Rajiv Gandhi University of Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA SYNOPIS PROFORMA FOR REGISTRTION OF SUBJECT FOR DISSERTATION

Smt. ANNAPURNA G GANTISIDDAPPANAVAR NAME AND ADDRESS OF 1st YEAR MSc NURSING 1. THE CANDIDATE N.D.R.K. COLLEGE OF NURSING B M ROAD, HASSAN, KARNATAKA. N.D.R.K. COLLEGE OF NURSING NAME OF THE 2. B .M .ROAD, HASSAN, INSTITUTION KARNATAKA. COURSE OF STUDY AND MASTER IN PSYCHIATRIC 3. SUBJECT NURSING.

DATE OF ADMISSION TO 4. 31/ 05/2008. THE COURSE

“BIO PSYCHO SOCIAL CHANGES 5. TITLE OF THE TOPIC DURING PRE MENSTRUAL PERIOD.”

“A STUDY TO ASSESS THE EFFICACY OF STP REGARDING KNOWLEDGE OF BIO PSYCHO 5.1 STATEMENT OF THE SOCIAL CHANGES DURING PRE PROBLEM MENSTRUAL PERIOD AMONG ADOLOSCENT GIRLS IN SELECTED PU COLLEGE AT HASSAN.” 6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION:

“ I maintain that cosmic religious feeling is the strongest and noblest

incitement to scientific research.”

Albert Einstein

A woman has to cope with many problems that start from her early age, when she experience her first period her menarche itself is a cause of frustration, anxiety and shock, if she is not aware of this earlier, some girls will develop inferiority complex, because of physical and social restriction imposed on her, without proper explanation of the reason that her menstruation is related to her child bearing capacity rearing and lasting accept her menopause.

One of the important area related to menstrual cycle is premenstrual syndrome that is related to last part of menstrual cycle started after ovulation, increased its intensity 5 t o 3 days prior to the menstruation to first day of menstrual flow is established, all girls has to under go similar hormonal changes in her life, but some girls distress related to her physical change mood behavior and changes in social adjustment.

How these changes cripples her life, need to be addressed properly as to days girls are not house bound only, our changing society need her contribution from labour work to aronautics , scientist and researcher have conducted many studies on this problems, this problem signs, symptoms, physical changes and effect of different drugs effect of several condition and environment.

6.1 NEED FOR THE STUDY:

“Health is a positive state of well-being, people are in a state of emotional, physical and social well-being , fulfils their responsibilities, function effectively in daily life and are satisfied with their interpersonal relationships and themselves.” According to WHO.

The pre menstrual period is one of the crucial period in adolescent girls, the reported prevalence of about 20-40 % shows that a significant group of woman may be affected by premenstrual syndrome. Reports of premenstrual syndrome among adolescents in western countries indicate a prevalence ranging from 14 to 30 percent. Some of the premenstrual syndrome symptoms like mood depression feeling of hopelessness lethargy and excessive fatigability may create serious negative consequences for the adolescents, their families and their social relationship including low self-esteem, low tolerance to stress and feeling of inadequacy. The consequences necessitate the adolescents learning to control their premenstrual symptoms. 1

A study revealed the following symptoms:  marked depressive mood, feeling of hopelessness or self depreciation thoughts -77.7%  difficulty of concentration -65.8%

 marked change in appetite ,over eating or specific food craving -82.8 %

 affective labiality ,with sadness tearful and increased sensitivity to

rejection 65.8%

 hypersomnia or insomnia 59.7%

 lethargy, excessive fatigability -91.6%

 breast tenderness ,swelling headache ,joint muscular pain and a sensation

of bloating and weight gain 81.9%

 the most severe symptoms were fatigue and irritability---73.9% - 2

premenstrual syndrome which can occur 7 -14 days before the onset of menstruation and subsides with the commencement of menstrual flow, affect girls during her reproductive age and is associated with physical, psychological and behavioral changes.

