M.Maimunisa

MSC(N) II YEAR

CHETTINAD HOSPITAL & RESEARCH INSTITUTE© 2009 Chettinad Hospital & Research Institute

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TITLE

• A study to assess the effectiveness of laughter therapy among patient with primary hypertension in a selected community area.

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BACKGROUND OF THE STUDY“Every one minute of anger/sadness you loss 6o

seconds of happiness.”

“100 Laughs In A Day Is Equal To 10 Minutes Of Morning Jogging Or Worked On Harrowing Machine / 15 Minutes On A Stationary Exercise”

.“Laughing 15 Minutes A Day Helps To Create An

Emotional Balance & Train The Brain”-SCALLY 2004

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Contd….In 21st century the attention on forwarding

alternative therapies like relaxation , meditation , laughter therapy , aroma therapy , along with pharmacological management.

Laugh releases endorphins , the body natural pain killers thus reduces the frequency & intensity of arthritis pain & muscular spasm. it is also known to help with insomnia , allergies , migraine.

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BENEFITS OF LAUGH THERAPY• STRESS RELIEF :Decrease the level of stress hormone epinephrine &

cortisol.STRENGTHEN IMMUNE SYSTEM :• T- cells which fights infections become more & more

active when person laughs • INCREASE IMMUNOGLOBULIN A&B :Immunoglobulin A works for respiratory tract infectionImmunoglobulin B provide antibodies with strength to

attack dysfunction cells

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Contd…The best doctor in the world is Dr .Diet , Dr. Quiet,

Dr. Merry man- Jonathan swift 2002

Emotional incontinence is a disorder of emotional control. It refers to the heightened tendency to cry / less commonly laugh out.

- Bharvathiv lee 2006Laughter the physical response to perceive humor

has demonstrated the effect on physical & psychological well being.

- kruse b.g 2006

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Contd…A sense of humor and an ability to laugh can be

therapeutic for both patient & care giver. It reduces stress enhance hope , relive tension & stimulate immune system.

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NEED FOR THE STUDY“Laughter makes every one feel good”A regular 20 minutes laughter session can have

a profound impact on our health & well being. Laughter is a gentle exercise, it fills the lungs & body with oxygen , deep laugh clears breathing passage and exercise lungs. This is really important for people who do not get regular aerobic exercise.

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Contd….

Due to escalating obesity & population ageing both developed & developing countries , the global burden of hypertension is rising & projected to affect 1.5 billion persons , 1/3rd of world population by 2025.

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Contd…

• In 2000 the number of people with blood pressure reading exceeding 140/90 mmhg stood at 972 million .India is now the country with the most of population having BP in the world. Over 10 crores Indian adults presently suffer from high BP the measure of force of blood against the wall of arteries.

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Contd…

• A silent killer that has become the single most important factor causing stroke, heart attacks, DM , blindness & paralysis , high BP affects 30 % of the country’s urban population & 10% of the rural folks ( kountney sinha 2007)

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Contd…

• High blood pressure is now also a global problem. Researchers in a study published recently in lancet medical journal predicted that 1 million people would have high blood pressure by 2027.

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Contd…..Thus Hypertension remains the leading cause of

death world wide & one of the world's greatest public health problem.

- American society of HTNWhen we laugh our body release a cocktail of

hormone & chemicals that have staring positive effect on our system & stress in reduced , BP drops , depression is lifted & immune system is boosted. Western science is just starting to discover the greater effects of laughter.

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Contd….Humor is power hazardous to illness , humor

leading to laughing & good feeling. While the value of humor is unique to each person & culture , its deliberate uses in the effective nursing intervention to decrease tension % anxiety. The nurses will learn what constitutes therapeutic humor & path way of humor.

