PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

Mrs. BEENA B.S

1st YEAR M.Sc. NURSING

CHILD HEALTH NURSING

2012-2014

PADMASHREE COLLEGE OF NURSING

GURUKRUPA LAYOUT NAGARBHAVI

BANGALORE-560072

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

1

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE

CANDIDATE AND

ADDRESS

Mrs. BEENA B.S

1st YearM.Sc. Nursing

Padmashree College Of

Nursing. GurukrupaLayout,

Nagarbhavi,Bangalore-560072

2 NAME OF THE

INSTITUTE

Padmashree College Of

Nursing

3 COURSE OF THE

STUDY AND

SUBJECT

1’st Year M.Sc. Nursing

Child Health Nursing .

4 DATE OF

ADMISSION

27-07-2012

5 TITTLE OF THE

STUDY

A study to assess the

effectiveness of bibliotherapy

on stress reduction among

orphan children in selected

orphanages of Bangalore.

6. BREIF RESUME OF INTENDED WORK

2

6.1 INTRODUCTION:

An orphan is a child permanently bereaved of or abandoned by his or her

parents. In common usage, only a child who has lost both parents is called an

orphan. Adults can also be referred to as orphans, or "adult orphans".1

Famous orphans include world leaders such as Nelson Mandela and

Andrew Jackson; the Muslim prophet Mohammed; writers such as Edgar Allan

Poe, and Leo Tolstoy. The American orphan Henry Darger portrayed the horrible

conditions of his orphanage in his art work. Other notable orphans include

entertainment greats such as Louis Armstrong, Marilyn Monroe, Babe Ruth, Ray

Charles and Frances McDormand, and innumerable fictional characters in

literature and comics.2

India has an orphan crisis. India has about three times the American

population living in one third of the space. Introduce intense poverty, famine,

drought, natural disasters, AIDS, and malaria, and you have a recipe for tragedy

and, most significantly, unaccompanied children. In such conditions, it is no

surprise that many parents die, leaving their children to a nation unable to take care

of them. 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.3

Stress can be understood as a state of imbalance between demand placed on

an individual and the individual’s ability to deal with the demands. It also can be

considered as a stimuli that an individual perceives as challenging or harmful. The

effect on the person can usually be called the stress reaction, to distinguish it from

the provoking events. These reactions include autonomic responses, endocrine

changes and psychological responses such as a feeling of being locked up4

Stress can be caused by internal stressors(that which occurs from within the

body),external stressors(that which originates from outside the

body),developmental stressors(that which occurs at a predictable time throughout

the life)and situational stressors(unpredictable that occurs anytime during the

3

life .example: .hospitalization and illness, loss or death of parents or family

members especially orphan hood).5

Over the recent years, there has been growing concern about management

of stress in nursing. Stress can have an effect on an individual, in terms of both

physical and psychological health. Nurse in context with stress faces demands to

provide a service that is efficient, effective and economic. Nurses are accountable

for the quality of care. A relaxed mind is a focused mind, when stress increase the

person’s ability to handle the daily challenges becomes a quality-of-life issue, a lot

can be helped by a nurse to deal with these issues.5

Bibliotherapy has received considerable importance as one of the effective

stress management technique. The term bibliotherapy goes back to the beginning

of the twentieth century, when Crothes (1916) labeled it as such. Most of us

recognize the power of therapeutic reading. We find ourselves entering the world

described in the pages of a good book, and we become involved with the

characters. We feel happy or sad, we cry with the character who suffers, we want

the good ones to cope and the bad ones to be punished; we really care. We usually

end up gaining new insights and ideas for our own lives as well6.

The term bibliotherapy is made up of two words: biblio, originating from

the Greek word biblus (book), and therapy, referring to psychological help. Simply

stated, bibliotherapy can be defined as the use of books to help people solve

problems. Webster’s Dictionary (1985, p. 148) defines it as ‘‘guidance in the

solution of personal problems through reading. ’There are two major schools of

bibliotherapy: ‘‘cognitive’’ and ‘‘affective.’’ Most of the existing literature on

bibliotherapy with children is of affective bibliotherapy (Gladding, 2005).

