“ A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE ON MENOPAUSE AND REMEDIAL MEASURES FOR MENOPAUSAL PROBLEMS AMONG MENOPAUSAL WOMEN IN A SELECTED RURAL AREA AT BANGALORE”
M.Sc. Nursing Dissertation Protocol Submitted to
Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore
By
Mrs.CHITRA.D
M.Sc Nursing 1st Year
2010-2012
Under the Guidance of
HOD, Department of OBG Nursing
Nightingale College of Nursing
Guruvanna Devara Mutt,
Near Binnyston Garden,
Magadi Road,Bangalore-560023 Rajiv Gandhi University of Health Sciences, Karnataka Curriculum Development Cell CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION Registration no :
Name of the Candidate : CHITRA.D
Address : Guruvanna Devara Mutt, Near Binny stone
garden, Magadi Road, Bangalore - 23
Name of the institution : Nightingale College of Nursing
Course of study and subject : MSc Nursing in OBG
Date of Admission to Course :
Title of the topic : A Study to assess the effectiveness of
Planned teaching programme on
Knowledge on menopause and remedial
Measures for menopausal problems
Among menopausal women in a
Selected rural area at Bangalore.
Brief resume of the intended work : Enclosed
Signature of the student :
Guide Name :
Remarks of the guide :
Signature of the Guide :
Co-Guide Name :
Signature of the co-guide :
HOD Name :
Signature of the HOD :
Principal Name :
Principal Mobile No. :
Principal Email ID :
Remarks of the Principal :
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES KARNATAKA, BANGALORE ANNEXURE – II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1: Name of the candidate and address (in MRS. CHITRA.D block letters) Ist YEAR M.Sc NURSING NIGHTINGALE COLLEGE OF NURSING MAGADI ROAD BANGALORE.
2: Name of the Institution NIGHTINGALE COLLEGE OF NURSING MAGADI ROAD BANGALORE.
3: Course of Study and Subject M. Sc. NURSING OBG NURSING
4: Date of Admission to the Course
5: TITLE OF THE STUDY: A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE ON MENOPAUSE AND REMEDIAL MEASURES FOR MENOPAUSAL PROBLEMS AMONG MENOPAUSAL WOMEN IN SELECTED RURAL AREAS AT BANGALORE.
6: BRIEF RESUME OF THE INTENDED WORK
6.0 .INTRODUCTION
Menopause is the physiological cessation of menstrual cycle associated with advancing age in any women, however it is considered as an unwelcome phenomenon among many women. Partially this belief is due to misconnects about menopause and partially due to the realistic reflection of social position of older women in our society3.
Menopause is derived from the Latin word, Meno (Month), pausia (Halt) and essentially marks the end of a women’s period of natural fertility. Meno (Menstruation) pause (stop) is, technically the last menstrual flow of a women’s life. The year just before and just after the Menopause itself refer to as the climacteric, for most women the climacteric span from yearly/mid 40’s to late 50’s / yearly 60’s including the premenopausal years, the menopause climax year , and the postmenopausal years popularly known as the change of life2.
Women play an important role in replenishing the earth but a reproductive capacity is not permanent. Its ceases one day which in a rural woman bring in lot of changes which she has to tackle to get rid of chronic illness especially psycho somatic problems. There efficient and effective means of preventing and controlling this problems in thorough improving in bring social support, self-esteem and empowerment1.
