Research article

1. A DESCRIPTIVE STUDY TO ASSESS THE ANXIETY & COPING MECHANISMOF CAREGIVERS OF CANCER
PATIENTS ADMITTED IN SELECTED HOSPITAL, LUDHIANA, PUNJAB.
Khushnasib
Author’s affiliation:- Principal,MD Oswal College of Nursing,Ludhiana,Punjab.
CorrespondingAuthor:- Khushnasib,AssistantProfessor,ArmyCollegeof Nursing,JalandharCantt,
Punjab
ABSTRACT
Anxietyisanemotioncharacterizedbyfeelingsof tension,worriedthoughtsandphysical changeslike
increasedbloodpressure. Materialsandmethods:- The Non- experimentalDescriptiveStudywas
conductedtoassessthe level of anxiety&copingmechanismamongcaregiversof cancerpatients
admittedinselected byNonRandomizedPurposive Sampling.Structuredquestionnaire(i) Standardized
modifiedBurnAnxietyInventoryScale and(ii) Assessmentof copingmechanismtool usedfordata
collection.The responsesare tabulated,organized,analyzedandinterpretedbyusingdescriptiveand
inferential statisticsbasedonobjectivesof the study. Results:- Findingsrevealedthat5% of caregivers
had minimal ornoanxiety,38%had mildanxiety,24% hadmoderate anxiety,8% hadsevere anxiety&
4% had extreme anxiety.Onassessingcopingmechanism,28% had maladaptive coping&72% had
adaptive coping.Conclusion:- Oncomparisonof anxietyscoreswithcoping scoresitwasinterpreted
that withincreasedseverityof anxiety,caregiversstartmovingtowardsfailure tocope withanxiety.
Therefore,itisneedtoeducate caregiversadaptationmethodsof copingtoimprove copingmechanism.
Introduction
Anxietydisorderpresentsavarietyof physical
symptoms& nonphysical symptomsi.e.
excessive&unrealisticworrying,trembling,
churningstomach,heartpalpitations,numbness
inbody,restlessness,trouble concentrating,
chestpain,shortnessof breathe anddizziness,
flashbacksornightmares,avoidance of people,
placesandthingsassociated withevent,
difficultysleeping,closelywatching
surroundings,irritability,diminishedfeelingsor
aspirationsforfuture.Anxietyisof twotypes
i.e.beneficial andharmful anxiety.Anxietyis
“fightor flightresponse”thatkeepscaregivers
safe fromstresses&tension.Itissaidthat
adrenaline isbeneficial undertense
circumstances.Itisreactionthat motivates,
preparesforthingswe have to face and
sometimesenergytotake actionwhenneeded.
Thisis calledbeneficial anxiety.Incase of
overwhelminganxietycaregiversfeel unableto
make decisions,avoidingthings,unabletogoto
occasion,can’t concentrate andcan’t stay
focused,interference withtheirdayto day life.
Thistype of symptomsproduce more anxiety
problemandneedprofessionalhelp.
Copingisto deal withstressesthata
personwhile livingthroughstressesindailylife
experience.Methodstocope withanxietyare
to accept reality,separate outreal risksand
changesthat situationspresent.Typesof coping
are adaptive andmaladaptive coping.Adaptive

2. copingisask yourself inthisproductive thought,
isit helpingme togo towardsmygoal,if its
negative thoughtsay‘stop’.Maladaptive coping
iswhencopingabilitiesbecome impairedi.e.
personbecomesunable tocope i.e.person
becomesunable tocope i.e.personknowsthat
it isa negative thoughtbutcannotbe
challenged.Differentmodalitiesof copingisto
learnto relax,breathe retraining,yoga,
meditation,exercise.
Needofthe study
While workinginclinical arearesearchermet
manyof the relativesof cancerpatientswitha
bigburden.Patient’srelativesfeltanxietyand
were havingdeficitincopingability.Itwas
causinginterference incaregivingandwas
makingfamilymembersinefficienttoperform
theirwork.Hence,needof attentioninthisarea
of research.
Studywas conductedtotestthe
competingmodelsforhusbandandadult
daughtercaregiversof breastcancerhospice
patients.Datawas collectedwithtwomodels
i.e ComplicatedGrief Model comprisingof
empiricallyderivedanxietyanddepression
symptomsandtheoreticallyderivedanxietyand
depressionsymptomsandtheoreticallyderived
psychological andhealthstrainformulations.
Both predictedthathusbandsfeltmore difficult
bereavementadjustmentsthandaughters.
Neithermode wassupportedforadult
daughters.The studypredictedbetter
bereavementadjustmentinoldcaregiversfor
bothhusbandsand daughters.Adultdaughters
experiencedmore caregiverrole strain than
husbandsdidi.e.adultdaughtersfeltmore
difficulttoadjustwithcaergivingburden.
Thisstudywas conductedtoexamine
predictorsof psychological stressforcaregivers
of cancerpatientsfollowingbereavement.It
was basedonfactors identifiedatthe time of
referral topalliative care agency.Sample
consistedof 178 caregiversof 178 caregiversof
cancer patients.The chief predictorsof
caregiver’spsychological symptomsand
severityof grief were scoresof psychological
symptomsduringreferral.Theywere also
measuredatthe time of adverse life events
aboutcaregivers’copingresponses,post
bereavementandseparationexperiences,
caregivers’relationshipduringandgreater
severityof patient’s illnessatthe time of
referral.These findingsindicate thatclinical risk
factors foradverse shorttermbereavement
outcome can be usedto identifythe
psychological needsof caregiverstoformthe
potential basisforinterventions&toenhance
the psychological outcome of familycaregivers.
Objectives
1. To identifythe anxietyof caregiversof
cancer patients.
2. To identifythe copingmechanismof
caregiversof cancerpatients.
3. To analyze the correlationof anxiety
and copingmechanismof caregiversof
cancer patients.
4. To findthe associationbetweenanxiety
withselectedvariables suchassex,age,
education,income,occupation,length
of hospital stay,massmediaexposure
and residential area.
5. To findthe associationbetweencoping
mechanismswithselected variables
such as age,sex,education,lengthof
hospital stay,massmediaexposureand
residentialarea.
6. To identifythe anxietyandcoping
mechanismdeficitinordertoprepare
healthguidelines.