Affective bibliotherapy uses fiction and other high-quality literature to help the

reader connect to emotional experiences and human situations through the process

of identification7

6.2NEED FOR THE STUDY:

4

It is estimated that 143-210 million orphans are living

worldwide.Approximately there are 12.44 million orphans, and close to 40 million

destitute children live in India.Each year, about a million new orphans are added to

the society in India. A walk through an orphanage, will be anunforgettable

experience, witnessing children in poverty, children discarded, children stunted

both physically and emotionally, thatstirsthe heart beyond belief 8.

India has the largest population of children under age 18 in the world –

about 400 million youngsters. Sadly, about 25 million of these are orphans who

must struggle each day against poverty and face many potential abuses8

Orphanhood is a curse, but it is bitter when associated with childhood. The

orphans face immense stress which gets created by varied, complex and intimately

connected needs for security, food, shelter, education and family connection. There

are many studies which portrayed the various causes of stress in orphans such as

losing opportunities for adequate education, health care, future, scarcity of basic

amenities, poverty, exploitation, stigma, sexual or physical violence, lack of access

to services, economical crisis, grief of being parentless, lack of affection, injustice,

lack of moral and emotional support and discrimination. 9

The problems the orphans mainly encounter in their life include: lack of

school fees, lack of scholastic materials, lack of love and care, loneliness, lack of

good clothes, lack of stable homes, discrimination, and cannot choose what they

want. Majority of the orphaned children try to cope with the problems by generally

working very hard, working in peoples’ gardens, fetching water, reading hard if in

school, and try to be well behaved. Others try to cope by begging from relatives

and friends, begging from one person to other. Some of them pray to god for

divine assistance and healing while others try shifting from one place to another.9

Orphan hood and problems faced by the orphans has emerged as a serious

threat to the community and national development. If the impending tragedy is to

be averted new and visionary policies and programs aimed at improving their

living condition and securing their future are urgently needed.9

5

A qualitative study was conducted to describe challenges and strategies for

coping with the challenges amongfourteen participants (11 males and 3 females)

ages 10-24 residing in an Indonesian residential institution (orphanage and Muslim

boarding school).The results found that insufficient access to educational resources

and basic necessities were major concerns of stress to the participants, as was the

residential institution's unresponsiveness and the lack of connection experienced by

residents. Individuals coped with these challenges by turning to others for social

support and by trying to change the focus of their thoughts, such as to more

pleasant thoughts or simply to mentally disengage10.

A study was conducted to examine the association of single and double

orphan hood with depressive symptoms and emotional distress among children and

adolescents in Namibia. A sample of 157 students from 3 schools including 84

non-orphans, 50 single orphans, and 23 double orphans were taken and children’s

depression inventory(CDI) was administered. The results found 21.9% of single

orphans and double orphans and 11.9% of non-orphans exhibited depressive(stress)

symptoms. The study provides evidence that orphan hood is associated with ill

mental health and that high rates of stress are present in approximately 1 in 6

children and adolescents in Namibia.11

The perceived stress among orphaned children has been portrayed in

different studies by researchers. All studies display a grave urgency because the

stress which is faced by orphaned children can cause thwarted deviation in the

developmental process of orphaned children. The results of studies are alarmingly

disappointing and suggest deep insightful further studies.12

Stress management is a creative and powerful tool as long as individuals

learn to use the methods appropriately.One of the recently developed stress

management technique is bibliotherapyThe process of providing advice and help

through books is called bibliotherapy. It is an old concept of library science. The

ancient greeks stressed the importance of literature by posting a sign above the

library doors describing itself as the “ healing place for the soul”. The basic

concept behind bibliotherapy is that reading is a healing experience. Literary

sources can assist with the resolution of complex problems.13

6

Apart from the bountiful educational and cultural benefits of encouraging

children to read, there are three other great therapeutic reasons to use children’s

books(bibliotherapy) to give advice:

1. Identification of character and social situation: This identification increases the

probability of learning different behaviors and receiving advice.

2. Catharsis: Through identification, an emotional connection with the character

or social situation allows children to act out and discuss their emotional responses

to the situation.

