International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 933
International Journal of Contemporary Pediatrics
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
http://www.ijpediatrics.com
pISSN 2349-3283 | eISSN 2349-3291
Original Research Article
Influence of bibliotherapy in reducing the stress among orphan children
in selected orphanages of Bangalore
Vijayalakshmi M.*
INTRODUCTION
A kid who has lost or had their parents abandoned is
considered an orphan. Only a kid who has lost both parents
is often referred to be an orphan. Orphans or "adult
orphans" are other terms for adults.
1
Known orphans include international leaders like Andrew
Jackson and Nelson Mandela, the Muslim prophet
Mohammed, and authors like Leo Tolstoy and Edgar Allan
Poe. In his artwork, the American orphan Henry Darger
depicted the appalling conditions of his orphanage. Other
noteworthy orphans include celebrities like Frances
McDormand, Ray Charles, Babe Ruth, Louis Armstrong,
Marilyn Monroe, and many fictional characters from
books and comics.
2
India has a problem with orphans. In India, three times as
many people live in the same area as Americans. It just
takes the addition of extreme poverty, starvation, drought,
natural catastrophes, acquired immune-deficiency
syndrome (AIDS), and malaria to create tragedy and, most
importantly, unaccompanied minors. It is not surprising
that many parents pass away under such circumstances,
leaving their children in the hands of a society that is
unable to care for them. Children are shockingly
defenseless on the streets; bad persons will cripple
orphaned kids so they may be used for laborious tasks like
ABSTRACT
Background: India has an orphan crisis. India has about three times the American population living in one third of the
space. On the streets, children are disturbingly vulnerable; evil adults will cripple orphaned children in order to use
them for works such as sexual abuse, physical violence, begging and many more just for monetary benefits.
Methods: The approach used for this study was evaluative research approach. The independent variable of the study is
bibliotherapy for orphan children (10-14 years) and dependent variable is level stress experienced by the orphan children
(10-14 years). The structured stress assessment statements were used to collect data and were analyzed and interpreted
using descriptive and inferential statistics.
Results: The majority (90%) had moderate stress and (10%) had mild stress in pre-test, whereas (100%) had mild stress
in post-test. The overall stress scores of respondents were found to be 53.63% with standard deviation 7.9 in pre-test.
The overall stress cores of respondents were found to be 38.24% with standard deviation 7.3 in post-test. It is evident
that the obtained "t" value 26.11 is greater than the table value at 0.01 level of significance. Therefore, "t" value is found
to be significant.
Conclusions: The present study was attempted to assess the influence of bibliotherapy on reduction of level of stress
experienced by orphan children and concluded that there is reduction in level of stress among orphan children after
exposure to bibliography. This supports that bibliography is effective in reduction of stress level among orphan children.
Keywords: Influence, Bibliotherapy, Stress, Orphan children, Orphanages
Department of Mental Health Nursing, Hillside College of Nursing, Bangalore, Karnataka, India
Received: 25 August 2022
Revised: 16 September 2022
Accepted: 19 September 2022
*Correspondence:
Dr. Vijayalakshmi M.,
E-mail: jeevaviji2003@gmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: https://dx.doi.org/10.18203/2349-3291.ijcp20222422
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 934
sexual abuse, physical abuse, begging, and other jobs for
money.
3
Stress is a condition of imbalance between the
expectations that are placed on a person and their capacity
to handle those demands. It may also be seen as a stimulus
that a person finds difficult or hurtful. To differentiate it
from the events that provoked it, the impact on the person
is typically referred to as the stress reaction. These
reactions include endocrine alterations, autonomic
responses, and psychological ones like the sensation of
being imprisoned.
4
Internal stressors (those that originate from within the
body), external stressors (those that come from outside the
body), developmental stressors (those that happen at
predictable times throughout life), and situational stressors
(unpredictable that happen at any time during the life) can
all contribute to stress. a few examples are hospitalizations
and illnesses, parent or family member loss, and
orphanhood.
5
Growing concern has been expressed in recent years
regarding how to handle stress in nursing. An individual's
physical and psychological well-being can be impacted by
stress. In a stressful situation, a nurse must meet demands
for fast, cost-effective treatment. The standard of care is
the responsibility of the nurses. A nurse can assist a lot of
people cope with these concerns since a calm mind is a
focused mind. When stress increases a person's capacity to
face everyday obstacles, it becomes a quality-of-life issue.