3. Hypothesis
Cancer patients’caregivershave anxietyand
deficitincopingmechanismondiagnosisof
familymemberwithcancer.
Conceptual framework
The presentstudywasbasedon RoyAdaptation
Model.The RAMsuggeststhe methodof
adaptationwithstressesandanxietiesinlife.It
include 3components:- Input,Output&Control
Processes.
1) INPUT:- Inputsare stimuli orfactorsof
personinfluencingadaptation.These
can be external orinternal factors.
Accordingto the presentstudy,
caregiversof cancerpatientsdevelop
anxiety due tofamilymember
diagnosedwithcancer.Itsinputswere
of 3 typesthat were influencinganxiety
of caregivers:-
a) Independentvariables(understudy):-
Gender,age,education,income,
occupation,lengthof hospital stay,
mass mediaexposure,residential area.
b) Internal factors(Notunderstudy):-
Knowledge,selfesteem, outlook,
relationshipwithpatient,skillsof
caregiving.
c) External factors:- Social role changes,
financial role change,lackof
communication,patient’s
characterstics,patient’sfunctional
ability,social pressures.
2) OUTPUT:- Accordingto stimulus,
responseswere produced.These canbe
adaptive ornon adaptive.
3) Control Processes:- Control Processes
are adaptive system.Inthisstep,coping
strategieswere minddiversion,
introspection,introjections,behavior
modification.Accordingtoadaptation
of caregivers,itcanbe adaptive or
ineffective.Accordingtolevel of

4. adaptation,assessmentof anxiety&
copingwas done.Nursinginterventions
giventoimprove copingmechanismi.e.
healthguidelinesforknowledgeof
anxiety&coping.Evaluationwasdone
whichrevealedthatcaregiverswere
betterable tocope upwithanxiety,
showeddecreasedanxiety,showed
decreasedanxiety&increasedcoping
scores.
RESEARCH DESIGN:-
Nonexperimental researchdesignwasapplied
to assessthe level of anxietyandcoping
mechanismamongcaregiversof cancer
patients.The independentvariablesinclude
gender,age,education,income,occupation,
lengthof hospital stay, massmediaexposure
and residential areaof caregiversof cancer
patientsadmittedinselectedhospital,
Ludhiana,Punjab.
Reviewof Literature:-
The Reviewof Literature forthe presentstudyis
gatheredandorganizedunderthe following
headings:-
1. Literature relatedtoanxietyandits
effects
2. Literature relatedtocopingmechanism
MATERIALS AND METHODS
Research approach & design
A quatitative approachwithnon-experimental
descriptive researchdesignwasusedtoconduct
the study.
Independependentvariables:- Gender,age,
education,income,occupation,lengthof
hospital stay,massmediaexposureand
residentialarea.
Dependentvariables:- Anxietyandcoping
mechanismof caregivers of cancerpatients.
Research setting
Differentwardsof cancerinMD Oswal
MultispecialityandCancerHospital,Ludhiana,
Punjab.