3. Insight: Through beneficial discussion and follow-up play, the child integrates

the link between the story and their own life, with opportunities to practice how to

address and solve issues of concern. Reading creates different brain waves and

allows children to think in a new and different way. Followed with a bit of

positively manipulated play, reading a book may well be the best super nanny or

child therapist in the world14

Bibliotherapy can assist children in building confidence and self-esteem. It

attempts to normalize a child's world by offering coping skills and reducing their

feelings of isolation, reinforcing creativity, and problem solving.15

Orphaned characters are extremely common as literary protagonists,

especially in children's and fantasy literature. The lack of parents leaves the

characters to pursue more interesting and adventurous lives, by freeing them from

familial obligations and controls, and depriving them of more prosaic lives. It

creates characters that are self-contained and introspective and who strive for

affection. Orphans can metaphorically search for self-understanding through

attempting to know their roots. Orphans are common in fairy tales, such as most

variants of Cinderella. Many studies have been conducted to prove effectiveness of

bibliotherapy in reducing the stress in both adults and children.16

A study was conducted to determine whether bibliotherapy has an effect on

the anxiety levels of 5’th grade students as measured by Beck Anxiety

Inventory. . The sample included 2 groups of 5th graders in a local educational

setting in a southern U.S. state. Group A received 2 weeks of bibliotherapy

intervention including 3, one hour lessons per week while Group B received

7

traditional treatment. Post treatment anxiety was measured and compared after

categorizing participants into low stress or high stress. The findings suggested a

significant relationship between the use of bibliotherapy and lower levels of

anxiety. The implications for social change are that the findings may add to the

body of knowledge for educators and parents about a coping strategy,

bibliotherapy, which is gaining momentum in the fight against childhood stress

and anxiety17.

An experimental study was done to identify the effectiveness of

bibliotherapy in reducing the stress of 20 inner city first grade students. A twenty

item stress questionnaire was given to assess pre test scores followed by

bibliotherapy intervention that was given for thirty minutes, 5 days a week, for 8

weeks. Post test was then assessed . Research results found that many stressors

were reduced when first grade students participated in bibliotherapy. The

researcher concluded that bibliotherapy is an effective approach for helping

children solve problems and reduce stress.18

There are several studies conducted by various researchers throughout the world stressing the effectiveness of bibliotherapy in stress reduction among adults and children of varied age groups.It is the need of the hour to expand the practical implication and scope of

bibliotherapy in solving the orphan stress and helping them develop as productive

citizens of the country. Henceforth this study has been proposed.

6.3 STATEMENT OF PROBLEM: A study to assess the effectiveness of bibliotherapy in reducing the stress

among orphan children in selected orphanages of Bangalore.

6.4 OBJECTIVES:1. To assess the existing level of stress among orphaned children.

2. To select and administer the bibliotherapy material among orphan children.

8

3. To assess effectiveness of bibliotherapy on level of stress among orphan

children.

4. To associate level of stress among orphan children with their selected

demographic variables.

6.5 OPERATIONAL DEFINITIONS:1. Effectiveness: In this study refers to the extent to which bibliotherapy was

effective in achieving the desired objective that is reducing the stress

among orphan children.

2. Bibliotherapy: In this study bibliotherapy refers to an intervention of

therapeutic book reading applied to reduce stress among orphan children

by providing selected reading materials fictional and nonfictional

3. Stress: In this study refers to any factor, mental or physical, the pressure of

which can adversely affect the functioning of subjects

4. Orphan children: All children in the age group of 10-14yrs who has lost

both their parents and living in orphanages

6.6 ASSUMPTIONS:1. All orphan children in the orphanages may have stress.

2. All orphan children may have less coping skills to overcome stress.

3. Lack of parental love and affection, strangeness of the environment is the

major source of stress among orphan children.

4. Bibliotherapy may reduce stress among orphan children.

6.7 HYPOTHESIS:1. H1: There will be significant difference between pre test and post test

scores for stress among orphan children receiving bibliotherapy.

2. H2:There is a significant association between thelevel of stress of orphan

children with their selected demographic variables.

6.8 REVIEW OF LITERATURE:

9

Review of literature is one of the most important steps in the research

process. Review of literature is a systematic identification, location, selection, and

summary of written material that contain information on the research problem. The

purpose of literature review is to convey the reader what knowledge and ideas have

been established on a topic and what are the strength and weaknesses.19

The review of literature of the present study was collected, organized and

has been presented under two sections.

