RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE : UJJUALA VALSALA FRANCIS
AND ADDRESS I YEAR Msc NURSING
BGS COLLEGE OF NURSING
APOLLO BGS HOSPITAL
MYSORE
2. NAME OF THE INSTITUTION : BGS COLLEGE OF NURSING
MYSORE
3. COURSE OF STUDY AND SUBJECT : I YEAR Msc NURSING
MEDICAL SURGICAL NURSING
4. DATE OF ADMISSION OF COURSE : 15-6-2010
5. TITLE OF THE TOPIC : INFORMATION BOOKLET ON SELF MANAGEMENT OF
MENSTRUALIRREGULARITIES
6) BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
”The adolescent girl still remains a young plant that neither gets light nor water. She remains the flower that could have blossomed but didn’t…..” Kamala Bhasin from “Our Daughters”
India has one of the fastest growing youth populations in the world, with an estimated 190 million adolescents. Girls below 19 years of age comprise one quarter of India’s rapidly growing population.
Adolescence is a transition period from childhood to adulthood. This complex passage from childhood to adulthood is particularly stressful for girls. The healthy adolescent population is considered as a social agent of change toward a population with a healthier life style. The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood. One of the major physiological changes that take place in adolescent girls is onset of menarche which is usually associated with a number problems among which dysmenorhoea is the most common.1
Menarche is the onset of menstruation and it is one of the most significant milestones in a woman's life. The mean age at menarche varies from population to population and is known to be a sensitive indicator of various characteristics of population including nutritional status, geographical location, environmental conditions and magnitude of socioeconomic inequalities in a society . Studies suggested that menarche tends to appear earlier in life as the sanitary, nutritional and economic conditions of a society improve. For most females, it occurs between the age of 10 and 16 years; however, it shows a remarkable range of variation. The normal range for ovulatory cycles is between 21 and 35 days. While most periods last from three to five days, duration of menstrual flow normally ranges from two to seven days. For the first few years after menarche, irregular and longer cycles are common .2
A vast majority of girls in India are suffering from either general or reproductive morbidities. If these are not treated early, they could lead to various disabilities and consequently affect their valuable lives. Adolescent girls will become mothers in the subsequent 5 – 10 years and these morbidities may affect the well being of future generations. By late adolescence, 75% of girls experience some problem associated with menstruation3
Menstruation has dual significance for women. Menstrual disorders affect not only India but millions of women in the United States and represent an important health burden. The most common menstrual disorders are dysmenorrhea and headache; these conditions are leading causes of work or school absenteeism and substantially impact quality of life. This study is an approach to assessment and management of dysmenorrhoea and menorrhagia that considers the cultural, social and personal significance of symptoms and management choices. Cultural influences, such as a woman's status within society, her life stage, religion, education and employment, determine whether a woman seeks medical help for menstrual problems, and the personal significance of dysmenorrhoea. Assessment involves consideration of pain, associated symptoms, effect on lifestyle and activities of daily living, and a psychosocial and cultural assessment. Management involves specific treatment of underlying pathology, psychosocial support and individualizing treatment according to impact of the pain, associated symptoms, reproductive stage, cost, and the woman's personal values and attitudes.4
A recent review of menstrual disorders in developing countries in journal revealed high rates of menstrual morbidity in population-based studies.5 By late adolescence, 75% of girls experience some problem associated with menstruation. Delayed, irregular, painful, and heavy menstrual bleeding are leading reasons for physician office visits by adolescents, and dysmenorrhoea is the leading reason for school absenteeism among girls.6
The true incidence and prevalence of dysmenorrhea are not clearly established in India. In recent times, George and Bhaduri concluded that dysmenorrhea (87.87%) is a common problem in
India. In Sweden the prevalence was >2–4%. Similar findings had been reported by Jayashree and Jayalakshmi, in rural married women of Andhra Pradesh. Dysmenorrhea has been estimated to be the greatest cause of time lost from work and school in the United States.7
The consequences of untreated dysmenorrhea range from lost of work and school hours to family and personal disruption. Therefore, dysmenorrhea affected not only the untreated person but also affected family, social and national economics as well.8
6.1 NEED FOR THE STUDY
Adolescent girls constitute one fifth of the female population in the world. Generally this group is considered healthy and has not been given adequate attention in health programmes. The reason is age specific mortality is comparatively low in this age group as compared to others. In countries like India, adolescent girls face serious health problem due to socio-economic, environmental conditions and gender discrimination. These factors make them more vulnerable to health risks.
