“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME ON KNOWLEDGE AND PRACTICE REGARDING
DYSMENORRHEA AND ITS MANAGEMENT AMONG
ADOLESCENT GIRLS IN SELECTED PU
COLLEGES AT TUMKUR”
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
SAUMIA JANE SIMON
OBSTETRICS AND GYNECOLOGICAL NURSING
ARUNA COLLEGE OF NURSING
RING ROAD, MARALUR,
TUMKUR.
2010-11
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESBANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the candidate : Miss SAUMIA JANE SIMON
And address M.Sc Nursing 1st year,
Aruna College Of Nursing,
Ring Road, Maralur
Tumkur, Karnataka
2. Name of the institution : Aruna College Of Nursing
3. Course of study and subject : First Year, M.Sc Nursing
Obstetrics and Gynecological
Nursing
4. Date of admission : 10.06.2010
5. Title of the topic : “A study to assess the effectiveness of
structured teaching programme of
knowledge and practice regarding
dysmenorrhea and its management
among adolescent girls in selected
PU colleges at Tumkur”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Quite often when I have patients with severe or even mild dysmenorrhea (pain associated with menstruation), I will treat the lower back
and that will relieve the dysmenorrhea”.
By, Dr.Lewis
Adolescence is a transition period from child hood to adult hood and is characterized by a spurt in physical, endocrinal, emotional and mental growth with a change from complete dependence to a relative independence. The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood[1].
One of the major physiological changes that takes place in adolescent girls in the onset of menarche, which is often associated with problems of irregular menstruation, excess bleeding and dysmenorrhea.Of these dysmenorrhea is one of the most common problems experienced by adolescent girls[2].
Dysmenorrhea is a gynecological medical condition characterized by severe uterine pain during menstruation.While most women experience minor pain during menstruation dysmenorrhea is diagnosed when the pain is so severe as to limit normal activities or require medication. In varying degrees, it affects 45-95% of reproductive aged women, causing 3 days of incapacitating symptoms and/or up to 3 lost duties per month in 10-15% of women with untreated dysmenorrhea.It occur most commonly in young nulli parous women[3].
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause.Dysmenorrhea can feature different kinds of pain, including sharp throbbing, dull, nauseating, burning or shooting pain.dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may co exist with excessively heavy blood loss known as menorrhagia[2].
Dysmenorrhea occurs when prostaglandin F2α (PG F2α) causes menstrual cramping
with or without associated symptoms of headache, nausea, anxiety, fatigue, diarrhoea
and bloating[2].
General management of dysmenorrhea includes improvement of general health and simple psychotherapy in terms of explanation and assurance.Usual activities including sports are to be continued.During menses,bowel should be kept empty;mild analgesics and antispasmodics may be prescribed.Drugs can also help in reducing dysmenorrhea,some of the drugs used are Prostaglandin synthetase inhibitors and Oral contraceptives(combined form of oestrogen and progestogen).Surgery is also done to reduce dysmenorrhea, some of the surgeries done are; Dilatation of the cervical canal, Bilateral block of the pelvic plexus and Presacral neurectomy[2].
Twenty years ago, that was understandable there were fewer tests and drugs that could help diagnose and treat menstrual disorders. But today experts say, the problem is simply a lack of awareness among teenagers, parents, school nurses and even some physicians that dysmenorrhea is a condition that needs medication, attention rather than just a natural part of growing up[4].
6.1 NEED FOR THE STUDY
There is a huge population of girls out there whose quality of life could be better one to two days a month-that’s two to three weeks a year. In the last decade or so, more and more doctors have begun to recognize that dysmenorrhea isn’t just a fancy name for girls who have a tough time dealing with menstrual cramps. Increasingly, it is seen as a medical condition that has a physiological effect on the body[4].
Dysmenorrhea is the most common gynecological complaint among adolescent and young adult females. Dysmenorrhea in adolescents and young adults is usually primary and is associated with normal ovulatory cycles and with no pelvic pathology .In approximately 10% of adolescents and young adults with severe dysmenorrhea symptoms, pelvic abnormalities may be found[1].
Despite an area of sophisticated drugs diagnostic tests, dysmenorrhea remains the leading cause of school absences among teenage girls, beating out even the common cold. Only a small percentage of those affected actually seek medical treatment. Nonsteroidal anti inflammatory drugs like ibuprofen and naproxen which block the effects of pain producing prostaglandins and are more effective than other pain killers like acetaminophen.The other treatment for dysmenorrhea includes nutritional supplements, hormonal contraceptives, non drug therapies such as acupuncture, acupressure, use of tens unit etc, herbal therapies and hormonal treatments[4].