SectionA:Studies related to stress among orphan children

Section B:Studies related to effectiveness of bibliotherapy

Section A: Studies related to stress among orphan children

A study was conducted to determine the stress related emotional and

developmental disorders among 294 orphan children in the age group of 6-12yrs in

Sharkia governorate. An assessment of depression, anxiety and stress, low self

esteem and developmental disorders using appropriate standardized scale revealed

that the prevalence rate of depression was 21%, anxiety and stress was 45%, low

self esteem was 23% and developmental disorder was 61%. The study concluded

that although the basic material needs could be met, orphans in orphanages were

almost totally separated from the outside world and could not access normal

families and society relations. This would very likely harm their personality in

adulthood and social skills. These results show distinct association between low

self esteem and depression were certain consequences of orphan hood and played a

significant role in lowering the children’s life quality.20

A study was conducted on perceptions of children on orphan circumstances

in rural district of Zimbabwe. Group discussions and interviews were conducted on

40 orphans, 25 caretakers and 33 community workers. The study revealed that

Orphan concerns included feeling different from other children, stress,

stigmatization, exploitation, schooling, lack of visits and neglect of support

responsibilities by relatives. Many community members, while recognizing their

limitations due to poverty, were already actively helping orphans and caretakers.

10

Extended family networks are the primary resource for orphans, though some

relatives exploit orphans or fail to fulfill their responsibilities.21

A study was conducted to explore the challenges and coping strategies

accompanying two possible life trajectories for orphaned children without adequate

adult care: 1) that they remain in rural areas in child-headed households, or 2) that

they are trafficked to an urban area. Two separate phenomenological studies were

conducted on12 orphaned children in a poor rural area and 15 orphan girls who

were trafficked from rural areas. Loss of parents, a lack of cash, and the need to

balance school attendance with food production were chronic stressors for the

children heading households. For the trafficked girls chronic stressors included

exploitation, long working hours, little or no pay, isolation and rape. The study

concluded that given physical and social assets the child-headed households were

able to cope with the challenges of caring for themselves and a younger child, but

isolation and dependency on employers made it difficult for the trafficked girls to

cope with this exploitation22

A study was done on the understanding of psychological well-being

among institutionalized orphans and vulnerable children. As the protective safety

net dissipates, many orphans and vulnerable children are forced to live in

overcrowded and understaffed orphanages. In the attempt to meet survival needs,

psychological health is pushed into the background. Qualitative interviews (N=12)

and field observations in orphanages (N=6) revealed that, institutionalized orphans

and vulnerable children were found living under poor general care with few

opportunities for lucid, educational, and social growth. Also among the findings

were neglect and abuse, attachment difficulties and traumatic stress symptoms.

This study opposes the disuse of orphanages and suggests interventions to improve

the orphans’ psychological well-being by reducing their stress.23

A comparative study was done to determine whether differences in stress

excess between school age orphaned children and non orphans. About 197

orphaned children and 528 non orphaned children in the age group of 8 - 15 years

participated in the study. The linear regression analysis showed a statistically

significant difference [P<0.05] in education, health and stress outcomes in

11

orphaned children than the non-orphaned children. The researcher concluded that,

the orphaned children experiences more stress than the non-orphaned children.24

Section B: Studies related to effectiveness of bibliotherapy

A study was conducted to assess the effectiveness of bibliotherapy as a

strategy to relieve transescent stress. Subjects for study included 160, 6’th grade

students selected through convenience sampling from four classrooms in Central

Arizona US. The results assessed through 1990 Iowa test of basic skills reading

comprehension subtest revealed significant increase in student’s reading

comprehension scores and thus a reduced transescent stress as a result of

bibliotherapy treatment.25

A study was conducted to assess effectiveness of bibliotherapy as a strategy

to help students with bullying and eve teasing. Salient research findings pertinent

to teasing and bullying have made their way into children’s literature over the

course of child adolescent teasing in schools (CATS). 85 6’th grade students were

exposed to fictional stories (bibliotherapy) about bullying and teasing after which

children have shared their own non fictional account of this often devastating

experience. The investigator concluded that bibliotherapy was effective in

reducing stress experienced by the bullied students and helped them to develop

coping strategies to deal with bullying and teasing that takes place in schools

nationwide.26

A Social Stories intervention package was used to teach 2 students with

autism to read Social Stories, answer comprehension questions, and engage in role

plays. Appropriate social behaviors increased and inappropriate behaviors

decreased for both participants, and the effects were maintained for up to 10

months. The intervention package was found to be useful in inclusive classroom

environments and does not require intensive supervision of the child's behavior27.