Investigator personally feels that a health education help in terms of increasing adolescent girls knowledge, regarding premenstrual and menstrual symptoms, and decreasing the incidence and severity of premenstrual and menstrual symptoms , gaining knowledge has been regarded as an important goal towards an improving individuals health status. A lack of knowledge can contribute to a variety of responses including anxiety and self care deficit. The

STP will increase knowledge and help in coping with such problems and reducing the symptoms of premenstrual syndrome.

6.2 REVIEW OF LITERATURE Review of literature is a critical summary on a topic of interest generally prepared to put a research problem in context to identify gaps and lacunae in prior studies so as to justify new investigation.

An education program was developed to determine an efficacy in increasing knowledge and decreasing the severity of symptoms of premenstrual syndrome, 94 schoolgirls aged between 14 and 18years from four secondary school in Hong Kong were participated, knowledge scores were measured by using the premenstrual syndrome knowledge questionnaire, after the education program experimental group had significantly increased knowledge after three months following education program, Experimental group girls reported significant reduction in total premenstrual syndrome score, subscale scores are measured by a translated version of Abraham’s menstrual symptoms questionnaire, the result showed there is no significant difference in pre test between two groups. and in the post test premenstrual syndrome scores were reduced in experimental group of young adolescent girls- 1.

A study was conducted to evaluate the prevalence of a potential premenstrual dysporic disorder (PMDD) during menstrual cycle in a general population of Casablanca, results found that marked depressive mood, feeling of hopelessness, self depreciation thoughts is 77.7% difficulty of concentration

65% marked change in effective over eating or specific food craving 82.8% marked affective labiality with sadness tearful and increased sensitivity to rejection 65.8% hypersomnia or insomnia 59.7% lethargy, excessive fatigability

91.6% physical symptoms including breast tenderness, swelling, headache, joint or muscular pain and a sensation of bloating weight gain 81.9% the most severe symptoms were fatigue and irritability according to this literature the disorder is common and has a bad impact on mental health and on quality of life of the women -2.

A Comparative study was conducted to assess mood and performance tasks in 29 normal cycling women, result showed that a significant increase in dysphoric mood during the luteal phase in women with premenstrual Dyshporic disorder. compare to their follicular phase. and compared to control women,

Further during the luteal phase. women with PMDD showed impaired performance on the immediate and delayed word recall task. And delayed digit recall task and the digit symbol substitution test. compared to control women, women with PMDD also showed increased desire for food items high in fat during luteal phase. compared to follicular phase. and women without PMDD.

Women with PMDD consumed more calories during the luteal phase, compared to follicular phase-3.

A study was conducted to assess the prevalence profile of premenstrual dysporic disorder in 87 healthy woman aged between 18-30 years were selected from croatine students. And young university graduates .assessed the severity of symptoms daily during two cycles according DSM-4. 5 out of 87 women fulfilled premenstrual dysporic disorder criteria result found that significantly higher prevalence of co-morbid disorder in their medical history compared to non-premenstrual disorder group-4.

A study was done for evaluation of behavior changes with a 17 year old female, result determined that. in premenstrual dysporic disorder the mood disturbance occur during the late luteal phase of the menstrual cycle, approximately 1 week before the onset of menstrual bleeding remains after the onset of menses. The symptoms are more severe than that of premenstrual syndrome and are associated with significant functional impairment-5

A study was conducted to assess the symptoms experienced during menstruation. and attitude towards management of menstruation. in this study

120 student nurses from two schools of nursing in Ibdan Nigeria surveyed, result showed that more participants experienced symptoms during premenstrual period. than menstrual period. and 93 % had positive attitude towards menstruation. 20 % consulted medical doctors whenever they experienced menstrual symptoms. 70% the student used sanitary pad to manage their menstruation- 6.

A study was conducted to describe the prevalence. Incidence 12 co- morbidity factors. and correlates of threshold. and sub threshold premenstrual dysporic disorder in the community of young women, results were found that. baseline 12 month prevalence of DSM—4 Premenstrual dysporic disorder was

5.8 % concurrent major depression and dysthymia decreased slightly. An additional 18.6 % were ‘near-threshold’ cases. cumulative life time incidence was 7.4%. PMDD syndrome was stable across 48 months with < 10% complete remissions among baseline premenstrual dysporic disorder cases. the 12 month life time co morbidity rates were high (anxiety disorders 47.4% mood disorders

20% somatoform 28.4%), 26.5% had no other mental disorder- 7.