Menopause is defined by the world health organization (WHO) and the stage of re productive ageing work shop (STRAW) working group as the permanent cessation of menstrual periods that occurs or is induced by surgery chemotherapy and radiation. Natural menopause is recognized if there is complete cessation of menstrual periods after 12 consecutive months that are not associated with the physiologic ( pregnancy , lactation) or pathologic cause. It is physiologically correlated with decline in oestrogen secretion resulting in the loss of follicular function. 5
During and after menopause the women may experience health problems. Like puberty and pregnancy, menopause is influenced by physical and psychological problems caused by hormonal changes. Osteoporosis which results in brittle bones can be accelerated by low levels of oestrogens. These low levels of estrogenic can also lead to heart problems. Other problems which women may experience are the development of Alzheimer's disease. The chances of developing Alzheimer's disease doubles every 5 years beyond 65. During menopause the typical menopause symptoms may be experienced such as night sweats, vaginal dryness, anxiety and hot flushes 6
6.1 NEED FOR STUDY:
Menopause transition consists of fluctuating ovarian function and occurs 2 to 8 years before menopause and up to 1 year after the final menses. It is a progressive process that eventually leads to persistent ovarian failure. The change in hormones during this period is often responsible for the clinical signs and symptoms that many women experience. Systems affected by the premenopausal phase include skin and hair, genitourinary (GU), neuro endocrine, cardiovascular, and skeletal.7
Menopause is an unavoidable change that every women will experience, assuming she reaches middle age and beyond.It is helpful if women are able to learn what to expect and what options are available to assist the transition, if that becomes necessary.8
Menopause is associated with many numbers of troubling symptoms, which persist for years in some cases. These symptoms are thought to be caused by changes in the progesterone, and oestrogen. The most common symptoms of menopause are hot flushes and night sweats. It is estimated that between 75 and 85%of women experience them. Weight gain specifically in the abdomen area is also quite common. These are just two of the literally dozens of possible menopause symptoms others includes: digestion problems, headache, dizziness, and irregular heartbeats, loss of libido, mood swings, fatigue, forgetfulness and bloating. Although women with mild symptoms may go through the change of life with only slight discomfort, those with severe life altering symptoms will often seek out treatment that can help them cope.9
A total of 488 postmenopausal women were evaluated in a 12 week study comparing placebo with estradiol gel 0.1 % at doses of 1.0, 0.5 and 0.25 mill gram per day with estimate daily deliveries of 0.027, 0.009and 0.003 mg estradiol, respectively. primary end points were the change from baseline in daily frequency and severity of moderate to severe vasomotor symptoms.10
In Jan 2003, based on the findings of the WHI study, the FDA advised women and health care professionals that menopausal hormone therapy is associated with an increased risk of heart disease , heart attack , strokes, and breast cancers.11
Researcher in her experience identified that menopausal women are lacking knowledge on menopause and remedial measures for menopausal problems. A planned teaching programme for women will help them to improve their knowledge on menopause and remedial measures for menopausal problems
6.2 REVIEW OF LITERATURE
1. Studies related to general view of menopause
2. Studies related to problems during menopause
3. Studies related to remedial measures for menopause
STUDIES RELATED TO GENERAL VIEW OF MENOPAUSE
According to Myles menopause is the end of a women’s reproductive life is marked by the gradual cessation of menstruation, the cycle first becoming irregular and then ceasing altogether at the menopause. This time of life is known as climacteric. It is often accompanied by physical symptoms like hot flushes & emotional changes such as mood swings. There is an increased tendency to obesity in the following years signs of aging will appear. These changes are due to a fall in the production of oestrogen because the ovary is no longer able to respond to pituitary gonadotropins. The sexual drive may not be diminished but some women find it difficult to accept that they are no longer fertile. The menopause usually occurs around the age of 50 years but it should not be assumed that the climacteric is complete until 2 years have elapsed since the last period. In the intervening months the women should continue to use contraception if appropriate.1