5
Bibliotherapy has gained a lot of attention as a useful
stress-reduction strategy. The first use of the term
"bibliotherapy" was by Crothes, who gave it that name at
the start of the 20
th
century. Most people are aware of the
effectiveness of therapeutic reading. When reading a
fantastic novel, we often find ourselves into the world the
characters are living in. When a character is suffering, we
cry alongside them, we experience joy or sorrow, and we
genuinely care about how the good people handle it and
how the evil people are dealt with. Typically, we also come
away with fresh perspectives and ideas for our own lives.
6
The phrases biblio and therapy, which both allude to
psychological support, are combined to form the term
bibliotherapy. Biblio is derived from the Greek word
biblus, which means "book." Bibliotherapy is the practice
of using books to assist individuals in resolving issues. It
is described as "instruction in the solving of personal
difficulties via reading" in Webster's Dictionary. The two
main schools of bibliotherapy are "cognitive" and
"affective," respectively. The majority of the literature that
is now available on bibliotherapy with kids is affective
bibliotherapy. Through the process of identification,
affective bibliotherapy employs fiction and other works of
high-quality literature to assist readers in making
connections to emotional experiences and everyday
events.
7
There are thought to be between 143.2 and 210 million
orphans in the globe. In India, there are close to 40 million
poor children and around 12.44 million orphans. In India,
a million new orphans are added to the population each
year. A tour of an orphanage will leave you with lifelong
memories since it's heart-breaking to see kids who are
living in abject poverty, being rejected, and being mentally
and physically stunted.
8
With 400 million children under the age of 18, India is the
country with the greatest population of children
worldwide. Unluckily, roughly 25 million of them are
orphans who must battle poverty every day and other
possible abuses.
8
Being an orphan is a misfortune, but it tastes even worse
when you are a youngster. Due to their numerous, intricate,
and intricately interwoven demands for safety, food,
housing, education, and family connections, orphans
experience extreme stress. Numerous studies have
described the various factors that affect orphans' stress
levels, including the loss of opportunities for quality
education, health care, and future development, a lack of
basic necessities, poverty, exploitation, stigma, sexual or
physical violence, restricted access to services, the
economic downturn, grief over losing one or both parents,
a lack of affection, injustice, a lack of moral and emotional
support, and discrimination.
9
Lack of school supplies, affection and care, loneliness, a
lack of decent clothing, unstable housing, prejudice, and
the inability to select what they want are the primary issues
that orphans face throughout life. The majority of
orphaned kids try to deal with the issues by working really
hard, helping out in people's gardens, carrying water,
reading a lot if they're in school, and doing their best to
behave themselves. Others resort to begging from friends
and family members or from one person to another in an
effort to cope. Some of them seek God's intervention and
healing via prayer, while others attempt to move from one
area to another.
10
Orphanhood and the issues orphans experience have
become a severe danger to local and national development.
New, forward-thinking policies and initiatives targeted at
enhancing their standard of living and guaranteeing their
future are urgently required if the approaching disaster is
to be avoided.
9
In an Indonesian residential institution, 14 participants,
aged 10 to 24, including 11 men and 3 women, participated
in qualitative research to discuss problems and coping
mechanisms (orphanage and Muslim boarding school).
Insufficient access to educational materials and essentials,
as well as residents' feelings of isolation and the residential
institution's lack of response, were determined to be key
sources of stress for the participants. People dealt with
these difficulties by seeking out social support from others
and attempting to shift the emphasis of their thoughts, such
as to more pleasant ones or by just mentally disengaging.
11
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 935
In Namibia, research was done to investigate the
relationship between single and double orphanhood and
depressive symptoms and emotional discomfort in kids
and teenagers. Children's depression inventory (CDI) was
given to 157 pupils from 3 schools, comprising 84 non-
orphans, 50 single orphans, and 23 double orphans.
According to the findings, depressive (stress) symptoms
were present in 21.9% of single and double orphans and
11.9% of non-orphans. The study provides proof that being
an orphan is linked to poor mental health and that stress
levels are high in about 1 in 6 children and adolescents in
Namibia.
12
Particularly in children's and fantasy fiction, orphaned
people are frequently the main characters. The absence of
parents frees the protagonists from parental
responsibilities and restrictions and deprives them of more
conventional lifestyles, allowing them to pursue more
intriguing and adventurous lives. Characters that are self-
contained, contemplative, and who aspire to love are the
result. In an allegoric sense, orphans might look within
themselves by striving to comprehend their origins. Fairy
tales frequently feature orphans, including most versions
of Cinderella. Numerous research has been done to
demonstrate that bibliotherapy is useful in lowering stress
in both adults and children.