A comparative study was conducted to evaluate the efficacy of a luteal phase medication dosing, symptom data from the daily record of severity of problems (DRSP) during first few days of menses. Results showed during the luteal phase demonstrate reduction in DRSP total scores into the first few days of menses regard less of whether active treatment was continuous throughout the menstrual cycle or was discontinued at the onset of menses- 8.

A study was conducted to assess the experience of menstruation among normal women. This study showed the importance of reducing bias in self reports of menstrual symptoms, and illustrates the lag between hormonal charges in the luteal phase and the peak of symptom severity at onset of menses.

Further research is needed to determine the nature and extent to which women with a premenstrual disorders- 9.

A study was conducted to examine the association between psychosocial stress and symptom severity, Stress mood physical symptoms. Result showed that there is no association between the severity of symptom. and the cumulative daily stress reported during each cycle- 10.

6.3 OBJECTIVES OF THE STUDY :

1. To assess the knowledge of biopsychosocial changes during premenstrual

period among adolescent girls through pre-test and post test.

2. To find the efficacy of STP regarding knowledge of biopsychosocial

changes during premenstrual period among adolescent girls. 3. To find the association between socio demographic variables and

knowledge of biopsychosocial changes during premenstrual period

Among adolescents girls.

6.4 HYPOTHESIS

H0- Adolescent girls will not have any significant difference in the

knowledge of biopsychosocial changes during premenstrual period among

adolescent girls.

H1– The STP will significantly increases the knowledge of biopsychosocial changes during premenstrual period among adolescent girls.

H2-There will be significant relationship between knowledge and socio demographic variables.

6.5 OPERATIONAL DEFINITIONS : 1) Efficacy : :In this study it refers to assess the impact of STPregarding theknowledge of bio psychosocial changes in adolescent girls during premenstrual period.

2) Structure teaching program : It is a teaching method will develop by theresearcher regarding biopsychosocial changes during premenstrual period Among adolescent girls.

3) knowledge : :It refers to correct answers to the knowledge items regarding biopsychosocial changes during premenstrual period among adolescent girls. 4) Bio Psycho social changes : Biopsychosocial changes that are seen and experienced by a girl, Bio (with reference to body)Psycho(with reference to mind) Social (with reference to social activities) changes.

5) Pre Menstrual Changes : Pre menstrual changes include changes occur during pre menstrual phase five days before and one day after the onset of menstrual flow.

6 ) Adolescent Girls: : The girls who are in the age between12 to 18 years.

6.6 ASSUMPTIONS

1) Adolescent girls will have little knowledge about biopsychosocial changes

during premenstrual period.

2) Structure technique teaching program will measure level of knowledge

regarding bio psycho social changes level of knowledge regarding

biopsychosocial changes during premenstrual period.

3) Socio demographical variable will have relationship with knowledge.

6.7 Delimitations of the study :

 The study period will be limited to 4 to 6 weeks.  Sample size will be limited to 50 students.

 The study will be limited only to the adolescent girls studying in Pre

University College at Hassan.

 Study design is limited to single group pretest post test design.

6.8 SIGNIFICANCE OF STUDY

The study signifies the importance of STP regarding biopsychosocial changes during Premenstrual period, will enhance the knowledge of adolescent girls related biopsychosocial changes and helps in increasing coping strategies and preventing biological psychological social problems related to premenstrual period.

7. MATERIAL AND METHODS

7.1 SOURCE OF DATA :- :data will be collected from adolescent girls studying in selected Pre University Cllege at Hassan.

7.1.1 Research Design : :Pre experimental design.

7.1.2 Conceptual frame work: : General system theory.

7.3 METHOD OF COLLECTION OF DATA

Part – A - Socio demographic profile.

Part – B – Data regarding Bio Psychosocial changes during premenstrual period will be collected from adolescent girls, though structured questionnaire by multiple choice questions.