A experimental study was conducted by Namrata Sharma on May 2010,out of the 100 sample,45(45%)of the subjects were in the age group of above 55 years ,more than half (51%) of the subjects were literates and majority 77(77%) of them were house wife .57% of the subjects belongs to joint family ,37(37%) of them had monthly income between rs.8001- 10,000,most 63(63%) of the women were married and 42(42%) of the women had their menopause occurred at the age between 40-45 years.54% of the women had inadequate knowledge regarding menopause.2
A descriptive study was conducted by sadhana.U.Adhyyapale on feb 2007,the working highest mean percentage score in the area of meaning (54%) and physiology(60%).there is knowledge deficit high in the area of signs and symptoms (44.4%)and health change(23.33%)which occurs after menopause.12
A descriptive study was conducted by national institute of health science data for the new study of age at natural menopause were collected in 2003-2004 when the median age of the mothers was 51 years. Six hundred and one of the original cohort of women was found, and 514 of these women completed interviews for the North Carolina Menopause Study. A computer-assisted telephone interview focused on reproductive and menstrual history with additional information collected on demographic, social and behavioural factors that could affect timing of menopause. A blood sample was collected from 285 participants based on sampling strata that involved criteria relating to age and menopausal status. The blood samples will be used to measure follicle stimulating hormone and luteinizing hormone levels to classify menopausal status of women with different menopause experiences.13
STUDIES RELATED TO PROBLEMS DURING MENOPAUSE
A study was conducted to assess the knowledge and attitude of women towards the health problems during menopause: As insufficient data were available for 35 women, 925 interviews were analyzed. There were 287 menopausal women, whose mean (SD) age at menopause was 47.1 (4.7) years (95% CI 46.8 to 47.6). Of these 287 women, 135 (47%) wanted their menses to continue and 235 (82%) had consulted a physician after the menopause. Of all 925 women, 58% knew the correct definition of the menopause, all had consulted a physician for various symptoms related to the menopause and 53% said that women should consult a physician premenopausal. Symptoms experienced by premenopausal women included lack of sleep (25%), fear of infertility (13%) and urinary incontinence (18%). The majority of the overall sample (52%) was sexually active. Of the sexually active women, 16% had marital problems, compared with 44% of sexually inactive women, and this difference was statistically significant (P < 0.0001). Source of knowledge about the menopause included relatives (35%), television (18%), neighbors (17%), friends (17%) and health-care providers (14%).14
A study was conducted to assess the Knowledge on the prevalence of sexual symptoms at the menopause and their impact on quality of life: The prevalence of sexual symptoms at the menopause differs across studies depending on several factors such as sample size, design, hormonal status and country. The most common sexual complaints are reduced sexual desire, vaginal dryness and dyspareunia, poor arousal and orgasm and impaired sexual satisfaction. Age and declining estradiol levels have significant detrimental effects on sexual functioning, desire and responsiveness (arousal, sexual pleasure and orgasm) across the normal menopause transition, while reduced androgens levels played a role in hypoactive sexual desire disorder (HSDD), a symptom frequently diagnosed in surgically menopausal women. Women attending menopause clinics are vulnerable to female sexual dysfunction (FSD) because of a complex interplay of individual factors variably affecting well-being. Surgically menopausal women may be more distressed by sexual symptoms. Giving women the opportunity to talk about sexual problems is a fundamental part of health care and may improve their quality of life.15
A study was conducted to determine the effect of sleep and related problems during menopause: Forty-six percent of middle-aged women reported feeling dissatisfied with their sleep. Total sleep hours were not significantly different as a function of menopausal status. Generally, the occurrence of sleep problems or poor sleep quality was most prevalent in the postmenopausal group and least prevalent in premenopausal women. After analysis by multiple logistic regressions, menopausal status was the independent factor of difficulty initiating sleep and sleep fragmentation. The Hospital Anxiety Depression Scale anxiety score was related to all sleep problems except for "excessive daytime sleepiness" and "awakening without further sleep." Almost half of the Taiwanese middle-aged women felt dissatisfied with their sleep. Both menopausal status and higher anxiety score were associated with poor sleep quality of midlife women.16