Dysmenorrhea is the most common gynecologic disorder among female adolescents, with a prevalence of 60% to 93%. In the United States, dysmenorrhea is the leading cause of recurrent short-term school absenteeism. Several studies have shown that adolescents with dysmenorrheal report that, it effects their academic performance, social and sports activities.9
A dysmenorrhea incidence of 33.5% was reported by Nag (1982), among adolescent girls in
India. A study done in Sweden showed that more than 50% of all menstruating women experience some discomfort. It has also been reported by a senior obstetrician that probably 5 –
10% of girls in their late teens suffer from severe spasmodic dysmenorrhea interrupting their educational and social life.7
A recent study conducted on the menstrual disorder of teenagers study concludes that menstrual pain and symptoms are common in teenagers. Girls indicating moderate to severe pain in association with a high number of menstrual symptoms, school absence and interference with life activities should be effectively managed to minimize menstrual morbidity. Those girls who do not respond to medical management should be considered for further investigation for possible underlying pathology, such as endometriosis.10
Jawaharlal Nehru Institute of post graduate medical education and research (JIPMER) study in
Tamilnadu on “Puberty rituals” (2001) showed the association between menstrual hygiene with reproductive tract infections. In another community based survey on “Dysmenorrhoea in adolescent girls in a rural area of Delhi” (1997) covered 300 girls aged 11-18 years. The study reflected that 70.8% of girls experienced dysmenorrhoea. A Study conducted in Chennai showed that the prevalence of reproductive morbidities was very high among the study group; about 82 percent of girls reported having had at least one reproductive health problem during the survey.
The mean number of problems reported was 2.5. Prevalence of dysmenorrhoea, severe backache during menstruation and white discharge were the major morbidities reported among adolescent girls. More than one third of girls (91/263) in the study had scanty/ excessive bleeding (56 had scanty and 35 had excessive bleeding problems) and about one fourth had irregular cycles.
Dysmenorrhoea was highly reported by girls in late adolescence (15-18 years). The incidence of severe backache and scanty bleeding was higher among early adolescents (11-14 years).
Menstrual irregularities and skin diseases were prevalent across all age groups.3
According to a study conducted analysis revealed that a large proportion of the adolescents
(64.5%) reportedly have been suffering from gynecological morbidity. The most frequent form of morbidity was menstrual disorders (63.9%) followed by lower abdominal pain (58.6%), burning sensation during urination (46.1%), genital itching (15.5%), vaginal discharge (3.4%) etc. Multivariate logistic regression analysis revealed that older adolescents aged 15-19 years, family income, type of family, type of residence and hygienic practice during menstruation appeared to be influencing factors for adolescents reproductive morbidity. The results also revealed that about one fifth (18.0%) sought health care for their gynecological ailments indicating that adolescents were unaware about their reproductive morbidity (p<0.05). For assessing the factors influencing their health care seeking for reproductive morbidity, multivariate logistic regression analysis found significant positive association with adolescents aged 15-19 years, having autonomy in treatment, working status, adolescents of joint or extended family (p<0.05).11 A study conducted by author on menstruation in adolescent girls in Rajasthan concluded that majority of the girls were not aware of the menstruation period when they first experienced it.
They used traditional methods and hence the prevalence of RTIs was more than three times higher among girls having unsafe menstrual practices. The article makes a strong case that ignorance, false perceptions and unsafe practices regarding menstruation are not uncommon among adolescents in the study area, having serious implications for reproductive and sexual health. Further, the study demonstrates that among the determinants for reproductive morbidity, practices during menstruation appear to be the most dominant factor. These findings reinforce the need to bring them out of traditional beliefs, misconceptions and restrictions, and encourage safe and hygienic practices. 12
Another study was conducted by Anil in 2010 on dysmenorrhoea among adolescent girls in
Gwalior in India. : An explorative survey technique with a co relational approach was used and nine hundred and seventy adolescent girls of age 15 to 20 years, studying in the higher secondary schools (Pre-University Colleges) of Gwalior was taken for the study. The results were the prevalence of dysmenorrhea in adolescent girls was found to be 79.67%. Most of them, 37.96%, suffered regularly from dysmenorrhea severity. The three most common symptoms present on both days, that is, day before and first day of menstruation were lethargy and tiredness (first), depression (second) and inability to concentrate in work (third), whereas the ranking of these symptoms on the day after the stoppage of menstruation showed depression as the first common symptoms. Negative correlation had found between dysmenorrhea and the General Health Status as measured by the Body surface area.7 Menstrual disorders and their adverse symptoms represent an important health issue for many women of child-bearing age. Aside from a deleterious effect on the individual's private life, menstrual disorders are being increasingly recognized as having significant implications at work.
This is particularly relevant in occupations such as nursing, where the majority of staff is female.
Various investigations have identified the prevalence, distribution, and risk factors associated with menstrual disorders, both in the general community and within the nursing profession.
