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                   KARNATAKA, BANGALORE
                         ANNEXURE II

                      FOR DISSERTATION

1.   Name of the candidate and address     NEELIMA APPUKUTTAN
                                           FIRST YEAR M.SC. NURSING
                                           CITY COLLEGE OF NURSING
                                           MANGALORE – 575 016.

2.   Name of the Institution               CITY COLLEGE OF NURSING,
                                           MANGALORE – 575 016.

3.   Course of study and subject           M. Sc. NURSING,
                                           PSYCHIATRIC NURSING

4.   Date of admission to the course       4.6.2009

5.   Title of the study:




            Mental health is as necessary for living a successful and happy life as physical health.
     We cannot think of our well-being and welfare without our mental health. The future of our
     country depends on the mental health and strength of our young people1. Among these
     mental illnesses, anxiety is a common disorder. Anxiety disorders are the second most
     common in mental health problems. It affects approximately one in ten people. Anxiety is a
     normal reaction of apprehension, tension, or uneasiness to any perceived threat or
     anticipation of danger2. Anxiety is more prevalent among women than men, and it affects
     children more. One of the most threatening events that cause anxiety in children today is
     examination. Examination anxiety is the fear of facing an examination. It can be caused by
     stress resulting from a variety of factors including fear of failure, lack of preparation, outside
     pressure, self doubts3.

            Examination anxiety is a major factor contributing to a variety of negative outcomes
     including psychological distress, academic under achievement, and academic failure. Many
     children have the cognitive ability to do well in the examinations, but may not do so because
     of high level of examination anxiety. Examination anxiety is a fairly common phenomenon
     that involves feelings of tension or uneasiness that occur before, during or after an
     examination. When students develop an extreme fear, they perform poorly in examinations
     and experience examination anxiety2.

            The anxiety can be reduced by regular use of pranayama (yogic breathing).
     Pranayama is the technique of breath manipulation to achieve desired level of emotional and
     physical wellness. Pranayama is a tool that can change our mental state, reduce negative
     thought patterns, and create an environment of wellness in body and mind.4

     6.1    Need for the study

            Anxiety is the most common psychiatric disorder. Almost all the students experience
     examination anxiety. Examination anxiety affects approximately 10-25% of population.
     According to a survey carried out by the Office for National Statistics (ONS) in the United
     States in 2000, anxiety disorders are the most prevalent mental health problems. Conditions

such as mixed anxiety and depressive anxiety, generalised anxiety disorders, phobias,
obsessive compulsive disorders, and panic disorders make up over 86% of neurotic
disorders5. Anxiety becomes problematic when an individual is unable to prevent the anxiety
from escalating to a level that interferes with the ability to meet the basic needs2. Most of the
parents force the child to get high score than others for getting a good career in future. For
that, prior to the examination, the child is not allowed to play, watch TV, or spend time with
family members6. Approximately 20-50% of the students experience examination anxiety.
Anxiety among students and their parents has been reported to be on the rise in India,
especially among those facing board certification examinations7. Pranayama is a powerful
tool for the reduction and prevention of excess states of anxiety. When practising pranayama,
the nervous system is naturally calmed and soothed. A slow deep breath at all times will
prevent and minimise examination anxiety. Recent medical studies have shown that a regular
practice of pranayama and yoga is effective at lowering levels of anxiety4.

       A descriptive study was conducted in Bangalore to assess the level of examination
anxiety in a randomly selected sample of 60 graduate nursing students using a structured
knowledge questionnaire. The study findings revealed severe anxiety level in first year B. Sc.
nursing students (42%) that gradually decreased in next level of students, with 25% among
the fourth year students. The study concluded that the students in first year were
experiencing higher anxiety than next level of students, and a series of exercises could help
reduce the anxiety before and during examination1.

       A cross-sectional exploratory study was conducted in United States of America to
assess the difference between students enrolled in yoga classes and those who were enrolled
in other kinesiology. A sample of 108 students was selected using convenience sampling and
a self-administered questionnaire was administered. The study findings revealed that the
kinesiology students reported significantly more anxiety than their counterparts (p<0.002).
Yoga students reported more positive coping strategies (p<0.008). The study concluded that
the yoga practice was the important factor in reducing stress and anxiety8.

       Based on review of the literature and from personal experience, the investigator came
to know that most of the students experienced anxiety before the examination. From this
instinct, the investigator was motivated to administer a relaxation therapy like pranayama to
reduce the examination anxiety in adolescents.