STUDIES RELATED TO REMEDIAL MEASURES FOR MENOPAUSE; Wikipedia review suggest that hormone therapy provides that relief, appropriate replacement of hormone therapy prevents osteoporosis, vascular diseases, insulin resistance in type II diabetes, depression and memory loss. Other alternative therapies like non hormone treatment provide less relief and more side effects. Even placebo is better in treating hot flushes and other menopausal symptoms than other remedies like iso flavone and black cphosh. They have serious side effects like breast cancer, therefore it is not recommended at any time.8
The international menopauses society says the efficacy and safety of complementary alternative medicines have not been demonstrated and further studies are required bodies promoting alternative therapies or not qualified to judge. There are no medical or scientific reasons unregistered bio identical hormones. The only proven and approved safe long term treatment which is appropriate to treat menopausal symptom is appropriate register hormone replacement therapy.18
Channing laboratory at women’s hospital in Boston. Boston as conducted larger number of studies and demonstrated that woman with yearly bilateral oophorectomy or at increased risk of coronary heart disease. The risk hormone higher in woman with the surgical menopause when compare to the woman with decreased ovarian function without surgery. These findings shows their increased risk because of oestrogen deficiencies, and there is lack of excess risks in woman with bilateral oophorectomy who takes replacement estrogen.17
Imsociety organization suggest HRT for the relief of menopausal symptom include life style and dietary changes, over-the-counter nutritional supplements and complementary therapies, many of which are consider to be natural. In this article, the effectiveness and safety of this alternative therapies are discussed. Some prescribe medications are also considered. Alternatives are not generally as effective as HRT, but they can help to reduce some symptoms.8.
6.3 .STATEMENT OF THE PROBLEM
“ A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME ON KNOWLEDGE ON MENOPAUSE AND REMEDIAL MEASURES FOR MENOPAUSAL PROBLEMS AMONG MENOPAUSAL WOMEN IN SELECTED RURAL AREAS AT BANGALORE”.
6.4. OBJECTIVES OF THE STUDY
TO assess the knowledge of menopause and the remedial measures adopted for menopausal problems among menopausal women’s. To determine the association between pre and post-test knowledge on menopause and remedial measures for menopausal problems with their selected demographic variables.
6.5 .HYPOTHESIS
The hypothesis will be test at 0.05 level of the significance H1.there will be the significant difference in pre and post-test knowledge scores of menopausal women on menopause and remedial measures for menopausal problems H2.there will be significant association between knowledge of menopausal women and selected demographic variables such as age, education, occupation, marital status, socio economic status.
6.6OPERATIONAL DEFINITION:
ASSESS: In this study it refers to evaluate(or)estimate the effect of planned teaching programme on menopause and remedial measures by the structure questionnaire and expressed as the post test scores of the experimental group
EFFECTIVENESS: In this study it refers to producing the desire or intended result of producing planned teaching programme on menopause and remedial measures for menopausal problems by the instrument and shown by the post test scores of the experimental group.
PLANNED TEACHING PROGRMME : It is a formal and specific teaching developed to menopausal women on menopause and remedial measures for menopausal problems.
KNOWLEDGE: In this study it refers to the correct responses of the menopausal women on menopause and remedial measures for menopausal problems to the knowledge part of the questionnaire of the interview schedule and expressed as knowledge scores.
REMEDIAL MEASURES FOR MENOPAUSAL PROBLEMS: In this study it refers to remedial measures adopted by menopausal women for menopausal problems.
MENOPAUSE It is formally defined as the permanent cessation of menstrual periods that occurs naturally. MENOPAUSAL WOMENS: In this study the word menopausal women refers to the age above 40 years.
6.7 ASSUMPTIONS: 1. Women will have inadequate knowledge regarding menopause and remedial measures for menopausal problems. 2. Planned teaching programme will helps the menopausal women to gain adequate knowledge regarding menopause and remedial measures for menopausal problems.
6.8 DELIMITATION:
The study is delimited 1. To women among the age group of 40 years and above. 2. Women Who knows to read and write Kannada or English.