A study done in Sweden showed that more than 50% of all menstruating girls experienced 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 education and social life[5].
In 1982 Nag reported that the incidence rate of dysmenorrhea was 33.5% among adolescent girls in India. Studies showed that women with primary dysmenorrhea- painful periods that are not caused by a pre- existing medical illness, have higher levels of hormone like chemicals known as prostaglandins than women who do not have symptoms. These prostaglandins cause the smooth muscles in the uterus to contract and stimulate an inflammatory response which causes pain and cramping to occur[6].
Physicians say it is disconcerting to think there are so many adolescents out there just living in pain .But of even greater concern ,they say ,they are the estimated 5-10% of women with severe pain who suffer from what doctors refer to as secondary dysmenorrhea[4].
A multi-choice questionnaire was administered to 182 adolescent girls, ages 14-18 years, to assess the prevalence of dysmenorrhea, the morbidity associated with dysmenorrhea, and level of knowledge regarding available treatment. Of the study group, 72.7% reported “pain or discomfort” during their period, 58.9% reported decreased activity, and 45.6% reported school or work absenteeism. Of the dysmenorrhic sample, only 15.5% had used a prescription medication and only 14.7% could name nay non steroidal anti-inflammatory agent, except aspirin, as potentially effective in relieving dysmenorrhea[1].
In an epidemiologic study of an adolescent population (aged 12-17), klein and Litt reported a prevalence of dysmenorrhea of 59% of patients reporting pain, 12% described it as severe; 37% as`morderate and 49% as mild Dysmenorrhea caused 14% of patients to miss school frequently. Although black adolescents reported no increased incidence of dysmenorrhea, they were absent from school more frequently (23.6%) than white (12.3), even after adjusting for socio economic status[7].
The prevalence of dysmenorrhea world wide is similar to that in US, with rates ranging from 15.8-89.5% with higher prevalence rates reported in adolescent populations.Dysmenorrhea can disrupt personal life and is a significant public health problem associated with substantial economic loss related to work abscences.Ten percent of women with the condition have severe pain that can be in capacitating. In the United States, the annual economic loss has been estimated at 600 million work hours and 2 billion dollars[8].
Menstrual cramps, known as dysmenorrhea affect 20 to 90% of adolescent girls .Many teenagers with severe cramps suffer for years before they seek treatment because they think painful periods are just part of growing up. It is difficult to determine exactly how prevalent the condition is, because the definition varies so widely. Some consider dysmenorrhea to be any menstrual pain at all, while others say it is excessive cramping that causes a woman to miss school or work[9].
In most casesdysmenorrheaoccurs at the start of menstruation and persists for only a few hours, but sometimes, acute cases can manifest premenstrually and persist for days. Stress can sometimes exacerbatedysmenorrhea. Something that many women report lessens the problem is the birth of a child; periods experienced afterwards are not as problematic. Treatments Nutrition Since poor eating habits can contribute to excessive production of prostaglandins, reforming the diet can have a profoundeffectin terms of curbing menstrual cramps[2].
Nurses are appropriate for teaching adolescent girls about menarche, menstruation, dysmenorrhea, its management, sexual health, conception, contraception and other health concepts and practice related to female reproduction health. Their training and knowledge promote a more positive out look on physiological process associate with sex.
Thus the investigator felt the need to design a study to assess the effectiveness of structured teaching programme on knowledge and practice regarding dysmenorrhea and its management among adolescent girls.
6.2 REVIEW OF LITERATURE
A review of literature is a body of text that aims to review the critical points of current knowledge and methodological approaches on a particular topic, the role of the literature review is to formulate and clarify the research problems, to ascertain what is already known in relation to problem of interest , for developing a broad conceptual context facilitate cumulating of scientific knowledge for interpreting the result of the study
Review of literature is the reading and organizing of previously written materials relevant to specific problem to be investigating frame work and methods appropriate to perform study.
A study was conducted on the current status of young girls with menstrual disorders, relation among dysmenorrhea, irregular menstruation and premenstrual symptoms, among 522 female students of 18 -20 years of age at Ashiya College in Japan. The intensity of dysmenorrhea was classified into 3 grades. Score 1 showed girls not requiring analgesic, score2 showed painful requiring analgesic and score 3, painful not relieved by analgesic.Dysmenorrhea scores were significantly higher than those with out any symptoms. The findings suggested that considerable numbers of young girls with dysmenorrhea are associated with pre menstrual symptoms[1].