7.3.1 SAMPLING PROCEDURE Population: Population consists of all the adolescent girls studying Pre

University College, at Hassan

Sample: The adolescent girls studying in Pre University College and who are

fulfilling the inclusion criteria

7.3.2 C riteria for selection of samples :

1. Inclusion criteria for sampling:

 Girls who will be present during data collection.

 Girls who are studying in PUC college.

 The age between 16 – 18 years.

 Those who are willing to participate.

2. Exclusion criteria for sampling:

 Those who are not willing to participating the study.

 Those who are having some health problems during the study.

 Those who are not available at the time of study.

Those who are not attained menarche.

Sample size: 50 adolescent girls studying in Pre University College

Sampling technique: Non probability convenient sampling technique.

Setting: The study will be conducted in selected Pre university College at Hassan.

7.3.3 PILOT STUDY: Pilot study will be planned for 10% the sample to find out the convenience and practical difficulties of the study. 7.3.4 VARIABLES:- Independent Variable : STP regarding bio psychosocial changes

during pre manestrul period among

adolescent girls

Dependent variable : knowledge of the adolescent girls regarding

Bio psycho social changes.

7.3.5 PLAN FOR DATA ANALASYS :

Data will be analyzed by using appropriate statistical measures.

7.4 Does the study require any investigation or interventions to be conducted on patients or other humans or animals? If so please describe briefly

STP is used as an intervention on adolescent girls of selected Pre University

College at Hassan

7.4.1 Has ethical clearance been obtained from you institution ?

Yes. 8. LIST OF REFERENCES

1) Janita P C, Chau and Anne. M , “effect of an educational programme on adolescent with pre menstrual syndrome”, Journal of Adolescent Health, Volume 18, Issue 4, April 2007. Pages 286,291.

2) Silber T J ,Valadez-Meltzer A, “Premenstrual dysphoric disorder in adolescents case reports of treatment with fluoxetine and review of the literature”. J Adolescent Health 2005 Dec;37(6):518-25.

3) Reed S C hevin F R Evans S M. “Changes in Mood Cognitive performance and appetite in the late luteal and follicular phase of menstrual cycle in women with and without PMDD”, in New York State Psychiatric Institute and Department of Psychiatry in Columbio University in USA. 2007.

4) Rojnic Kuzmun M Hotujac L. “Premenstrual disporic disorder – a neglected diagnosis?” Preliminary study on a sample of croatine student in University Hospital centre Zagreb Coll Antropol.2007 Mar;31(1):131-7.

5) NUR M.M Romano M.E Siqueiru L.M. “Premenstrual dysphoric disorder in an adolescent female”, J pediatr Adolesc Gynecol. 2007Jun;20(3):201-4.

6) Moronkola OA, Uzuegbu VU. “Menstruation symptoms management and attitude of female Nursing student” in Ibdan NigiriaAfr J Repord Health.2006 Dec;10(3):84-9

7) Wittchen H U Becker E Lied R “prevalence Incidence and stability of premenstrual dysphoric disorder in the community” as per Article psychological medicine. 32(1):119-132, January 2002

8) Yonkers K.A Pearlstein T, Fayyad R, “Luteal Phase treatment of Premenstrual dysporic disorder improves symptoms that continue into post menstrual phase”. Affect Disord.2005 Apr;85(3):317-21.

9) Meaden P M Hartlage Cook – Karr J. “Timing and severity of Symptoms associated with the menstrual cycle in a community based sample” in the Midwestern United states. Department of Psychiatry Rush University Medical Centre in Chikago USA. Psychiatry Res.2005Mar 30;134(1):27-36.

10) Lorrine Beck PHD Richard Gevirtz PHD and Joseph F “the predictive Role of Psycho social stress on symptoms severity in premenstrual syndrome” as per Article Psychological Medicine 29(5):1043-1053 ,September 1999. 9 Signature of candidate

10 Remarks of the guide

11 Name & Designation of (in block letters)

11.1 Guide

11.2 Signature 11.3 Co-Guide (if any)

11.4 Signature

11.5 Head of Department

11.6 Signature

12 12.1 Remarks of the chairman & Principal

12.2 Signature