6.9 PROJECTED OUTCOME: The present study will help the menopausal women to gain knowledge regarding menopause and remedial measures for menopausal problems.
MATERIALS AND METHOD:
7.1 SOURCE OF DATA
The data will be collected from menopausal women’s the age 40 years and above.
7.1.1 RESEARCH DESIGN
The research approach is evaluative.
7.1.2 SETTINGS The study will be conducted in Sumanahalli rural community area at Bangalore; it is 10km away from the college.
7.1.3 POPULATION: The population selected are menopausal women’s, the age 40 years and above. 7
7.2 METHOD OF DATA COLLECTION:
7.2.1 SAMPLING PROCEDURE
The sampling technique adopted for this study is purposive.
7.2.2 SAMPLE SIZE
The Sample size is 60.
7.2.3 INCLUSION CRITERIA
The criteria for sample selection are menopausal women’s: 1. Age 40 years and above. 2. Women who knows to read and write Kannada or English language.
7.2.4 EXCLUSION CRITERIA. 1. Mothers below 40 years of age.
7.2.5. INSTRUMENTS INTENDED TO BE USED
SELECTION OF TOOL This consists of 3 parts: 1. Part 1 : Consist of demographical variables such as age, education, socio economic status occupation 2. Part 2 : Questionnaire will be used to assess the knowledge of menopause and remedial measures for menopausal problems 3. Part 3 : Planned teaching program regarding menopause and remedial measures will also be use
SCORING PROCEDURE:
If answer is yes 1 If answer is no 0
SCORING INTERPRETATION:
Good:- 75-100% Average:- 50-75% Poor:- below 50%
7.2.6. DATA COLLECTION METHOD The menopausal mothers in the selected rural area will be selected for the study using non-probability purposive sampling. Formal administrative permission will be obtained from the panchayat president. The data will be collected from 60 mothers after obtaining their consent. The procedure will be explained to them and confidentiality will be assured. Pre-test will be conducted using structured knowledge questionnaire on menopause and remedial measures will be administered on the same day and after 6 days the post test will be conducted with the score knowledge questionnaire.
7.2.7. DATA ANALYSIS PLAN
The plan of data analysis are
All data will be tested at 0.05 level of significance.
Demographic data will be analysed using frequency, percentage and graph.
Paired ‘t’ test will be used to find the effectiveness of the planned teaching programmer.
Association between pre-test knowledge scores and demographic variable will be found by using chi-square test
7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS TO BE CONDUCTED ON PATIENTS, OR OTHER ANIMALS? IF SO PLEASE DESCRIBE BRIEFLY.
Yes, a planned teaching programme on uses of copper t will be given.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?
Yes, ethical clearance will be been obtained from the research committee of Nightingale College of Nursing Consent will be taken from the panchayat president and permission will be taken from the study subjects before the collection of data
REFERENCES :
1. Myles ;A Text Book of Midwives; 4th edition, published by Churchill Livingstone, 2003, Page No 137.
2. Namrata Sharma; Nightingale Nursing Times, Assessment of the Knowledge, Attitude, Problems faced and remedial measures adopted by menopausal women, Vol 6, No 2, May 2010, Page No: 12 -13.
3. Sharadha Ramesh ;Nightingale Nursing Times, Social Support System in Menopause, Vol 5, No 6, September 2009, Page No:12-13.
4. Sadhana U Adhyapak ;Nightingale Nursing Times A study to assess the effect of structure teaching related to knowledge of menopause among the working women. Vol 2, issue 11, February 2007, Page No: 21-22. 5. M. R. Soules, S. Sherman, E. Parrott, R. Rebar, N. Santoro, W. Utian and N. Woods 8. ReadMore:http://informahealthcare.com/doi/abs/10.1080/cmt.4.4.267.272? journalCode=cmt 2001, Vol. 4, No. 4 , Pages 267-272 Executive summary: Stages of Reproductive Aging Workshop (STRAW) Read More: http://informahealthcare.com/doi/abs/10.1080/cmt.4.4.267.272?journalCode=cmt
6. The clinical use of a preparation based on phyto-oestrogens in the treatment of menopausal disorders. Author: Russo R, Corosu Publication: Acta Biomed Ateneo Parmense. 2003 Dec; 74(3):137-43.