- ( global distribution of mortality attributable to 20 leading risk factors)

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Contd….Laughing helps to protect the heart there are

studies that explains the mental stress impair the endothelium which is the protective barrier lining of a person’s blood vessels. Once the endothelium is impaired , it cause serious inflammatory reaction that lead to cholesterol build up in a persons coronary artery disease which ultimately cause heart attack.

A psychologist explains the people who are chronically angry & hostile have a greater like hood for heart attack.

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Contd…

Peoples who lives in anxious , stressed out life style have greater blockage of their coronary arteries the people who are chronically depressed have 2 times greater chance of heart disease.

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Contd…

• According to a study conducted in chennai,one in every five persons was hypertensive . A majority of unaware and even those undergoing treatment does not have their condition under control (ramya kannan 2006)

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• This study attempt ‘s to assess the effectiveness of laughter therapy among patient with primary hypertension in POONJERY,CHENNAI,TAMILNADU.

AIM OF THE STUDY

SPECIFIC OBJECTIVES

• To asses the pretest level of blood pressure in both control and experimental group.

• To asses the effectiveness of laughter therapy on experimental group.

• To correlate the pretest and post test level of blood pressure in both experimental and control group.

• To associate the post level of blood pressure with selected demographic variables.

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OPERATIONAL DEFINITIONS• EFFECTIVENESS :• Laugh therapy is capable of reducing the Blood

pressure. By imparting laughter therapy , the effectiveness is measured by standard sphygmomanometer.

• LAUGHTER THERAPY :• It is a technique to stimulate laughter for primary

hypertensive patient followed by deep breathing and gentle stretching. It is given in five session with each session lasting 30 minutes.

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Contd…

• PATIENT WITH PRIMARY HYPERTENSION Client blood pressure is more than

140/90—180/110 mm of Hg in selected community area.

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ASSUMPTION

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•Laughing produce relaxation on individuals

•It decreases the Blood pressure by increasing heart rate and exercise the heart muscle by increasing the blood circulation.

•It regulates respiratory rate by excising the lung.•It improves psychological well being by reduction of stress hormones.

HYPOTHESIS

• There will be significant difference between the pretest and post test level of blood pressure on laughter therapy in reducing blood pressure among patient with primary hypertension

• There will be significant association between demographic variable on laughter therapy in reducing blood pressure among patient with primary hypertension 23

NULL HYPOTHESIS

• HO 1: There will be no significant difference between the pretest and post test level of blood pressure on laughter therapy in reducing blood pressure among patient with primary hypertension

• HO 2: There will be no significant association between demographic variable on laughter therapy in reducing blood pressure among patient with primary hypertension 24

MATERIALS AND METHODS APPROACH :• Evaluate the effectiveness of laughter therapy

among patient with primary hypertension so evaluative approach is selected for the study.

DESIGN :• True Experimental research design is selected

for this study.

Contd….POPULATION: All the patient with primary Hypertension in

POONJERY CHENNAI ,TAMILNADU.

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Cont….

Sample size :• 60 samples of patients who satisfy the criteria

for sample selection out of 60 subjects , 30 were allotted to experimental group & 30 were allotted to control group

SAMPLING TECHNIQUE :• Simple Randomised probability sampling

technique.

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CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA:• Patient who have diagnosed primary HTN

with BP ranging 140-180/90-110mmhg.• Who are willing to participate• Those who can able to understand Tamil and

English

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EXCLUSION CRITERIA• Patient who are mentally ill. • Patient with either hearing / visual impairment

patient who is having other serious disorder like Ischemic heart disease , CVA , tuberculosis & other respiratory problem

• Who experience acute orthopedic distress such as rib/shoulder gridle fracture.

DEVELOPMENT AND DESCRIPTION OF THE INSTRUMENT:

• TOOL 1:• structured interview to elicit the data of

demographical variables.

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CONT……

LAUGHTER THERAPY SESSION PROTOCAL

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ETHICAL CONSIDERATIONS

• DEPARTMENT PERMISSION• INFORMED CONSENT• ETHICAL CLEARANCE

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