate Professor,
VNSS,College of nursing
Kollam
4Mrs.Arpitha poopadyAssosiate professor
Holy cross college of nursing
Kottiyam5Mrs Sijin K.S
Lecture
Department of psychology
Fatima Mata National College
Kollam
6Dr.Shelly M.R
Head of the department of Malayalam
Fatima Mata National College
7 Mrs.Akila.U.SAssistant Professor
N.S .Memorial College of Nursing
Kollam
8Veena R Nair
Assosiate professor
Travancore College of Nursing
Kollam
PARTICIPATION INFORMATION SHEET

Respected Madam /Sir
I, Miss. Bincy Babu, IInd year MSc Nursing student of Bishop Benziger College of Nursing, Kollam is conducting a study titled as “Effect of structured teaching program on knowledge and practice regarding prevention of stroke among hypertensive patients in selected urban coastal community area kollam.” This study is focused in imparting knowledge among the hypertensive patients regarding prevention of stroke.

I request you to participate in this study, and your participation will be voluntary and during the course of the study you can even withdraw from the study. Your answers to the questions will not be published other than the research purpose and you have no financial commitments for the study.

Yours faithfully,
Name of the participant Name of the researcher:
Contact Details: Contact Details:
Signature:Signature:
Place:Place:

Date Date

Spielberg’s state trait anxiety inventory
A number of statement are given below. Read each statement and mark the appropriate number to the right statement to indicate how you feel right now
Sl.no Not at all Some what Moderately so Very much so
1 I feel calm 2 I feel secure 3 I feel tense 4 I feel strained 5 I feel ease 6 I feel upset 7 I am presently worrying over possible misfortunes 8 I feel satisfied 9 I feel frightened 10 I feel uncomfortable 11 I feel self-confident 12 I feel nervous 13 I feel jittery 14 I feel indecisive 15 I am relaxed 16 I feel content 17 I am worried 18 I feel confused 19 I feel steady 20 I feel pleasant
1-20 No anxiety 21-40 Mild anxiety 41-60 moderate anxiety 61-80 severe anxiety
NEUMERICAL PAIN SCALE

0 No pain
1-3 mild pain
4-6 Moderate pain
7-10 severs pain

Demographic data
SAMPLE NO
Age
…………………………..

2) Sex
a) Male
b) Female
3) Educational status
a) Illiterate
b) Primary
c) High school
d) Intermediate/Diploma
e) Graduate
d) Professional PG and above
4) Type of family
a) Nuclear
b) Joint
5) Marital status
a) Married
b) Un married
6) Religion
a) Hindu
b) Christian
c) Muslim
d) others
7) Occupation
a) light job
b) Heavy job

Clinical Data

Type of surgery done ………………………

2)Previous major surgery
a) Yes
b) No
3) Type of anesthesia
a) General
b) Spinal

PROGRESSIVE MUSCLE RELAXATION
Benson muscle relaxation technique involves the alteration of tensing muscle and relaxing muscles with specific intension of developing an acute awareness of the difference. Follow steps below in order.

Sit in a comfortable position arms at your sides legs apart and keep body free keep your eyes closed tightly.

Take deep breath …………….slowly breath in through your nose and out through your mouth , Give complete awareness to your toes. Bend your toes down wards and tense your feet. Feel the tension and hold it .Now move your attention to the calf muscles. Feel the tension and hold it. Now slowly relax your calf muscle feel the relaxation.

Next bring the attention to your knee and thighs squeeze the muscles in your thighs feels the tension spreading throughout the thighs your thighs are very tight now. Now sloly relax and feel the relaxation spreading throughout the thighs. Next bring the attention to your buttocks muscles. Feel the tension and hold it. Now slowly relax your buttocks muscle feel the relaxation.

Next bring the attention to your elbow, shoulder and finger. Feel the tension and hold it .Now slowly relax your muscle feel the relaxation.