Overall, it is clear that menstrual disorders and their adverse symptoms represent an important occupational health challenge for modern nursing. Future interventions specifically aimed at reducing the work-related burden of these issues should be urgently considered. A more dedicated commitment from higher management regarding the overall health of nurses at work is also required.13
Women may use herbs and supplements for chronic gynecologic conditions, such as menopause, premenstrual syndrome, dysmenorrhea, cyclic mastalgia, and infertility. This review is an evidence-based evaluation of herbs and supplements for these conditions. Therapies that carry a higher level of support from randomized controlled trial evidence include black cohosh for menopause; vitamins B1 and E for dysmenorrhea; calcium, vitamin B6, and chasteberry for premenstrual syndrome; and chasteberry for cyclic mastalgia. There were too few trials involving herbs and supplements in infertility to warrant a solid recommendation, but chasteberry, antioxidants, and Fertility Blend have some preliminary support. Midwives may want to consider these alternatives in addition to more traditional treatment options when meeting with patients.14 According to the author, yogashhasthra, reducing stress, increasing exercise, and making dietary changes around the time of menstruation can prevent PMS symptoms from worsening. Women should be encouraged to eat regular, well-balanced meals. A diet low in salt and sugar, adequate in protein, moderate in fat, and high in complex carbohydrates (fruit, vegetables, and whole grains, good quality protein, nuts and seeds) will all help rebalance and maintain hormones.
While experiencing PMS, Shashankasana & a simple breathing exercise called Anulome Vilome can be performed at any time of the day to relax the muscles and nerves, which are under constant stress, strain and irritation.15s
Due to its estrogen-like properties, fenugreek is believed to help increase libido and lessen the effect of hot flashes and mood fluctuations that are common symptoms of menopause and PMS.
Wild yam, a plant containing diosgenin is used to treat vaginal dryness in older women, PMS
(premenstrual syndrome), menstrual cramps, osteoporosis, and reduced energy and sexual drive in men and women.16
Studies show Reflexology may be helpful in the battle against mood swings, bloating, sleepless nights and cravings that come with PMS.17
In 2001, three studies were done comparing magnesium to a placebo as a treatment for dysmenorrhoea. The overall result was magnesium was more effective than a placebo for pain relief, with a lesser need for additional pain medications. There have been at least eight studies involving over 1000 women, demonstrating that fish oil capsules, which contain omega-3 fatty acid, had a positive effect on these cramps.18 Wheat germ oil [one or more tablespoons or 15 ml.] added to the daily diet has been used for over 50 years to regulate menses, protect the heart, and help keep the vagina lubricated. Vitamin
E does the same thing.19
Another recommendation for menstrual cramps is that a tea made from ginger root can help relieve painful cramps. Red raspberry leaf strengthens the uterine walls, while helping to regulate menstrual flow.18
As found out menstrual problems among adolescent girls exist as a major problem and a cause for school/college absenteeism. Studies done in various states of India prove that majority of girls suffer from menstrual irregularities and very few seek medical advice for it. Hence I selected some of the treatment options other than traditional ones which can be practiced safely in household settings without much adverse effects; provided she has taken expert guidance t practice it such as yoga and reflexology.
6.2 REVIEW OF LITERATURE
The review of literature for the present study can be described under two headings.
Studies related to menstrual irregularities
Studies related to management of menstrual irregularities.
1. STUDIES RELATED TO MENSTRUAL IRREGULARITIES
A descriptive study was conducted on menstrual disorders in adolescent girls in Singapore with
5561 participants, 23.1% reported having irregular cycles. Oligomenorrhea was the most frequently reported problem (15.3%), and polymenorrhea was much less prevalent (2.0%). With increasing body mass index (BMI), there was a significant increase in the prevalence of oligomenorrhea, whereas polymenorrhea was more prevalent in the girls with a low BMI.
Dysmenorrhea was a significant problem, with 83.2% respondents reporting it in various degrees and 24% girls reporting school absenteeism owing to it. Dysmenorrhea was severe enough to require analgesics for pain relief in 45.1% of all subjects. In spite of menstrual problems being common, only 5.9% girls reported seeking medical advice for them. Traditional Chinese medications were used most commonly for menstrual cycle problems, and over-the-counter medications for dysmenorrhea. The use of oral contraceptives for menstrual problems was minimal. The study concluded that menstrual problems among adolescent females are common and a significant source of morbidity in this population. Appropriate health education measures need to be put into place to prevent this trend.20
A cross sectional descriptive study was conducted on prevalence and severity of dysmenorrhoea among first and second year female medical students in rewa India, to evaluate the menstrual problem specially dysmenorrhea and its severity in female medical students and its effect on their regular activities. It was conducted on 107 female medical students, all participants were given a questionnaire to complete; participants were given 20 minutes to complete the questionnaire. The mean age of subjects at menarche was 12.5 (±1.52) years, with a range of 10-
15 years. The prevalence of dysmenorrhea was 73.83%; approximately 4.67%of dysmenorrhic subjects had severe dysmenorrhea. The average duration between two periods and the duration of menstrual flow were 28.34 (±7.54) days and 4.5 (±2.45) days respectively. Prevalence of other menstrual disorders like irregularity, prolonged menstrual bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and 3.73% respectively. Among female medical students who reported dysmenorrhea; 31.67% and 8.68% were frequently missing college & classes respectively. Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08% reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among female medical students, it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. Maximum participants do not seek medical advice and self treat themselves with prostaglandin inhibitors; like Ibuprofen.8
A comparative cross-sectional study was conducted on dysmenorrhoea among adolescent school girls (101 girls in urban areas and 79 girls in rural areas) in the district of Karimnagar. The prevalence of dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas)
2 (X df = 0.1, P = 0.05). Sickness absenteeism (28–48%), socio economic losses, and perceived quality of life losses are more prevalent among girls in urban areas than in girls in rural areas.
