RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGLORE KARNATAKA
PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / BINDHUKUMARI SNAVANEETHAM COLLEGE OF NURSING
NO:132/1, 5th CROSS ROAD,
HORAMAVU
BANASAWASI, BANGLORE
2 / NAME OF THE INSTITUTION AND ADDRESS / NAVANEETHAM COLLEGE OF NURSING
NO:132/1, 5th CROSS ROAD,
HORAMAVU
BANASAWASI, BANGLORE
3 / COURSE OF STUDY AND SUBJECT / MSc NURSING I YEAR
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 08-06-2010
5 / STATEMENT OF THE PROBLEM / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING HOME REMEDIES IN REDUCING DYSMENORRHOEA ON KNOWLEDGE AMONG THE NON MEDICAL UNDERGRADUATE STUDENTS IN SELECTED COLLEGES IN BANGLORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”
6. BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION
“DYSMENORRHEA IS THE LEADING CAUSE OF SHORT-TERMCLASS ABSENTEEISM.”1
Dysmenorrhoea literally means painful menustration. But a more realistic and practical definition includes causes of painful menustration of sufficient magnitude so able to capacitate day to day activities.2
Dysmenorrhea (or dysmenorrhoea) is a gynecological medical condition characterized by severe uterinepain 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.3
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.3
Although reproductive health, in particular related to maternal health and reproductive tract infections (RTIs), is recognised as a health priority in developing countries, much less attention is paid to menstrual health and menstrual disorders. A recent review of menstrual disorders in developing countries in this journal revealed high rates of menstrual morbidity in population-based studies. However, much of the existing research focuses on prevalence estimates; there is little information on the determinants and consequences of menstrual dysfunction. Of all menstrual complaints, dysmenorrhoea is by far the most common and, arguably, the least understood and addressed complaint.4
Dysmenorrhea can be classified as either primary or secondary based on the absence or presence of an underlying cause. Secondary dysmenorrhea is dysmenorrhea which is associated with an existing condition. The most common cause of secondary dysmenorrhea is endometriosis. Other causes include leiomyoma, adenomyosis, ovarian cysts, and pelvic congestions. The presence of a copper IUD can also cause dysmenorrhea. In patients with adenomyosis, the levonorgestrelintrauterine system (Mirena) was observed to provide relief.3
6.2 NEED FOR THE STUDY
Dysmenorrhoea is a common condition that occurs in 52%, 72% or even 90% of women. Previous studies have found high rates of absenteeism from work and school due to dysmenorrhoea, with 13–51% of women ever absent and 5–14% frequently absent. Although the majority of women experience dysmenorrhoea at some time, data on the natural history of primary dysmenorrhoea over the reproductive life span are lacking. Only two prospective studies, both focussing on women in their teens and early 20s, have examined the natural history of dysmenorrhoea. The purposes of the present study were to describe the prevalence and severity of primary dysmenorrhoea in a large cohort of women, over half of whom were over 30 years of age at the time of the baseline assessment; to examine the longitudinal course of this symptom using a second evaluation six years later; and to identify factors associated with a change in symptoms.5
Reports of dysmenorrhea are greatest among individuals in their late teens and 20s, with reports usually declining with age. One study indicated that 67.2% of adolescent females experienced dysmenorrhea. A study of Hispanic adolescent females indicated a high prevalence and impact in this group. Another study indicated that dysmenorrhea was present in 36.4% of participants, and was significantly associated with lower age and lower parity. Childbearing is said to relieve dysmenorrhea, but this does not always occur. One study indicated that in nulliparous women with primary dysmenorrhea, the severity of menstrual pain decreased significantly after age 40. A questionnaire concluded that menstrual problems, including dysmenorrhea, were more common in females who had been sexually abused.3
Painful menstruation affects approximately 50% of menstruating women, and 10% are incapacitated for up to 3 days. Painful menstruation is the leading cause of lost time from school and work among women of childbearing age. This pain may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off. Although some pain during menstruation is normal, excessive pain is not. Dysmenorrhoea refers to menstrual pain severe enough to limit normal activities or require medication. It may co-exist with excessively heavy blood loss (menorrhagia).6
6.3 STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING HOME REMEDIES IN REDUCING DYSMENORRHOEA ON KNOWLEDGE AMONG THE NON MEDICAL UNDERGRADUATE STUDENTS IN SELECTED COLLEGES IN BANGLORE WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”
6.4 OBJECTIVES OF THE STUDY
To assess the level of knowledge regarding home remedies in reducing dysmenorrhoea among the non medical undergraduate students before and after structured teaching programme.