Slowly breathe in and exhale through your mouth
Now you mentally seen your whole body and notice there is a remaining tension if so relax and let go
All the muscles are relaxed now enjoy ….the wave of relaxation slowly spreading throughout the body .Slowly take a deep breath and exhale out. Once again take a deep breath slowly………in and out. Now slowly open your eyes.
SlNo Item 1 2 3 4 5 6 7 Agreement
(%) Remarks Final
Items
1 Age ? ? ? ? ? ? 100% Accepted as
it is 2 Sex ? ? ? ? ? ? ? 100% Accepted as
it is 3 Educational ? ? × ? ? ? ? 85.71% 1 expert advised modification for options Options modified as per suggestions
4 Type of family ? ? ? ? ? ? ? 100% Accepted as
it is 5 Marital status ? ? ? × ? ? ? 85.71% Accepted as it is 6 Religion ? ? ? ? ? ? ? 100% Accepted as
it is 7 Occupation ? ? ? ? ? ? ? 100% Accepted as
it is 8 Monthly income ? ? ? ? ? ? ? 85.71% 1 expert advised modification for options Section B
1 Type of surgery done ? ? ? ? ? ? × 85.71% Accepted as
it is 2 Previous major surgery ? ? ? ? ? ? × 85.71% 1 expert
advised to Options
modified as
modify question per advice
3 Type of anesthesia ? ? ? ? ? ? ? 100% Accepted as it is 4 Co morbidities ? ? ? ? ? ? ? 100% Accepted as it is 1 0 No pain ? ? ? ? ? ? ? 100% Accepted as
it is 2 1-3 Mild pain ? ? ? ? ? ? ? 100% Accepted as
it is 3 4-6 Moderate pain ? ? ? ? ? ? × 85.71% 1 expert advised to modify question Options modified as per order
4 7-10 Sever pain ? ? ? ? ? ? × 85.71 1 expert advised to modify question Option modified as per advices
1 I feel calm ? ? × × ? ? ? 71.42% Accepted as
it is 2 I feel secure × ? ? ? ? ? ? 85.71% Accepted as
it is
3 Ifeel tense ? ? ? ? ? ? ? 100% Accepted as
it is 4 I feel strained ? ? ? ? ? ? ? 100% Accepted as it is 5 Ifeel ease ? ? ? ? ? ? ? 100% Accepted as it is 6 I feel upset ? ? ? ? ? ? ? 100% Accepted as it is 7 I am presently worrying over possible misfortunes ? ? ? ? ? ? ? 100% Accepted as it is 8 I feel satisfied ? ? ? ? ? ? ? 100% Accepted as it is 9 I feel frightened ? ? ? ? ? ? × 85.71% 1 expert advised to modify the option Option modified as per suggestions
10 I feel uncomfortable ? ? ? ? ? ? ? 100% Accepted as it is 11 I feel self –confident ? ? ? ? ? × ? 85.71% 1 expert advised to
modify the Modified questions as
per
12 I feel nervous question suggestions
13 I feel jittery ? ? ? ? ? ? ? 100% Accepted as it is 14 I feel indecisive ? ? ? ? ? ? ? 100% Accepted as it is 15 Iam relaxed ? ? ? × ? ? × 71.42% 2 experts advised to modify options Options modified as per suggestions
16 I feel content ? ? ? ? ? ? ? 100% Accepted as it is 17 I am worried ? ? ? ? ? ? × 100% Accepted as
it is 18 I feel confused ? ? ? ? ? ? ? 100% Accepted as
it is 19 I feel steady ? ? ? ? ? ? ? 100% Accepted as
it is 20 I feel pleasant ? ? ? ? ? ? ? 100% Accepted as
it is ANXIETY SCALE
1 1-20 No anxiety ? ? ? ? ? ? ? 100% Accepted as it is 2 21-40 Mild anxiety ? ? ? ? ? ? ? 100% Accepted as it is 3 41-60 Moderate anxiety ? ? ? ? ? ? ? `100% Accepted as
it is 4 61-80 Sever anxiety ? ? ? ? ? ? ? 100% Accepted as
it is Alcohol 3 Leafy vegetables are least included in my diet ? ? ? ? ? ? ? 100% Accepted as it is 4 Fruits and vegetables are included in my diet ? ? ? ? ? ? ? 100% Accepted as it is 5 Small fishes are included in my diet ? ? ? ? ? ? ? 100% Accepted as it is 6 Pickles and dried fishes are included in the diet ? ? ? ? ? ? ? 100% Accepted as it is 7 Ghee, butter, dalda are used for preparing food items for me ? ? ? ? ? ? ? 100% Accepted as it is 8 I engage in physical activity for about 30 minutes a day ? ? ? ? ? ? ? 100% Accepted as it is 9 I perform prayer and meditation daily ? ? ? ? ? ? ? 100% Accepted as it is 10 I am strictly adhered to medication regimen as per order ? ? ? ? ? ? ? 100% Accepted as it is 11 My family members help me for
Avoiding ? ? ? ? ? ? × 85.71% 1 expert advised to modify the
statement Statement modified as per
suggestion
smoking and alcoholism 12 I believe regular health check up is hardly
Mandatory ? ? ? ? ? ? × 85.71% 1 expert advised to modify the statement Statement modified as per suggestion
13 Monitoring for the development of signs and symptoms of stroke are hardly
Necessary ? ? ? ? ? ? ? 100% Accepted as it is 14 I try to be active and busy during
free time ? ? ? ? ? ? ? 100% Accepted as it is 15 I have least interest to achieve knowledge regarding healthy life
Styles ? ? ? ? ? ? ? 100% Accepted as it is Instructional module ? ? ? ? ? ? × 85.71% 1 expert
advised modifications Modifications
done as per suggestions