Girls in rural areas resort to physical labor and other natural methods to obtain relief while the girls in urban areas are mainly depending on medications. Dysmenorrhoea can also be managed effectively by natural methods without resorting to medicines, provided one is psychologically prepared to face it without anxiety.21
A study was conducted on dysmenorrhea among Japanese women. A prospective cohort study was used and the results were among 823 enrolled participants (age range, 18–51 years), dysmenorrhea (mean duration 1.75 days; range 1–5 days) was reported in 15.8% (95% CI, 13.3–
18.3) during the 1-month study period. Common associated symptoms included headache
(10.77%), back pain (6.92%), and fatigue (5.38%). No participant with dysmenorrhea visited a physician, while 51.5% of the women used self-medication, and 7.7% used complementary/alternative medicine. In this study, about half used self-medication, while some preferred complementary/alternative medicine. Dysmenorrhea is significantly associated with younger age and employment status.22 A cross sectional survey study conducted on menstrual disorders and their influence on low back pain among Japanese nurses in a university teaching hospital has shown that an increasing body of evidence now suggests that menstrual disorders may influence the development of Low
Back Pain (LBP) among women of reproductive age. Nurses reported a wide range of symptoms both prior to and during menstruation, including breast tenderness, stomach pain, light headedness and fatigue. Around three-quarters had experienced at least one episode of LBP in the previous 12-months, with most symptoms lasting one week or less. Increasing body weight was correlated with an increased risk of LBP affecting their daily activities (OR: 12.94, 95%CI:
1.54-116.56). Having three or more children was correlated with a reduced risk of experiencing
LBP (OR: 0.13, 95%CI: 0.01-0.97). Nurses who reported breast tenderness prior to menstruation were twice as likely to suffer LBP (OR: 2.09, 95%CI: 1.20-3.73), while those who reported breast tenderness during menstruation were almost twice as likely to suffer LBP that interfered with their daily activities (OR: 1.85, 95%CI: 1.06-3.32). Overall, study suggests that reproductive symptoms and menstrual disorders may influence the development of LBP among
Japanese nurses, although the magnitude of this effect appears to be less than that reported in some previous research.23
A study was conducted on the burden and determinants of dysmenorrhoea in goa, India. A total of 2262 women were eligible. More than half reported dysmenorrhoea; moderate to severe dysmenorrhoea was reported by 755 participants (33.4%, 95% CI 31.4–35.4). There was a linear association between severity of pain and impact (medication and taking rest) and the onset of pain (premenstrual onset associated with more severe pain). On multivariate analyses, the risk of moderate–severe dysmenorrhoea was associated with the experience of violence (OR 2.23, 95%
CI 1.5–34); other somatic complaints (OR 3.67, 95% CI 2.7–4.9 for highest somatoform symptom score category compared with the lowest); gynecological complaints (non-menstrual lower abdominal pain: OR 1.78, 95% CI 1.3–2.3; dysuria: OR 1.98, 1.4–2.7); menorrhagia (OR
1.92, 95% CI 1.4–2.6); and illiteracy (OR 1.32, 95% CI 1.0– 1.7). Having had a pregnancy (OR
0.53, 95% CI 0.4–0.7), older age of menarche (OR 0.70, 95% CI 0.5–0.9, for age >14 compared with <13 years) and older age (OR 0.43, 0.3–0.6 for age 40–50, compared with 18–24 years) were protective. The conclusions were the burden of dysmenorrhoea is greater than any other gynecological complaint, and is associated with significant impact. Social disadvantage, co- morbidity with other somatic syndromes and reproductive factors are determinants of this complaint.5
A community based survey was conducted on menstrual hygiene practices and reproductive morbidity in rural thiruvananthapuram, Kerala. Multi stage cluster sampling method of 'thirty cluster of twelve' was used to identify the sample population. The sample comprised 360 married or unmarried, non-pregnant, non-lactating women in the reproductive age group (12-45). A house-to-house survey was conducted using a structured pre tested questionnaire. Majority (60.8 percent, 95%CI: 56.4 -65.2)) dealt with menstruation unhygienically. A statistically significant association was seen between menstrual hygiene maintenance and education, SES, knowledge prior to menarche, type of protection, and accessibility to water, bathroom facilities and menstrual disorders. Multiple logistic regression identified a significant positive relation between hygiene maintenance and SES (OR=1.15 95%CI: 0.60-2.15 for middle, OR=3.65 95%CI: 1.35-