13
In general, the author was enlightened by facts and
statistics to carry out a study on the influence of
bibliotherapy in reducing the stress among orphan children
in selected orphanages of Bangalore, with the objectives:
to assess the existing level of stress among orphaned
children, to select and administer the bibliotherapy
material among orphan children, and to assess
effectiveness of bibliotherapy on level of stress among
orphan children.
Hypothesis
H
1
There will be significant difference between pre-test and
post-test scores for stress among orphan children receiving
bibliotherapy.
METHODS
The present study is evaluative research approach was
adopted in ordered to assess the influence of bibliotherapy
in reducing the stress among orphan children at Sneha
orphanages, Bangalore. A one-group pre-test post-test
(pre-experimental) design has been used to attain the
objectives of the present study. Study was conducted at
Sneha orphanages, Bangalore. The independent variable is
bibliotherapy for orphan children and dependent variable
is level stress experienced by the orphan children. The
target population of the present study comprises of orphan
children in the age group of 10-14 years living in selected
orphanages in Bangalore. By adopting purposive sampling
technique 60 orphan children of age group of 10-14 years
was used to collect data. Data collection was carried out
for a period of one month. This data was entered into the
excel sheets and analysed using statistical package for the
social sciences (SPSS) for windows, version 16.0, Chi-
square test was used for the evaluation of the level of
significance.
The researcher adhered to several critical ethical
considerations regarding obligations and responsibilities
in the recruitment of participants and data collection:
approval has obtained from Institutional human ethics
committee, formal administrative permission was obtained
from a nursing institute administration, informed printed
agreement was taken from the subjects, and maintain the
confidentiality of data.
Sampling criteria
The samples were selected with the following
predetermined set of criteria.
Inclusion criteria
All orphan children in the age group of 10-14 years living
in orphanages suffering from considerable stress;
conscious and mentally alert; children who were
cooperative; and children having the ability to read and/or
write Kannada were included in the study.
Exclusion criteria
Children who were critically ill, with neurological deficit,
and who were not interested in reading were excluded from
the study.
Selection and development of the tool
The investigator has prepared the structured stress
assessment statements to assess the level of stress
experienced by orphan children in selected orphanages for
the present study. The tool was having two sections,
section 1: demographic variables such as age, sex,
educational status, duration of stay in the orphanage, any
visitors and the number of visits. Section 2: stress
statements on which include social stress physical stress
cognitive stress, emotional stress and spiritual stress.
Development of bibliography
The first draft of the bibliography was developed based on
the objectives of the study and was given to 7 experts in
the field of child health nursing along with objectives,
criteria rating scale based on their suggestions and
recommendations (i.e. expansions of abbreviations used
and correction of certain items), the final draft of
bibliography was prepared for orphan children (10-14
years). Bibliography stories included ‘biography of A.P.J.
Abdul Kalam’, ‘The Star Fish Story’, ‘Loyalty’ and
‘Friendship’, ‘The Secret of Happiness’, ‘Reflection of
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 936
You’, ‘Inspiring stories of Orphans of our time’ and ‘An
orphan girls success story’.
Reliability
In order to establish reliability of the tool, the technique
called split half method was used and reliability co-
efficient was calculated by using raw score formula. The
calculated ‘r’ value is 0.80 and the developed tool was
found to be highly reliable.
Method of data collection
After receiving official authorization from the relevant
authority, data was gathered from 60 participants, with the
orphan children chosen using a purposive selection
approach. The subject's willingness to engage in the study
was determined after the investigator gave a self-
introduction and described the objective of the
investigation. The individuals have been guaranteed of
their anonymity and the confidentiality of the information
they have supplied, and signed informed permission has
been acquired. The pre-test was administered on the first
day, followed by the bibliography, after one week, and the
post-test was administered using the same tool.
RESULTS
The data were analysed on the basis of the study
objectives, using both descriptive and inferential statistics.
Findings are organized in the following headings.
The distribution of the subjects by age revealed that the
(40%) were completed 14 years and (10%) completed 10
years of age, orphan children (50%) were males and
females respectively. Education status of orphan children
(50%) was studying high school and only (10%) were not
having formal education. Duration of stay in orphanage
children (40%) were staying more than 5 years and only
(10%) were staying from past six months and number of
visitors per day orphan children (80%) was not having any
visitors and only (20%) were getting one or two persons as
visitors.
The distribution of orphan children according to their
stress level shows majority (90%) had moderate stress and
(10%) had mild stress in pre-test, whereas (100%) had
mild stress and no participants had moderate or severe
stress. The maximum mean percentage obtained by the
orphan children is found in the aspect of emotional stress
(52.9%) followed by physical stress (56.62%), spiritual
stress (52.9%), cognitive stress (51.12%) and least mean
score (49.02%) found in the aspect of social stress. The
overall stress scores of respondents were found to be
53.63% with standard deviation 7.9 in pre-test.