CONSENT FORM
IMr/Miss/Mrs.…………………………….is agreeing to participate in the research study conducted by Miss. Bincy babu, MSc Nursing student, of Bishop Benziger College of Nursing on the topic:
Effectiveness of progressive muscle relaxation exercise on anxiety and pain among post abdominal surgery patients in selected hospitals, Kollam.

I am participating in this study voluntarily knowing the facts that, I can even withdraw from the study during its course, and my answers to the questions will not be published other than the research purpose and I have no financial commitments for the study.

Name of the research participant: Signature:
Name of the witness:
Signature:
Place: Date:
k½-X-{Xw _nj¸v s_³kn-KÀ tImtfPv Hm^v gvknwKv hnZymÀ°n
B³ s_³kn-en, _ncp-Zm–´c _ncpZ tgvknwKv T–`m-K-ambn S-¯p¶ £-m-X- tcmKn-I-fn ssII-fpsS Ne–tijnbn³ta andÀ sXdm-¸n-bpsS ^e-km-yX F¶ Kth-j-W-¯n kl-I-cn-¡m³ Rm³ qÀ®-ambn k½Xw ÂIp-¶p.
{kvXpX Kth-j-W-¯nsâ `mK-ambn Ft¶mSv Nne tNmZy-§Ä tNmZn-¡p-sa¶v Rm³ a-Ên-em-¡p-¶p. CXn-te-¡m-bpÅ kl-I-cWw F
¡v kz´-Xo-cp-am{Imcw Ft¸mÄ thW-sa-¦nepw Ah-km-
-¸n-¡m-hp-¶-Xm-sW-¶pw, GXp ka-b-¯n-ep-apÅ Fsâ
Ê-l-I-cWw F
¡v e`n-¡m-hp¶ NnIn-Õsb bmsXmcp hn-¯nepw _mn-¡p-I-bnà F¶pw Rm³ a-Ên-em-¡p-¶p.

F¶nÂ
¶pw tiJ-cn-¡p¶ hnh-c-§Ä cl-ky-ambn kq£n¡p-sa-¶pw, Cu hnh-c-§Ä {kvXpX Kth-j-W-¯n-te-¡mbn am{Xta D-tbm-Kn-¡p-I-bpÅq F¶pw F
¡p t_my-am-bn-«p-­v.

ta¸-dª Kth-j-W-¯n kl-I-cn-¡p¶ hyàn F¶
e-bn Fsâ FÃm-hn kwi-b-§Ä¡pw Rm³ _Ô-s¸-tS­ hyàn B³ -s_³knen am{X-am-bn-cn-¡pw..

kl-I-cn-¡p¶ Bfnsâ H¸vØew :Kth-j-I-bpsS H¸vXobXn :k½-X-{Xw_nj¸v s_³kn-KÀ tImtfPv Hm^v tgvknwKv hnZymÀ°n
mÀÆXn N{µ³, _ncp-Zm–´c _ncpZ tgvknwKv T `mK-ambn S-¯p¶
sImÃs¯ sXc-sª-Sp¯ Bip-{XnIfnse lrZb kw_-Ô-amb tcmK-ap-Å-hcpw AIyq-«vsIm-tdm-Wdn kn³{U-¯nsâ Krl-cnNc-W-¯n-s-¸-än-bpÅ Adnhn³ta hoUntbm D-tbm-Kn-¨pÅ Tn-¸n-¡-ensâ ^e-km-²y-X F¶ Kth-j-W-¯n kl-I-cn-¡p-hm³ Rm³ qÀ®-ambn k½Xw ÂIp-¶p.