9.85 for upper compared to lowest SES). Symptoms suggestive of RTI were reported by 36.1 percent (95%CI: 33.6-38.6) of the women. Skin problems related to sanitary protection were reported by 45.8 percent (95%CI: 43.2-48.4) of the women. Unhygienic management of menstruation was significantly associated with RTI (OR=1.86, 95%CI 1.18-2.94) and Skin problems .associated with sanitary protection (OR= 3.95, 95%CI 2.49-6.27).24
2. STUDIES RELATED TO MANAGEMENT OF MENSTRUAL IRREGULARITIES
A study was conducted on the influence of dietary intake of dairy products on dysmenorrhoea. A self-assessment questionnaire was completed by 127 female university students aged between 19 and 24 years. Participants gave information that included demographics, the nature, type, and severity of pain associated with menstruation if any, management used to relieve dysmenorrhea, associated symptoms, and a general assessment of dietary intake of dairy products. The prevalence of primary dysmenorrhea in the population studied was 87.4% with the majority of the participants' pain symptoms beginning a few days before and continuing through the first two days of menstruation. Forty-six percent of students were found to have severe dysmenorrhea.
Abdominal bloating was the most frequently expressed symptom associated with dysmenorrhea amongst the population studied. Dysmenorrhea and associated symptoms were found in significantly fewer female students who consumed three or four servings of dairy products per day as compared to participants who consumed no dairy products. Primary dysmenorrhea is common in young women. This study helps us to better understand the relationship between low dietary intake of dairy products and the risk of dysmenorrhea.25
A study was conducted on skipping breakfast adversely affects menstrual disorders in young college students. In the present study a questionnaire survey was conducted to examine the relationship between dietary habits and menstrual disorders in young women. Subjects were recruited from 315 college students and were classified as: Group I, eating breakfast; Group II, skipping breakfast; Group III, not eating fast foods; Group IV, eating fast foods; Group V, not eating processed foods; and Group VI, eating processed foods. The intensity of dysmenorrhea was scored using three grades. All participants were further divided into groups based on having regular or irregular menstruation, having premenstrual symptoms or not, and self-perception of good or poor general health. General health was poor in Groups II and VI, and dysmenorrhea scores were high in Groups II, IV and VI. The incidence of irregular menses was also high in
Group II. However, there was no apparent relation between premenstrual symptoms and dietary habits. These findings suggest that skipping breakfast adversely affects menstrual disorders in young college students.26
A randomized controlled trial study was conducted on effects of acupressure on primary dysmenorrhoea. A total of 30 young college female students with primary dysmenorrhea were randomly allocated to intervention (n = 15) and control (n = 15) groups. Significant differences were observed in the scores of dysmenorrhea between the two groups immediately after
(3.50 ± 1.42 vs. 5.06 ± 1.43, p = 0.004) and also 3 h after treatment (1.66 ± 1.98 vs. 4.80 ± 1.37, p = 0.000). Acupressure on the SP6 meridian can be an effective non-invasive nursing intervention for alleviating primary dysmenorrhea and its effects last for 3 h post-treatment.27
A study was conducted to find out the effect of planned yoga therapy for 12 weeks on dysmenorrhoea of adolescent girls. A total of 1648 adolescent girls from six districts of
Karnataka were surveyed to find out the incidence of dysmenorrhoea in Karnataka in the first phase of the study. Eighty three adolescent girls in three groups (experimental, control I and control II) constituted the sample for the second phase. An explorative survey technique was used for the first phase, and the second phase used evaluative approach with pre-test post-test control group design, where a 12 weeks yoga therapy was used as the intervention. Major findings of the study were that the incidence of dysmenorrhoea was 87.87 percent among the adolescent girls. A significant positive correlation ( r= 0.1275, ▁P < 0.01) between the severity of dysmenorrhoea expressed in dysmenorrhoea scores and stress was found in adolescent girls under study. Yoga therapy was found to be a highly effective intervention in reducing the occurrence of dysmenorrhoea, the intensity of pain during dysmenorrhoea, and the dysmenorrhoea scores. The yoga therapy was also effective in reducing the stress scores among adolescent girls with dysmenorrhoea.1
A study on effect of 61-points relaxation technique on stress parameters in pre menstrual syndrome was done in india.61-points relaxation exercise (61-PR), a relatively less known hatha yoga technique, is a successful means of stress relaxation and is expected to relieve PMS as well.