12

An experimental study examined the value of modifying empirically

validated treatment for childhood anxiety for application through written materials

for parents of anxious children. Two hundred sixty-seven clinically anxious

children ages 6-12 years and their parents were randomly allocated to standard

group treatment, waitlist, or a bibliotherapy version of treatment for childhood

anxiety. In general, parent bibliotherapy demonstrated benefit for children with

anxiety resulting in around 15% more children being free of an anxiety disorder

diagnosis after 12 and 24 weeks post intervention. These results have implications

for the dissemination and efficient delivery of empirically validated treatment for

childhood anxiety.28

A study was conducted to investigate the effect of bibliotherapy in dealing

with problems of personal development and interpersonal relationships

encountered by children affected with social violence The sample included 90

school children in the age group of 9-11yrs living in an area known for its gang

violence. The study concluded that bibliotherapy had meaningful effects on

subjects by increasing their self esteem in terms of appreciation of his/her own

worth and harmonious acceptance of the conditions of life at large. The

investigator also reported that bibliotherapy has the potential of exercising a

beneficial influence in psychological makeup of the individual29.

An experimental research was done to study coping with stress through

bibliotherapy for Taiwan college students using zhuangzi’s fables. About 343

samples were selected using convenient sampling method, quasi experimental

research design was used. The research concluded that there are significant effects

on reduction of the following stress: Financial Problems, Career Planning, School

Work, and Interpersonal Relationships. People with a “Type ABehavior Pattern”

can be helped in stress reduction. Females are more influenced than males in stress

reduction by bibliotherapy intervention; however, males are more influenced than

females in stress reduction by self-help bibliotherapy. The results show the

beneficial effects of the intervention, which can be recommended by educational or

health professionals as an alternative approach in coping with stress.30

13

A study examined the efficacy of supplementing bibliotherapy for child

anxiety disorders with therapist-initiated telephone or email sessions, or with

client-initiated contact in a randomised trial using a waitlist control. Participants

were 100 anxiety-disordered children and their parents from rural and remote

communities. All treatment conditions resulted in improvement on self-report

measures and clinician rated severity. The results suggest that therapist

supplemented bibliotherapy could provide an efficacious treatment option for

families isolated from traditional treatment services.31

A study was conducted to examine the use of an assisted bibliotherapy for

mild to moderate stress/anxiety in an adult clinical population referred by their

general practitioner. Assisted Bibliotherapy was provided for a brief period of 8

weeks, with limited therapist contact (20-min sessions). Non-parametric statistical

testing of scores from the Zung Anxiety Scale and the Clinical Outcomes in

Routine Evaluation (CORE) questionnaire indicated positive results. There was

significant improvement at post-treatment, which was maintained at 3 month

follow-up. The results from this trial and a previous trial of assisted bibliotherapy

by Kupshik and Fisher in 1999, indicate that it is an effective treatment which

could be used as part of a stepped care approach to managing and treating

stress/anxiety in primary care.32

A randomized control trial of cognitive therapy, a self help booklet and

repeated assessment on early intervention of PTSD was conducted in London UK.

The objective of the study was to determine whether cognitive therapy or self help

booklet given in initial months after a traumatic event is more effective in

preventing PTSD. The selected 97 subjects were motor vehicle accident survivors

who had PTSD in initial months. The results revealed that both cognitive therapy

and self-helpbooklet(bibliotherapy) were effective in reducing symptoms of

PTSD. 33

It is evident that society has changed. And, too, so have the children and the

teachers. Educators are recognizing the critical need for delivering literacy

instruction to at-risk and homeless children and their families (IRA, 1990). Four

14

books which may be used for homeless children and their families are Fly Away

Home (Bunting, 1991), The Polka Dot Horse (Thiel, 1992), Homelessness

(Seymour-Jones, 1993), and Changing Places — A Kid's View of Shelter Living

(Chalofsky, Finland, and Wallace, 1992). The role of the reading teacher cannot be

ignored in terms of crisis intervention,and the amelioration or attitudes can be a

legitimate cause in using bibliotherapy. The role of the reading teacher should

beviewed as that very special person who can break emotional barriers to learning

when crises arise34

7. MATERIALS AND METHOD:

7.1 SOURCE OF DATA:

The data will be collected from the children 10-14 years at selected

orphanages in Bangalore.