{-kvXpX Kth-j-W-¯nsâ `mK-ambn Ft¶mSv Nne tNmZy-§Ä tNmZn-¡p-sa¶v Rm³ a-Ên-em-¡p-¶p. CXn-te-¡m-bpÅ kl-I-cWw F
¡v kz´ Xocp-am–{-Imcw Ft¸mÄ thW-sa-¦nepw Ah-km-
-¸n¡mhp¶XmsW-¶pw, GXp ka-b-¯n-ep-apÅ Fsâ
Êkl-I-cWw F
¡v e`n-¡m-hp¶ NnIn-Õsb bmsXmcp hn-¯nepw _mn-¡p-I-bnà F¶pw Rm³ a–Ên-em-¡p-¶p.

F¶nÂ
¶pw tiJ-cn-¡p¶ hnh-c-§Ä cl-ky-ambn kq£n-¡p-sa-¶pw, Cu hnh-c-§Ä {kvXpX Kth-j-W-¯n-te-¡mbn am{Xta D-tbm-Kn-¡p-I-bpÅq F¶pw F
¡v t_my-am-bn-«p-­v.

taÂ-d-ªn-cn-¡p¶ Kth-j-W-¯n kl-I-cn-¡p¶ hyàn F¶
e-bn Fsâ FÃm-hn kwi-b-§Ä¡pw Rm³ _Ô-s¸-tS­ hyàn mÀÆXn N{µ³ am{X-am-bn-cn-¡pw.
kl-I-cn-¡p¶ Bfnsâ H¸vØew :XobXn :Kth-j-I-b
t{m{K-Êohv akn dnem-Ivtk-j³ sSIv
¡v{Ia-ambn ico-c-¯nse tin-IÄ hen¨v apdp-¡p-Ibpw Ab-¨n-Sp-Ibpw sNbvXp-sIm­v B hyXym-k-§-fn {i² tI{µo-I-cn-¡p¶ Hcp dnem-Ivtk-j³ coXn-bm-Wv s_³k¬ dnem-Ivtk-j³ coXn. Xmsg d-bp¶ {Ia-¯n hymbmaw sN¿p-I.
kuI-cy-{-Z-amb Hcp Øe¯v I®p-IÄ apdp¡n AS¨v Ccn-¡p-I. BZys¯ Ipd¨v
an-j-§Ä aÊv kzØ-am¡n hbv¡m³ {ian-¡p-I.icocw apgp-h³ Ab-¨n-«p-sIm­v
§-fpsS apgp-h³ {i²bpw izmtkm-Ñm-k-¯n tI{µo-I-cn-¨p-sIm­v kmh-Imiw ZoÀL-ambn c­p-X-hW aq¡n-eqsS izkn-¡p-Ibpw hmbn-eqsS DÑz-kn-¡p-Ibpw sNbvXv
§-fpsS icocw im´-am-Ip¶Xdn-bp-I.
C

§-fpsS {i²sb ImÂhn-c-ep-I-fn-tebv¡v tI{µo-I-cn-¡p-I. hnc-ep-IÄ c-am-hn Xmtgbv¡v hf¨v mZ-¯nse amwk-t-in-IÄ hen¨v apdp-¡p-I. C{-Imcw D­m-Ip¶ ncn-ap-dp¡w Ap-`-hn-¡p-I. C
kmh-m–¯n ImÂhn-c-ep-IÄ Ab-bv¡p-Ibpw A{-Imcw Ah kzX-{´-am-Ip-¶Xv Bkz-Zn-¡p-Ibpw sN¿p-I.

C
ImÂh-®-bnse amwk-t-in-I-fn-tebv¡v {i² tI{µo-I-cn-¡p-I. ImÂh-®-bnse amwk-t-in-IÄ hen¨v apdp-¡p-I. C
Ahsb kmh-Imiw Ab-¨n«v ncn-ap-dp¡w CÃm-Xm-Ip-¶Xv Ap-`-hn¨v Bkz-Zn-¡p-I. AXn-p-tijw Im ap«nse amwk-t-in-I-fn-te¡v {i² tI{µo-I-cn-¡p-I. ImÂap-«nse amwk-t-in-IÄ hen¨v apdp-¡p-I. F¶n«v Ahsb kmh-Imiw Ab-¨n«v ncn-ap-dp¡w CÃm-Xm-Ip-¶Xv Ap-`-hn¨v Bkz-Zn-¡p-I. C