5. Population
The populationcomprisedof caregiversi.e.
bloodrelatedrelatives/familymembersof
cancer patientsprovidingcare tothe patients
providingcare to the patientsfordurationof 3-
7 daysin hospital andfacinganxietyandaltered
copingmechanismwhilecaringforthe patient.
Sample and samplingTechnique
Sample size was100 caregiversof cancer
patients.NonRandomizedpurposive and
Convinience samplingwasused.
Developmentoftool
The tool forthe presentstudywasStandardized
Burn AnxietyInventorytool andNon
Standardizedstructuredquestionnaire for
assessinglevel of copingbasedonreviewof
literature andobjectivesof the study.
Descriptionof the tool
The tool consistsof 3 sections:-
SectionI:- Sample characterstics:- Itcontain8
demographicvariablesincludinggender,age,
education,income,occupation,lengthof
hospital stay,massmediaexposureand
residentialarea.
SectionII:- BurnAnxietyInventoryScale:- It
contained32 itemsrelatedtoanxiety
symptoms.
SectionIII:- A structuredquestionnaire with32
itemsrelatedtocopingsymptoms.
Data collection
The data collectionwascarriedoutby
investigatorbypersonallyadministering
questionnaire tostudysubjects.The responses
of caregiverswastabulated,organized,
analyzedandinterpretedbydescriptive and
inferential statisticsbasedonobjectivesof the
study.
Ethical clearance
Ethical clearance wastakenfrom Ethical
Committee.
RESULTS
In the presentstudy,in sample of 100 subjects
54% were malesand46% were females,
accordingto age in20-40 yrs of age were 57%,
41-60 yrsof age were 41% & <61 yrs of age
were 2%,18% were illiterates,43% were
matriculationpassed,39% were graduates,
income>5000 were 45%, 5001-10,000 were
28%, 10,000-15,000 were 16% &<15,000 were
11%, 71% were employed,29% unemployed,3-
5 dayshospital staywere 39%, 5-7 days hospital
stay were 31%, 7 or above days were 30%,mass
mediaexposure dailywere 18%,sometimes
47%, neverwere 35% & rural 19%, semi urban
46% andurban were 35%. On assessinglevel of
anxiety,38% had mildanxiety,24% had
moderate anxiety,21% had borderline anxiety,
8% had severe anxiety,51% hadminimal orno
anxiety,4% hadextreme anxiety.Itconcluded
that majorityof caregiverswere able tocope
withanxiety.
On findingthe associationandlevelof
variance,there issignificantassociationof
anxietywitheducation(F=4.16),occupation
(t=1.42) and gender(t=0.04). Onanalyzingco-
relationwithlevel of anxiety andcopingof
caregivers,there wasnegativerelationbetween
anxietyandcopingmechanismi.e.asthe level
of one increases,the otherdecreasesandvice
versa.
Hence,Hypothesis(H) suggestingcancer
patients’caregivershave anxietyanddeficitin

6. copingmechanismondiagnosisof family
memberdiagnosedwithcancerisaccepted
partially.

8. DISCUSSION
The discussionof the studyisbasedon the
findingsobtainedfromstatistical analysisand
accordingto the objectives.Tofindoutthe level
of anxietyof caregivers,5%hadminimal orno
anxiety,21%had borderlineanxiety,38% had
mildanxiety,24%hadmoderate anxiety,8%
had severe anxietyand4% had extreme anxiety
i.e.minimumpercentage of caregivershadmild
anxietyandfew hadextreme anxiety.On
findingcopingmechanism, 28% caregivershad
maladaptive and72% hadadaptive coping
whichj concludedthatmajorityof caregivers
were able tocope withanxietydue tofamily
memberdiagnosedwithcancer.

9. To determine the relationshipbetween
anxietyandcopingof caregiversof cancer
patients,there isnegativecorrelationi.e.with
increase inmeananxietyscores,the mean
copingscoresdecreasesandvice versa i.e.as
the anxietyincreasesthe personstartsfailingto
cope.The analysisrevealedthatthere is
significantassociationof anxietyandcoping
witheducation,occupationandgender.
RECOMMENDATIONS
The followingstudiescanbe made basedon
presentresearch.
1. The study can be replicated ona large
sample.
2. A comparative studycanbe done to
assessthe effectivenessof different
copingmechanism
3. A quasi experimental studycanbe
conductedtoassessthe anxietyand
copingusingcontrol & experimental
group.
4. The study can be conductedon
differentpopulationandindifferent
settings.
5. An exploratorystudycanbe conducted
to detectpredisposingfactorsof anxiety
instudentnurses.
6. A comparative studycanbe conducted
to identifymeasurestakenbystudent
nursesto reduce anxiety.
CONCLUSION
The data collected&statistical analysisof
researchand interpretationhasclearlyshown
that anxietyoccursincaregiversof cancer
patientswhichdeclinescopingmechanism.The
statistical analysisindicatednegative
correlationbetweenanxietyandcopingamong
caregivers.Byprovidinghealthinstructionsor
enhancingthe life styleordietwe maybe able
to reduce anxietyandcopingmechanism
amongcaregiversof cancer patients.
Source of finding:Self
Conflictof interest:- None
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