M.

Maimunisa MSC(N) II YEAR CHETTINAD HOSPITAL &

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.

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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BACKGROUND OF THE STUDY

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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 infection Immunoglobulin B provide antibodies with strength to attack dysfunction cells
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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 2006 Laughter the physical response to perceive humor has demonstrated the effect on physical & psychological well being. - kruse b.g 2006
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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.

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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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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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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A silent killer that has become the single most important factor causing stroke, heart attacks, DM , blindness & paralysis , high BP affects 30 % of the countrys 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 HTN When 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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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.

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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 persons 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
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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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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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AIM OF THE STUDY

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

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

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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 140/90180/110 mm of Hg in selected community area.

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ASSUMPTION
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.

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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

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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

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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.

POPULATION: All the patient with primary Hypertension in POONJERY CHENNAI ,TAMILNADU.

Contd.

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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 140-180/90110mmhg. 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.

 TOOL 1: structured interview to elicit the data of demographical variables.

DEVELOPMENT AND DESCRIPTION OF THE INSTRUMENT:

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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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