6.2    Review of literature

       A study was conducted in Italy to assess the role of anxiety symptoms in school
performance in a community sample of adolescent and children. The sample of elementary
(N=131, age 8-10 years), middle (N=267, age 11-13 years), and high school (N=80, age 14-
16 years) was selected using a survey and anxiety was measured using Multi-Dimensional
Anxiety Scale. The study findings revealed that out of the 478 children, 35 (7.3%) was in
anxious range. The rate of children in the anxious state was 2.3% in elementary, 7.9% in
middle, and 15.9% in high school (2=7.8, df=2, p<0.05), and was 14.1% among students
with insufficient grades, 9.4% among those with sufficient grades, and 3.9% among those
with good or very good grades (2=11.68, df=2, p<0.01). The study concluded that the
prevalence of anxiety symptoms increased with age and that high level of anxiety was
negatively associated with school performance9.

       A study was conducted in Tamil Nadu Medical College to assess and quantify the
prevalence of depression, anxiety and stress in undergraduate Medical students. A sample of
109 students was selected using random sampling and a structured questionnaire was
administered. Depression, anxiety and stress were measured using the Depression Anxiety
Stress scale. The study findings revealed that the amount of anxiety and stress was
comparatively higher than depression and the incidence of stress was 51.3%, anxiety
66.05%, depression 39.44%. Academic factors were perceived as more stressful (p<0.05).
The study concluded that there is need for interventions that will help the students to cope
with stress and anxiety, to make a smooth transition from school to medical college, and to
adjust to different learning environment10.

       An experimental study was conducted in Azad University, Iran to evaluate the
influence of pranayama in relieving symptoms of depression and anxiety in Women. A
sample of 80 women was selected using convenience sampling and randomly assigned into
experimental and control group. The study findings revealed that the average prevalence of
depression in the experimental group pre- and post-yoga intervention was 2.82±7.9 and
10.79±6.4, respectively. When the experimental group was compared with the control group,
women who participated in pranayama classes showed significant decrease in state anxiety
(p=0.03) and trait anxiety (p<0.001). The study concluded that pranayama can lead to

significant reduction in perceived levels of anxiety. The researcher suggests that pranayama
can be considered as a complementary therapy or an alternative method for medical therapy
in the treatment of anxiety11.

       A correlation study was conducted in Hong Kong to assess the degree of anxiety and
the relationship between anxiety and academic achievement of secondary school students. A
sample of 384 students was selected using convenience sampling and anxiety was measured
by Taylor’s Manifest Anxiety Scale (MAS). The study findings revealed that the anxiety
level of students were relatively high (mean=31.11) and also students with low debilitating
anxiety (mean=23.63) performed better than those with high anxiety. The study concluded
that the moderate anxiety (mean=27.6) had less direct relevance to academic performance12.

       An experimental study was conducted in 8 public schools of Punjab to assess the
effect of yoga on academic performance in relation to stress and anxiety. A sample of 800
students was selected using the score obtained in Bisht Battery of Stress scale – high stress
(150) and low stress (142) students. Experimental and control groups were selected and pre-
test in three subjects, i.e., mathematics, science, social studies, and yoga module was
administered and post-test was conducted for their performance on the same subjects. The
study findings revealed that high stress and anxiety affected students’ performance
negatively. The academic performance score of experimental group was (M exp=32.63) higher
than the control group (Mc =22.4), thereby showing that students who practised yoga
performed better than those did not. The study concluded that yoga intervention technique
improves the academic performance by optimising the stress and anxiety level13.

6.3    Statement of the problem
       Effectiveness of pranayama on the reduction of examination anxiety in the final year
pre-university students in a selected college at Mangalore.

6.4    Objectives of the study

1.     To determine the examination anxiety among final year pre-university students as
       measured by a structured anxiety scale.

2.     To evaluate the effectiveness of pranayama in terms of reduction of the examination

3.     To find the association of pre-test anxiety score with selected demographic variables.

6.5   Operational definitions

1.    Effectiveness: In this study, effectiveness refers to the extent to which pranayama
      has attained the desired reduction in anxiety as evidenced by the post-test.

2.    Examination anxiety: In this study, examination anxiety refers to the anxiety about
      the examination as measured by the test anxiety scale.

3.    Final year pre-university students: Students who are studying in second year pre-
      university college science group.