The present study was conducted on 50 clinically healthy women volunteers who were in their reproductive age group and in their premenstrual period, from which a control group (n = 20) and a PMS group (n = 30) based on the symptoms were identified. In both groups basal heart rate
(HR/min), systolic (SBP; mmHg) and diastolic blood pressure (DBP; mmHg), electromyogram
(EMG; mV), electrodermal galvanic activity (EDG; microv), respiratory rate (RR/min) and peripheral temperature (T; degrees F) were recorded and the subjects were taken through a guided 61-PR. The symptoms and parameters were re-recorded after the 61-PR. In control group, the basal HR was 82.06 +/- 8.07, SBP 111.95 +/- 8.23, DBP 76.8 +/- 6.42, EMG 4.08 +/- 2.99,
EDG 9.77 +/- 3.29, RR 15.60 +/- 3.77 and T was 97.86 +/- 0.63. After 10 minutes of 61-PR, HR
(77.27 +/-10.85, P < 0.05), SBP (107.35 +/- 7.41, P < 0.05), DBP (75.25 +/-7.57, P < 0.05),
EMG (2.07 +/- 1.90, P < 0.05), EDG (8.06 +/- 2.87, P < 0.05), RR (16.00 +/- 4.12, P < 0.05) fell significantly and T (97.97 +/- 0.64, P > 0.05) rose significantly. In the PMS group, the basal HR was 90.61 +/- 8.46, SBP 122.5 +/- 11.52, DBP 83.53 +/- 8.26, EMG 5.79 +/-2.75, EDG 13.14 +/- 6.54, RR 19.13 +/- 3.76 and T was 93.43 -/+ 5.29. After 10 minutes of 61-PR, HR (75.58 +/-
10.11, P < 0.0001), SBP (114.53 +/- 9.70, p < 0.0001), DBP (77.46 +/- 8.68, P < 0.0001), EMG
(2.56 +/- 1.77, P < 0.0001), EDG (10.64 +/- 5.72, P < 0.0001), and RR (16.13 +/- 3.76, P <
0.0001) declined to a much greater extent and T (93.49 +/- 5.28, P < 0.0001) rose more significantly. These results suggest a reduction in sympathetic activity by 61-PR, also the high basal sympathetic tone present in subjects of PMS group due to stress is considerably reduced by relaxation. 61-PR is effective in providing relief from PMS and may be a useful adjuvant to medical therapy of PMS and other stress disorders.28
A quasi experimental study was conducted on reflexology for premenstrual syndrome and dysmenorrhoea among female college students in Korea. Of the forty female college students, twenty were assigned to the experimental group and, twenty to the control group. The data were obtained over 2 months (November 26, 2001 to January 31, 2002) from a Nursing C College located in S city. Subjects in the experimental group received foot reflexology for 6 times with 1 hours during 60 days, and subjects assigned to the control group did not receive foot reflexology.
The results of the study are as follow, 1.The symptoms which the group of experimental and the group of control discomforts the most are sensitiveness (35%), abdominal pain (30%), lower abdominal pain (30%) and lumbago (20%). The method of relieve premenstrual syndrome and dysmenorrhea by which the subjects employ the most to solve their premenstrual syndrome and dysmenorrhea is the getting along by enduring (67.5%) and bed rest (32.5%). 2. The mean score of the premenstrual syndromes and dysmenorrhea before foot reflexology was 8.35; it was 4.16 at the first menstruation after foot reflexology and 3.25 at the second menstruation for the experimental group. 3. The relieved symptoms after foot reflexology was fatigue (50%), insomnia (40%), abdominal pain(35%), lower abdominal pain (30%) and constipation(30%). Foot reflexology was effective in improve the symptoms of the female college students who have the premenstrual syndrome and dysmenorrhea.29
6.3 STATEMENT OF THE PROBLEM
A STUDY TO ASSESS THE EFFECTIVENESS OF INFORMATION BOOKLET ON
KNOWLEDGE AND ATTITUDE REGARDING SELF MANAGEMENT OF MENSTRUAL
IRREGULARITIES AMONG NURSING STUDENTS IN SELECTED NURSING COLLEGES
AT MYSORE
6.4 OBJECTIVES
1. To assess the effectiveness of information booklet on knowledge and attitude regarding
self management of menstrual irregularities among nursing students in selected nursing
colleges at Mysore.