A study was conducted on the prevalence of dysmenorrhea and severity of problem with associated symptoms and general health status among adolescent girls in PU colleges of Gwalior.970 adolescent girls of age 15-20 years were selected. The prevalence of dysmenorrhea in adolescent girls was 79.67% and 37.96% suffered regularly from dysmenorrhea.The three most common symptoms present on both days were lethargy and tiredness, depression and inability to concentrate in work. Negative correlation was found between dysmenorrhea and general health status[2].
A study was conducted on menstrual knowledge, primary dysmenorrhea, and assessment of severity of pain and management strategies among adolescent girls in Nigeria. The knowledge and practice of 150 randomly selected healthy Nigerian adolescent girls were studied.58%of respondents reported pain and majority used inappropriate methods to manage primary dysmenorrhea.The findings revealed that the adolescents had a knowledge deficit regarding menstruation and dysmenorrhea.There is an acute need for education and school nurses should be able to assist the adolescents in proper management of primary dysmenorrhea[10].
A study was conducted on familial pre-disposition of dysmenorrhea among medical students of Isra university, Hyderabad (2007).197 medical students were selected for an observational study.Dysmenorrhea was observed in 76% of the students, the mean age of students were 20.9 SD ± 1.7;mean age at menarche with dysmenorrhea was 13.2 SD ± 1.1 and without dysmenorrhea was 12.7 SD ± 0.9. Positive family history of dysmenorrhea was seen in 33% of mothers and 43% in sisters and there was a group of students who had positive history in both mothers as well as in sisters. The findings suggested that the genetic factor was involved in the pathogenesis of primary dysmenorrhea and increases the familial tendency[11].
A study was conducted on socio-economic loses, quality of life loses and management of dysmenorrhea among adolescent girls in the district of Karimnagar.180 adolescent girls, in which 101 girls from urban area and 79 girls from rural area were selected. Findings showed that prevalence of dysmenorrhea was 54%, that is (53% of girls in urban areas and 56% of girls in rural areas).The proportions and x2 test were used (x2df = 0.1, p =0.05). Sickness Absenteeism (28-48%), socio economic loses and perceived quality of life loses are prevalent among girls in urban areas than girls in rural areas. Dysmenorrhea can be managed effectively by natural methods with out restoring to medicines[12].
A study was conducted on the incidence of dysmenorrhea among adolescent girls from six districts of Karnataka.1648 adolescent girls were selected for the study. The incidence of dysmenorrhea was 87.87% among adolescent girls, and stress was also found in them. A significant correlation (r = 0.1275, p< 0.01) was found between the severity of dysmenorrhea expressed in dysmenorrhea scores. Yoga therapy was found to be highly effective in reducing the occurrence of dysmenorrhea. It was also effective in reducing the stress among adolescent girls with dysmenorrhea[1].
A study was conducted on the prevalence and knowledge of dysmenorrhea and its management among senior high school students in Perth, Western Australia. 388 female students were selected for the study. The prevalence of dysmenorrhea among those girls were 80%, 50% of the girls reported that it limited their activities, 37% said it affected their school activities. 53% of girls used analgesics medication, 42% of girls used NSAID, 27% of girls were unaware that NSAID’s were a possible treatment option for dysmenorrhea. The study indicated that the prevalence and impact of dysmenorrhea was high among high school girls and they lacked knowledge and practice with effective treatment[13].
A study was conducted on the prevalence and associated factors of Premenstrual Dysphoric Disorder (PMDD) among medical students of the university of Llorin College Of Health Sciences in Nigeria.208 female medical students were selected for a cross sectional study.36.1% of the students met the criteria for diagnosis of PMDD.21.5% reported mild pain, 49.2% moderate and 29.2% severe form of menstrual symptom. The study showed that the rate of PMDD was high .Therefore; efforts should be made to alleviate the pain associated with menses[14].
A study was conducted on prevalence of dysmenorrhea, its impact and treatment seeking behavior among secondary schools of Kuala Lumpur, Malaysia. 1092girls were selected in which 74.5% of girls who have reached menarche had dysmenorrhea. 51.7% of the girls reported that it affected their concentration in class; 50.2% that it restricted their social activities; 21.5% caused them to miss school and 12.0% said it caused poor school performance. Only 12.0%consulted a physician and 53.3% did nothing about their conditions. There were ethnic differences in the prevalence, impact and management of dysmenorrhea[2].