Xw-_-`m-K-¯nse amwk-t-in-I-fn-te¡v {i² tI{µo-I-cn¨v tin-IÄ hen¨v apdp-¡p-I. AXn-p-tijw kmh-Imiw Ab-¨n«v ncn-ap-dp¡w CÃm-Xm-Ip-¶Xv Ap-`-hn¨v Bkz-Zn-¡p-I. A§s ssIap«v. tXmÄ, ssIhn-c-ep-I-fnse amwk-t-in-Ifn-tebv¡v {i² tI{µo-I-cn-¡p-Ibpw amwk-tinIÄ hen-¨vap-dp-¡n-b-tijw kmh-Imiw Ab-¨n«v ncn-ap-dp¡w CÃm-Xm-Ip-¶Xv Ap-`-hn¨v Bkz-Zn-¡p-I.
C
kmh-m–¯n ZoÀL-ambn aq¡n-eqsS izmkw FSp¯v hmbn-eqsS DÑz-kn-¡p-I. Ccp-Xv
anjw Cu coXn XpS-cp-I. CSbv¡v I®v Xpd¶v Cu kabw cn-tim-n-¡m-hp-¶-Xm-Wv. t£ Aemdmw D-tbm-Kn-¡-cp-Xv. CXnptijw
i-_vZ-ambn Ipd¨v
an-j-§Ä I®-S¨v Ccn-¡p-I. AXn-p-tijw I®v Xpd-¡p-I.
§-fpsS ico-c-¯nse FÃm amwk-t-in-Ifpw Ct¸mÄ kzX-{´-am-Wv. im´-X-bpsS Xcw-K-§Ä ico-c-am-k-Iew hymn-¡p-¶Xv
§Ä¡n-t¸mÄ Adn-bm-
-S-bm-Ipw.

tÌäv s{Sbväv AMvsskän kvsIbn Ct¸mÄ a-Ên tXm¶p-¶Xv
{Ia w {kvXm-h–IÄ hf-sc-b-nIw (4) ~Hcp cn-n-hsc (3) Ipd¨v am{Xw (2) H«p-w
CÃ (1)
1 F
¡v kam-mw D­v2 F
¡v kpc-£nXXz t_m-ap­v3 F
¡v am-knI k½À±w D­v4 F
¡v Bbmkw Ap-`-h-s¸-Sp¶p5 F
¡v Bizmkw Ap-`-h-s¸-Sp¶p6 Rm³ Akz-Ø-m-Wv. 7 F
¡v imco-cnI hymIp-eX
Ap-`-h-s¸-Sp¶p8 Rm³ kwXy-vX-mWv9 Rm³ kw`o-X-m-Wv. 10 F
¡v kuJyw Ap-`-h-s¸-Sp-¶nÃ11 F
¡v Bß hnizmkw D­v12 F
¡v sscy-an-Ãmbva
Ap-`-h-s¸-Sp¶p13 F
¡v cn-{`m´n tXm¶p¶p14 F
¡v
K-a–§-fn F¯m³ Ign-bp-¶n-Ã. 15 Rm³ im´-mWv16 Bbn-cp¶ Ah-Ø-bn Rm³ XrvX-mWv17 Rm³ Zp:JnX-mWv18 F
¡v Nn´m-Ip-g¸w D­v. 19 Rm³ Ønc-Nn-¯-m-Wv. 20 Rm³ {k-¶-m-Wv. Ap-tbm-Py-ambn AS-bm-f-s¸-Sp-¯pIyqsa-dn-¡Â sbn³ kvsIbnÂ0 12345678910
þthZ CÃ
1þ3þtcnb thZ
4-þ6þanX-amb thZ
7-þ10þAXn-`-b-¦c thZ
tNm-Zym-hen{mY-anI hnh-c-§Ä
km¼nÄ ¼À
hbÊv :
enwKw :
398970514986000F)pcp-j³
39897055334000_n)kv{Xo
hnZym-`ymk tbmKyX39770058064500F)
c-£-c³
39770054508500_n)ss{adn hnZym-`ymkw39693853556000kn)sslkv¡qÄ hnZym-`ymkw39693857239000Un)lbÀsk¡³Udn hnZym-`ymkw39617655143500C)_ncpZw39103305969000F^v)_ncp-Zm–´c _ncpZXewIpSpw_w39408102667000F)AWp-Ip-Spw_w3933190-63500392557040068500_n)Iq«p-Ip-Spw_wkn)hnkvXrX IpSpw_w
s-sh-hm-lnI
e
39103303111500F)hnhm-lnX/hnhm-ln-X³
39027102603500_n)Ahn-hm-lnX/Ahn-hm-ln-X³
39027101333500kn)hnh/hnpc³
aXw37363406286500F)lnµp37363403746500_n){InkvXy³
37465008509000kn)apÉow37465009906000Un)aäp-f-fhtPmen/sXmgnÂ37668206096000F)kzImcy Poh–¡m-c³/Poh–¡mcn37687254254500_n)kÀ¡mÀ Poh–¡m-c³/Poh–¡mcn37763451079500kn)kzbw sXmgnÂ37503108445500Un)tPmen CÃ
amk hcp-amw
7149083622037363409906000F)<5000
7213603492537363404064000_n)5001– þ 10000
7150104064037363404318000kn)10001 -þ 20000
718185615953743960444500Un)>20000
BtcmKy kw_-Ôn-bmb hkvXp-X-IÄ
hnt-b-amb ikv{X-{Inb :
ap³v henb ikv{X-{In-bbv¡v hnt-b-am-bn-«pt­m?
31800806350000F)D­v31800805397500_n)CÃ
A-kvtXjy31800804445000F)kmm-c-W-bmbn sImSp-¡p-¶Xv
31800802984500318008038227000_n)s«-Ãn sImSp-¡p-¶Xv
kn)aäp-f-fhaäv Akp-J-§Ä
31610308572500F)D­v31610302857500_n)CÃ