Table 1: Frequency and percentage distribution of
demographic profile of orphan children.
Frequency
Percentage
Age (years)
6
10.0
12
20.0
6
10.0
12
20.0
24
40.0
Gender
30
50.0
30
50.0
Educational status
6
10.0
12
20.0
12
20.0
30
50.0
6
10.0
Duration of stay in orphanage
6
10.0
18
30.0
12
20.0
24
40.0
Number of visitors per day
48
80.0
12
20.0
60
100
The maximum mean percentage obtained by the orphan
children is found in the aspect of Spiritual stress (42.9%)
followed by social stress (41.08%), emotional stress
(40.58%), cognitive stress (36.05%) and least mean score
(31.2%) found in the aspect of physical stress. The overall
stress scores of respondents were found to be 38.24% with
standard deviation 7.3 in post-test.
The obtained "t" value 26.11 is greater than the table value
at 0.01 level of significance. Therefore, "t" value is found
to be significant. It means there is reduction in stress level
among orphan children after exposure to bibliography.
This supports that bibliography is effective in reduction of
stress level among orphan children.
Table 2: Pre-test and post-test stress level of orphan children (N=60).
Stress level
Pre test
Post test
Frequency
Percentage
Frequency
Percentage
Mild stress
6
10.0
60
100.0
Moderate stress
54
90.0
0
0.0
Severe stress
0
0.0
0
0.0
Total
60
100
60
100
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International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 937
Table 3: Mean, mean percentage and standard deviation for the pre-test stress scores of orphan children (N=60).
S. no.
Stress aspects
No. of items
Max score
Mean
Mean %
SD
1
Social stress
12
48
23.53
49.02
2.258
2
Physical stress
10
40
22.65
56.62
2.711
3
Cognitive stress
10
40
20.45
51.12
2.078
4
Emotional stress
15
60
34.35
57.25
2.169
5
Spiritual stress
5
20
10.58
52.9
1.680
Overall
52
208
111.57
53.63
7.997
Table 4: Mean, mean percentage and standard deviation for the post-test stress of orphan children (N=60).
S.
no.
Stress aspects
No. of items
Max score
Mean
Mean %
SD
1
Social stress
12
48
19.72
41.08
2.811
2
Physical stress
10
40
12.48
31.2
0.504
3
Cognitive stress
10
40
14.42
36.05
2.381
4
Emotional stress
15
60
24.35
40.58
0.481
5
Spiritual stress
5
20
8.58
42.9
2.52
Overall
52
208
79.55
38.24
7.343
Table 5: Comparison of pre-test and post-test stress scores of orphan children regarding bibliography (N=60).
S.
no.
Stress aspects
Pre test
Post test
Mean
difference
t value
Df
Inference
Mean
S D
Mean
SD
1
Social stress
23.53
2.258
19.72
2.811
3.817
8.767
59
S
2
Physical stress
22.65
2.711
12.48
0.504
10.167
27.543
59
S
3
Cognitive stress
20.45
2.078
14.42
2.381
6.033
15.063
59
S
4
Emotional stress
34.35
2.169
24.35
0.481
10.0
36.618
59
S
5
Spiritual stress
10.58
1.680
8.58
2.52
2.0
5.935
59
S
Overall
111.57
7.997
79.55
7.343
32.017
26.11
59
S
Figure 11: Comparison of pre and post-test stress scores of orphan children.
DISCUSSION
Based on the data analysis, the following findings were
reached: the current study sought to determine the
influence of bibliotherapy in reducing the stress among
orphan children in selected orphanages of Bangalore.
Findings revealed that that majority (90%) had moderate
stress and (10%) had mild stress in pre-test, whereas
(100%) had mild stress in post-test. The overall stress
scores of respondents were found to be 53.63% with
standard deviation 7.9 in pre-test. The overall stress scores
of respondents were found to be 38.24% with standard
deviation 7.3 in post-test. This finding of the study was in
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Social
stress
Physical
Stress
Cognitive
stress
Emotional
stress
Spiritual
stress
Overall
Percentage
Comparison of pre test and post test Stress scores
Pretest Scores
Post-test scores
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 938
consistent with study conducted by Georg who assessed
the effectiveness of bibliotherapy on stress reduction
among Hansen’s disease patients in selected settings in
Mangalore and found that the post-test stress level was less
than and pre-test stress level.