2. To correlate knowledge and attitude regarding self management of menstrual
irregularities among nursing students in selected nursing colleges at Mysore
3. To find out the association of knowledge and attitude regarding menstrual irregularities
and other selected background variables
6.5 PROJECTED OUTCOME (HYPOTHESIS)
At 0.05 level of significance H1: There will be a significant difference between pretest and post-test knowledge score
on self management of menstrual irregularities among the nursing students.
H2: There will be a significant difference between pretest and post-test attitude score on
self management of menstrual irregularities among the nursing students.
6.6 OPERATIONAL DEFINITIONS
Effectiveness: It refers to gain in the knowledge and attitude on self management of menstrual irregularities reported by nursing students which is measured by using the knowledge and attitude scores.
Knowledge: It refers to the awareness of nursing students regarding self management of menstrual irregularities as tested in terms of questionnaire.
Attitude: It refers to the way in which they accept the self management of menstrual irregularities as tested by questionnaire.
Menstrual irregularities: It includes the premenstrual syndrome, menorrhagia which are the most common among the women who are in reproductive age.
Self Management: It refers to the treatment modalities that they themselves can follow to regulate menstrual blood flow without any side effects, along with their regular treatment.
Nursing students: It refers to the students those who are studying in nursing.
Background Factors: It refers to those issues thought to influence menstrual irregularities such as age, type of family, heredity, food habits, and socioeconomic status. 6.7 ASSUMPTIONS
The researcher assumes that
Menstrual irregularities will be more common among adolescent students
The response of the nursing students will be the true measure of menstrual
irregularities.
6.8 DELIMITATIONS
The research is delimited to nursing students
Available time for the study
Having the problem of menstrual irregularities.
Aged between 17-21 years
7. MATERIALS AND METHODS:
7.1 Source of data:
The data will be collected from nursing students aged between 17-21 years in selected nursing colleges at Mysore.
7.1.1 Research Design:
The study design selected for this study is (pre experimental) one group pre-test and post-
test design.
7.1.2 Settings:
The study will be conducted in selected nursing colleges at Mysore. 7.1.3 Population:
Nursing students aged between 17 -21 years studying in selected nursing colleges at Mysore.
7.2METHOD OF DATA COLLECTION:
7.2.1 Sampling Technique: Convenient sampling
7.2.2 Sampling Size: 50
7.2.3 Inclusion Criteria for Sampling:
The study will include the nursing college students
Aged between 17-21 years.
Identified with the problems of menstrual irregularities
Those who are present at the time of the study.
7.2.4 Exclusion Criteria for Sampling:
The study will exclude the students
Those who do not give consent to participate in the study.
Those who are absent during the data collection.
Boys in nursing college
7.2.5 Instrument Used: self administered structured questionnaire.
7.2.6 Data Collection Method: The data collection technique adopted in the study is structured questionnaire on management of menstrual irregularities among adolescents.
7.2.7 Duration of data collection and follow up: 1 month
7.2.8 Data Analysis Plan:
The data obtained would be analyzed using both descriptive and inferntial statistics.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION ON INTERVENTION TO
BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO
PLEASE DESCRIBE BRIEFLY:
Yes, information booklet regarding self management of menstrual irregularities will be provided to the nursing students with the consent of authorities.
7.3 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION
IN CASE OF 7.3:
Yes.
Due permission from college authorities will be taken BIBLIOGRAPHY
1) Anice.G.J., “effect of yoga therapy on dysmenorrheal in adolescent girls,praceeding of international conference of health science on integrated health care towards global well being”, mahavidyapeetha Mysore,2005,Feb 25-35. (http://www.we.asc.org/anice)
2) Desalegn Tegabu Zegeye. “Age at menarche and the menstrual pattern of secondary school adolscents in northwest Ethiopia”, BMC women’s health 2009
3) P Balasubramanian; “Health needs of poor unmarried adolescent girls-a community based study in rural tamilnadu”, rural women’s social education centre, tamilnadu
4) Reddish Sue, Australian family physician, 2006, vol35, 842-849
5) V Patel, etal. “The burden and determinants of dysmenorrhoea: a population based survey of
2262 women in goa, india, 2006Feb
6) Lee L K, etal. “Menstruation among adolescent girls in Malaysia: a cross sectional school survey”, Singapore med j, 2001; 47(101):869.
7) Anil K Aggarwal, Anju Agarwal. “A study of dysmenorrhoea during menstruation in adolescent girls”, Indian journal of community medicine, 2010Jan; v35 (1):p159-164.
(http://www.ncbi-nlm.nih.gov/pmc/articles/pmc2888348)
8) Kamonsak Tangchai etal. “Dysmenorrhoea in Thai adolscents: prevalence, impact, knowledge and treatment”. Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital,
Mahidol University, j med assoc Thai, 2004; 87(suppl3):p369-73 9) Amita Singh, et al. “prevalence and severity of dysmenorrhoea: a problem related to menstruation, among first and second year medical students”, rewa, Indian j physiol pharmacol,
2008; 52(4):p389-397.