7.2 METHOD OF DATA COLLECTION:

I. RESEARCH DESIGN-

The research design for this study is one group pre test post test design.

II.RESEARCH VARIABLES-

1. Independent variables: Bibliotherapy

2. Dependent variable: Stress

3. Demographic variables:Age, sex, educational status, duration of stay in the

orphanage, any visitors and the number of visits.

III.SETTING-Thisstudy will be conducted in selected orphanages of Bangalore.

IV. POPULATION-Orphanchildren in the age group of 10-14 years living in in

selected orphanages in Bangalore.

V. SAMPLE SIZE: The sample size in the study will be 60 Orphan children’s of

age group of 10-14 years who will fulfill the inclusion criteria of the study.

15

VI. CRITERIA FOR SAMPLE SELECTION:

Inclusion criteria-

1. All orphan children in the age group of 10-14years living in orphanages

suffering from considerable stress.

2. Conscious and mentally alert.

3. Children who are cooperative.

4. Children having the ability to read and /or write kannada

Exclusion criteria:

1. Children who are critically ill.

2. Children with neurological deficit.

3. Children who are not interested in reading.

VII. SAMPLE TECHNIQUE:Children will be selected using simple random

sampling technique(lottery method) and would be allotted to interventional

strategy

VIII. TOOL FOR DATA COLLECTION:

Tool consists of two sections

1. Section A: Demographic data of children: This section contains items of

demographic characteristics of orphan children including age, sex, educational

status, duration of stay in the orphanage, number of visitors and the visiting

status.

2. Section B:Stress assessment scale: standard stress assessment questionnaire

will be used to assess the stress of orphan children.

IX. METHOD OF DATA COLLECTION:

Phase I: Prior administrative permission will be obtained from trustees of

orphanages. Informed consent will be obtained from the guardians of orphan

children (samples) also. The samples will be selected according to the inclusion

criteria of the study.

Phase II: Pre test will be conducted by administering the stress assessment

questionnaire.

16

Phase III: Bibliotherapy is administered for four weeks. Each session lasts for

one hour and includes story reading followed by post interventional activities and

discussion.

Phase IV: Post test stress score will be assessed by administering the stress

assessment questionnaire.

X. PLAN FOR DATA ANALYSIS:

The data collected will be analyzed using descriptive and inferential statistics

Descriptive statistics:

Frequency and percentage distribution will be used to study the demographic

variablesof orphanchildren.

Mean and standard deviation will be used to analyze the effectiveness of

bibliotherapy on level of stress among orphan children.

Inferential statistics:

Paired “t” test will be used to analyze the significant difference between the

mean pretest and post test level of stress scores of orphan children.

Chi-square test will be used to associate the post test level of stress among

orphan children with their selected demographic variables.

XI. PROJECTED OUTCOME:

As the investigator has planned for use of bibliotherapy for stress reduction

there will be a reduction in the level ofstress experienced by orphan children

living in orphanages.

7.3 Does the study require any investigation or intervention to be conducted

on patients or other human beings or animals.

Yes, with prior consent from the guardians of orphan children(sample) the

study will be conducted in selected orphanage of Bangalore. The study will

require intervention in the form of bibliotherapy(book reading) only. No other

intervention which cause any harm will be done for the subject.

7.4 Has ethical clearance been obtained from your institution:

17

Yes, the permission will be obtained from concerned authority and

guardians of the subjects.

1. Privacy, confidentiality and anonymity will be guarded

2. Scientific objectivity of the study will be maintained with honesty and

impartiality.

3. Ethical clearance report has been enclosed for the verification

18

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9. Signature of the Candidate :

10. Remarks of the guide :The study will be appropriate, feasible and relevant to

enhance the knowledge in the field of pediatrics

speciality

11Name and Designation of the

11.1 Guide : Mrs. Renuka V

Asst. Professor

11.2 Signature :

11.3 Co-guide :

11.4 Signature :

11.5 Head of the Department : Mrs. Renuka .V

Asst. Professor

11.6 Signature :

12.1 Remarks of the Principal : The study is feasible and relevant to the

specialty chosen.

12.2 Signature :

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