14
The resulting "t" value 26.11 is greater than the table value
at 0.01 level of significance. Therefore, "t" value is found
to be significant. It means there is reduction in stress level
of orphan children regarding bibliography. This supports
that bibliography is effective in reduction of stress level
among orphan children. The findings of the present study
were consistent with the study findings of Georg
who
assessed the effectiveness of bibliotherapy on stress
reduction among Hansen’s disease patients In selected
settings in Mangalore and found that the post-test stress
level was reduced after exposure to bibliography.
14
One
more conducted by Hridya who assessed effect of
bibliotherapy on stress among children at selected
orphanages, Coimbatore and found that mean scores of
stress before and after bibliotherapy were, 59.33 and 39.68
with the standard deviation of 13.07 and 8.07
respectively.
15
The calculated ‘t’ value 8.10 was compared
with the table value (3.526) at 0.001 level of significance.
The calculated ‘t’ value is greater than the table value.
Implications of the study
Nursing practice
In the delivery of healthcare, nurses perform a crucial and
significant role. Stressing health education and awareness
programs will help to increase measures to avoid
psychological issues, such as stress. To reduce the risk of
psychiatric morbidity, nurses who work in both hospitals
and the general population should be knowledgeable about
caring for patients who have acute or chronic illnesses.
Stress-related health and psychological issues are avoided
by early detection and management. Bibliotherapy is a
stress-reduction strategy that is both affordable and
effective. The public should be made aware of this
intervention by the nurses.
According to the study's findings, orphan children require
bibliotherapy; customers need to be ready to care for them
and overcome depressing ideas and pessimism.
Nursing education
The current healthcare delivery system places more of a
focus on prevention than on cure. The study also suggests
that medical professionals need to be aware of alternative
stress management and preventive strategies in addition to
prescribing medications. The nursing curriculum should
be designed such that students are exposed to various
treatment techniques for clients who have psychological
issues. Nursing students should be encouraged to read
books that will help them deal with their own stress. This
experience will also help them choose books for their
patients, especially those in long-term care facilities, to
help them cope with their stress and anxiety. Reading
materials ought to allow readers to see themselves in the
shoes of those who overcame impairments. If
bibliotherapy is proven to be beneficial, it can be utilized
as a stress-reduction technique for careers of clients,
orphan children, and student nurses.
Nursing administration
Nurse Managers should take the initiative to develop
policies or strategies for offering library services to
patients and their families while they are hospitalized. The
majority of mental institutions had developed libraries by
the eighteenth century in Europe, and by the middle of the
nineteenth century in the United States. Early in the
nineteenth century, numerous doctors started advising
books for the emotional struggles of the mentally sick. The
nurse administrator should encourage the use of
bibliotherapy in diverse contexts since it is very affordable
and less costly. It is important to provide in-service
programs to lower-level administrators like ward in-
charges so they may choose the resources for their patients'
outpatient therapy. The nurse authors should take a keen
interest in writing, developing and refining bibliotherapy
material for the effective use in various areas like clinical
practice, community and home healthcare.
Nursing research
In terms of India, the use of bibliotherapy in clinical
practice is still a largely untapped field. To evaluate the
effectiveness of this extremely viable and less expensive
therapy in numerous additional disorders and contexts,
many more research studies might be conducted. The
current study is only a first attempt, but it will inspire and
drive health professionals to do several other research
studies in this field. Researchers may also look at
medicines that boost patients' self-esteem and sense of
value.
The current analysis thus provides limitless possibilities
and consequences for nursing practice, education, and
research aspects of orphan children on lowering their level
of stress.
Limitations
Study was conducted in specific geographic area imposes
limits on generalization: the findings could be generalized
only to the population which fulfilled the criteria in the
study; the study limited to assessment of stress; the sample
was limited to 60 only; and long-term follow-up could not
be carried out due to time constraints.
CONCLUSION
The present study was attempted to assess the influence of
bibliotherapy on reduction of level of stress experienced
by orphan children and concluded that there is reduction in
level of stress among orphan children after exposure to
Vijayalakshmi M. Int J Contemp Pediatr. 2022 Oct;9(10):933-939
International Journal of Contemporary Pediatrics | October 2022 | Vol 9 | Issue 10 Page 939
bibliography. This supports that bibliography of great
personality have influenced the orphan children in
reduction of stress level what they experience in
orphanage.
Recommendations
A similar study can be replicated on a large sample to
generalize the findings. Also, a similar study may be
conducted in different setting.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: The study was approved by the
Institutional Ethics Committee
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