10) Parker M A, etal. “The menstrual disorder of teenagers: determining typical menstrual patterns and menstrual disturbance in a large population based study of Australian teenagers,
BJOG; 2010Jan; 117(2):p185-92
11) Rahman M M, J Ayub, “Adolescent self reported reproductive morbidity and health care seeking behavior”, 2004 april-june;16(2)p9-14, Bangladesh
12) Anoop khanna, Goyal R S, Rahul Bhawsar, “menstrual practices and reproductive problems, a study of adolescent girls in Rajasthan”, journal of health management, 2005April, vol 7 no91-
107
13) Derek r smith; “Menstrual disorder and their adverse symptoms at work: an emergency occupational health issue in the nursing profession, nursing and health sciences”, 2008Sep;
3(10):p222-228, (http://onlinelibrary.wiley.com/doi/10.1111/j.1442-2018.2008.00391.x/abstract)
14) Cathi.e.dennely, “The use of herbs and dietary supplements in gynaecology: an evidence based review”, Journal of midwifery and women’s health, 2006Nov, 6(51), p402-409
15) Yoga for premenstrual syndrome http://yogashaasthra.blogspot
16) Xylestrl http://www.practicalweightloss.org
17)http://www.suite101.com/content/reflexology-for-pms-a51768
18) http://www.homeremedies-digest.com/menstrualcramps.html/ 19) http://www.project-aware.org/managing/alt/menstrual.shtml
20) Anupriya Aggarwal, Annapoorna Venkat; “questionnaire study on menstrual disorders in adolescent girls in Singapore”, journal of pediatric and adolescent gynecology, 2009Dec, 6(21), pages 365-37 (http://www.jpagonline.org/article/s1083-3188 (09)001247-7abstract)
21) Atchuta Kameswararao Avasarala and Sai Bharghavi Panchangam. “Dysmenorrhoea in different settings: Are the rural and urban adolescent girls perceiving and managing the dysmenorrhoea problem differently”. Indian j community med.2008oct; 33(4)246-249
22) S.Ohde, et al “Dysmenorrhoea among Japanese women”, international journal of gynecology obstetrics, 2008Jan, 1(100), p13-17. (http://www.ijgo.org/article/soo2o-7292 (07)00430-
4/abstract)
23)Derek r smith; menstrual disorders and their influence on low back pain among Japanese nurses, industrial health,vol47,(2009),no3,pp301-312
(http://www.jstage.jst.go.jp/article/indhealth/47/3/47-301/-article)
24) Anuradha, Menstrual hygiene practices and reproductive morbidity, a community based survey in rural thiruvananthapuram, Sree chitra tirunal institute for medical sciences and technology, Kerala, India,(http://www.sctimst.ac.in/amchss/research/ge3.htm)
25) Abdul Razzaq K K etal. “Influence of dietary intake of dairy products on dysmenorrhoea” ,j obstet gynaecol res;2010 april;36(2);327-83 (http://www.ncbi.ntm.nih.gov/pubmed/20492391)
26)Fujiwara T, Sato N,Awaji H, Sakamoto H; skipping breakfast adversely affects menstrual disorders in young college students,journal-int j food sci nutr; 2009 may1-9
(http://www.ncbi.nlm.nih.gov/pubmed/19468949) 27) Neda Miebagher Ajorpaz, etal. “Effects of acupressure on primary dysmenorrhoea: a randomized controlled trial”, Kashan University of Medical Sciences, Medical Surgical Nursing
Department, Kashan, Iran, July 2010
28) Dvivedi J, Dvivedi S, Mahajan K K, “Effect of ’61-point’s relaxation technique’ on stress parameters in premenstrual syndrome”, Indian j physiol pharmacol; 2008jan-march52 (1):69-76
29) Kim Y H, Cho S H, “The effect of foot reflexology on premenstrual syndrome and dysmenorrhoea in female college students”, Korean j women health nurse, 2002June8 (2):212-
221, ( http://www.reflexology-research.com/koreaabstracts.html)
WEBSITE REFERENCES www.google.com www.pubmed.com www.askMedline.com www.elseivierhealth.com 9. SIGNATURE OF THE CANDIDATE :
10. REMARKS OF THE GUIDE :
11. NAME AND THE DESIGNATION
OF THE GUIDE :
11.1 SIGNATURE OF THE GUIDE :
11.2 HEAD OF THE DEPARTMENT :
11.3 SIGNATURE :
12. REMARKS OF THE PRINCIPAL :
12.1 SIGNATURE :