7. Julie A. Elder Holly L. Thacker http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womenshealt h/menopause/
8. Chad Wilson Menopause,Courtesy : http://en.wikipedia.org/wiki/Menopause
9. Sikon, Andrea and Holly Thacker M.D. Treatment for Menopausal Hot Flashes. Cleveland Clinic Journal of Medicine. July 2004: 71 (7)."Hot flashes ... in January. Canadian Medical Association Journal. 2004: 170 (1).Miller, Heather and Rose Maria Li, M.D. Measuring Hot Flashes: Summary of a National Institutes of Health Workshop. Conference report. Mayo Clinic. June 2004: 79. http://www.34- menopause-symptoms.com/hot-flashes.htm
10. Menopause. 2009 Jan-Feb; 16(1):132-40.Transdermal estradiol gel 0.1% for the treatment of vasomotor symptoms in postmenopausal women. Hedrick RE, Ackerman RT, Koltun WD, Halvorsen MB, Lambrecht LJ.Hawthorne OB/GYN Associates, Winston-Salem, NC 27103, USA. [email protected] http://www.ncbi.nlm.nih.gov/pubmed/18971794
11. FDA Commissioner Mark B. McClellan, M.D., Ph.D., Menopausal Hormone Therapy http://www.mamashealth.com/women/mentherapy.asp
12. Keratoconus: A review of presentation patterns Rajesh Sinha, Nupur Gupta, Namrata Sharma, Raghav Gupta, Jeewan S Titiyal May-June 2010, 58(3):263-268
13. Brian Shelley, MD University of New Mexico School of Medicine, Section of Integrative Medicine, MSC 10-5550, Albuquerque, NM [email protected] http://chp.sagepub.com/content/11/2/107.abstract
14. Age at menopause, and knowledge of and attitudes to menopause, of women in Karachi, Pakistan.Baig LA, Karim SA.University of Calgary, 66 Tuscarora Way NW, Calgary, Alberta T3L 2G9, Canada. [email protected] http://www.ncbi.nlm.nih.gov/pubmed/16776858
15. Maturitas. 2009 Jun 20; 63(2):138-41. Epub 2009 May 21.Menopause and sexuality: prevalence of symptoms and impact on quality of life.Nappi RE, Lachowsky M.Research Center for Reproductive Medicine, Department of Morphological, Eidological and Clinical Sciences, Italy. [email protected] http://www.ncbi.nlm.nih.gov/pubmed/19464129
16. Menopause. 2008 Sep-Oct; 15(5):958-62.The relationship of self-reported sleep disturbance, mood, and menopause in a community study.Cheng MH, Hsu CY, Wang SJ, Lee SJ, Wang PH, Fuh JL.Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan. http://www.ncbi.nlm.nih.gov/pubmed/18779680
17. Postmenopausal Hormone Use and Secondary Prevention of Coronary Events in the Nurses' Health Study: A Prospective, Observational Study Francine Grodstein, ScD; JoAnn E. Manson, MD; and Meir J. Stampfer, MD http://www.annals.org/content/135/1/1.long
18. Board of the International Menopause Society Amos Pines (President), David W Sturdee (General Secretary), Martin H Birkhäuser (Treasurer), Hermann PG
19. Schneider, Marco Gambacciani and Nick Panay www.touchbriefings.com/download.cfm?fileID=14277&action... 9. SIGNATURE OF THE CANDIDATE
10. REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12.1 REMARKSOF THE 12 PRINCIPAL
12.2 SIGNATURE