SL NO AGE SEX EDUATION TYPE OF FAMILY RELIGION MARITAL STATUS PRETEST ANXIETY SCORE POST TEST ANXIETY SCORE PRETEST PAIN SCORE POSTTEST PAIN SCORE
E1 B A C A A A 55 40 8 5
E2 D B C A B B 60 30 7 4
E3 D B B A A A 68 68 6 5
E4 D A C’ A B A 69 38 8 6
E5 D B D A C A 70 42 6 5
E6 D B B B A A 58 29 7 5
E7 E A B A B A 57 15 8 4
E8 E A D B A A 55 68 9 5
E9 E B B A C A 40 32 8 3
E10 E A B A C A 54 35 7 4
E11 B A D B A A 64 42 7 5
E12 E B D A B A 55 22 8 5
E13 A B F A A B 70 28 7 5
E14 B A D A B A 80 32 9 4
E15 B A F B A A 74 30 8 3
E16 C A D A B B 78 31 9 4
E17 C A D B A A 50 28 8 3
E18 B A C B C A 51 29 7 4
E19 A B E B C B 64 30 8 5
E20 B B D B C A 65 40 7 6
E21 B A C A C A 70 41 9 5
E22 B B G A B B 68 42 8 4
E23 D A E A C A 63 38 7 3
E24 C B F B C A 62 25 7 4
E25 A A D B B A 65 67 7 2
E26 A B E A C A 78 70 6 4
E27 E B D A B A 60 60 8 3
E28 D B E B B A 59 55 7 3
E29 D B E B B A 49 30 8 3
E30 D B F B B A 55 50 9 5
SL NO AGE SEX EDUATION TYPE OF FAMILY  RELIGION MARITAL STATUS  PRETEST ANXIETY SCORE   POST TEST ANXIETY SCORE PRE TEST PAIN SCORE POST TEST PAIN SCORE
C1 A B D A C A 59 46 7 7
C2 B B E B B B 70 47 8 7
C3 C A D A A A 49 60 7 5
C4 D B E A B A 71 89 6 6
C5 C A C B A A 62 71 7 7
C6 D B D A C A   62 8 7
C7 D A B A C B 54 43 9 8
C8 C B C A A A 70 55 8 8
C9 E A B A C A 89 71 9 9
C10 B B D B C A 62 81 7 8
C11 B A C B C A 64 63 8 7
C12 B B C A C B 68 65 9 9
C13 B A D A C A 77 68 8 8
C14 C B B B B A 76 76 6 6
C15 A A C A B A 77 77 5 5
C16 B B D B B A 86 78 8 8
C17 C A C A A A 62 85 5 5
C18 B B B A B A 64 66 6 7
C19 B A D B B A 32 65 4 8
C20 B A C A C A 47 38 5 4
C21 B A D B B A 59 48 6 5
C22 B B C A B A 60 60 5 6
C23 C A E A C A 78 78 4 4
C24 C B D A B A 75 64 8 7
C25 D A D B B A 74 69 7 8
C26 E A E A B A 70 64 5 7
C27 D B D B B A 60 62 6 5
C28 D B F B C A 62 73 7 7
C29 C B E B C A 65 84 6 6
C30 C B B B C A 68 70 7 6