4.    Pranayama: Pranayama is one of the branch of yoga that focuses specifically on the
      physical postures, called ‘asanas’ that are integrated with a special form of breathing

6.6   Assumptions

      Study assumes that:

1.    Students have some anxiety regarding examinations.

2.    Examination anxiety is common in pre-university students.

3.    Pranayama is an effective method in reducing examination anxiety.

6.7   Delimitations

     Students in the selected college.

     Students who are in the science group.

     Students who are present in the college at the time of data collection.

6.8   Hypotheses

      The hypotheses will be tested at 0.05 level of significance.

H1:   The mean pre-test anxiety score of final year pre-university students on examination
      will be significantly higher than their mean post-test anxiety score.

     H2:    There will be a significant association between the pre-test anxiety scores on
            examination and the selected demographic variables.

7.   Material and methods

     7.1    Sources of data

     In this study data will be collected from the final year pre-university students who are having
     anxiety about examination in a selected college at Mangalore.

     7.1.1 Research design

            One group pre-test–post-test design.

     7.1.2 Setting

            The study will be conducted at the selected pre-university college of Mangalore.

     7.1.3 Population

            Population includes final year pre-university students of the selected college of

     7.2    Method of data collection

     7.2.1 Sampling procedure

            The sample for the study will be selected by simple random sampling technique.

     7.2.2 Sample size

            In this study, the sample size will be 50 students.

     7.2.3 Inclusion criteria

     1.     Students who were in final year pre-university college science group

     2.     Students in the age group of 16-19 years.

     3.     Students who are willing to participate in the study.

     4.     Students who are able to communicate in English.

7.2.4 Exclusion criteria

      Students who are trained in yoga.

7.2.5 Instruments intended to be used

      Structured anxiety scale.

      Pranayama technique.

7.2.6 Data collection method

       Permission will be obtained from the selected college. Fifty subjects will be collected
using simple random sampling. Purpose of the study will be explained and consent will be
taken from the subjects. The pre-test anxiety of the participants will be assessed by
administering a structured anxiety scale and pranayama will be given for three days for them.
Post-test will be conducted after 15 days using the same anxiety scale.

7.2.7 Data analysis plan

      Pre-test and post-test data will be analysed using mean, median and standard

      Effectiveness will be analyzed using paired ‘t’ test.

      The association will be analysed using chi-square test.

7.3    Does the study require any investigation or intervention to be conducted on
       patients or other humans or animals?

       Yes, the investigator needs to evaluate the effectiveness of pranayama on reduction
of examination anxiety among students of final year pre-university college.

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

       Yes, ethical clearance has been obtained from authority.

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      Nightingale Nursing Times 2007;4-8.
2.    Townsend MC. Psychiatric mental health, nursing concepts of care in evidenced-
      based practice. 5th ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd.
3.    Prabhudeva SS. Examination anxiety. Nightingale Nursing Times 2006 Jun;9-11.
4.    Burgin T. Yoga for anxiety. [online]. Available from:
5.    Kirkwood G, Rampes H, Tuffery V, Richardson J, Pilikigton K. Yoga for anxiety.
      British Journal of Sports Medicine 2005 Dec;39(12):884-91.
6.    Sujendra Prakash BS. Overcoming examination anxiety. [online]. Available from:
7.    Thergaonka NR. Relationship between test anxiety and parenting style. Journal of
      Indian Association of Child and Adolescents Mental Health 2007;2(4):10-2.
8.    Permuth-Levine R. Differences in perceived stress, affect, anxiety and coping ability
      among college students in physical education courses. [online]. Available from:
9.    Mazzone L, Ducci F, Scoto MC, Passanite E. The role of anxiety symptoms in school
      performance in a community sample of children and adolescents. BMC Public Health
10.   Vaidya PM. Prevalence of depression anxiety and stress in undergraduate medical
      students and its co-relation with their academic performance. The Indian Journal of
      Occupational Therapy 2007 Apr;XXXIX(1).
11.   Javnbakh M, Hejazi KR, Ghasemi M. Effects of pranayama on depression and
      anxiety of women. Complementary Therapies in Clinical Practice 2009 May;102-4.
12.   Cheung FM. Anxiety among secondary school students in Hong Kong and its
      relationship   to   academic performance. Journal       of   Abnormal   and Social
13.   Sharma N, Kauts A. Effect of yoga on academic performance in relation to stress.
      International Journal of Yoga 2009 Jun;21: 39-45.


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