To compare the level of knowledge regarding home remedies in reducing dysmenorrhoea between pre test and post test score.
To associate the level of knowledge with the selected demographic variables among non medical under graduate students.
6.5 HYPOTHESIS
There will be significant difference in the level of knowledge regarding home remedies in reducing dysmenorrhoea among non medical undergraduate students.
6.6 ASSUMPTIONS
Home remedies will relieve dysmenorrhoea to some extent.
Group teaching will enhance each participant for achieving learning.
Knowledge of students has strong influence in adaptation of healthy behaviour.
Information booklet will help the student to improve knowledge about home remedies in reducing dysmenorrhoea.
6.7 OPERATIONAL DEFINITIONS
Assess:- It is the act to measure the knowledge on home remedies in reducing
dysmenorrhoea.
Effectiveness:- Refers in terms of increased scores in the knowledge on home
remedies in reducing dysmenorrhoea among non medical undergraduate students after post test.
STP:- Systematically, scientifically prepared information on home remedies in reducing dysmenorrhoea for 45 minutes to 1 hour by using flash card, flip chart, OHP,chart after pre test. It includes definition, incidence, etiology, pathophysiology, clinical manifestations, diagnostic measures and management.
Home Remedies:- A means of dealing with or improving an undesirable situation at home.
Dysmenorrhoea:- Pain or discomfort experienced just before or during menstrual periods.
Knowledge:- Refers to the number of correct responses of the non medical undergraduate students to the questions stated in the closed end questionnaire.
Non medical undergraduate students:- They are the under graduate students of arts colleges.
6.8 CRITERIA FOR SELECTION OF THE SAMPLE
Inclusion Criteria
Students of non medical undergraduate students.
Students present on the day of the presentation.
Students who are willing to participate in the study.
Exclusion Criteria
Medical undergraduate students
Those who are not willing to participate in the study.
Those students who are on medical leave or absent.
6.9 DELIMITATION OF THE STUDY
The study is limited to non medical undergraduate students.
Sample size is limited to 80 students.
Prescribed data collection period is 4 to 6 wks.
Study designed is limited to quasi experimental design.
6.10 SIGNIFICANCE OF THE STUDY
The purpose of the present study is to find out knowledge of the student about home remedies in reducing dysmenorrhoea and to help them to develop scientific knowledge which in turn may help to reduce dysmenorrhoea and to promote health status by practicing positive health practice.
6.11 CONCEPTUAL FRAMEWORK
Conceptual model of the study is based on system model (1985) guide for development, utilization and evaluation.
6.12 REVIEW OF LITERATURE
Review of literature is an essential step in development of research project. The presentation of review of literature is organized under the following headings.
Literature related to dysmenorrhoea
Literature related to home remedies in reducing dysmenorrhoea
Literature Related To Dysmenorrhoea
A study conducted by V Patel, V Tanksale, M Sahasrabhojanee, S Gupte, P Nevrekar on The burden and determinants of dysmenorrhoea: a population-based survey of 2262 women in Goa, India, the purpose of the study is to To describe the prevalence and determinants of dysmenorrhoea, the most common menstrual complaint, in a community in 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); gynaecological 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.7
A study conducted by Pragya Sharma, Chetna Malhotra, D. K. Taneja and Renuka Saha in India on Problems related to menstruation amongst adolescent girls, the purpose of the study isTo study the types and frequency of problems related to menstruation in adolescent girls and the effect of these problems on daily routine. More than a third (35.9%) of the study subjects were in the age group 13-15 years followed by 17-19 years, 15-17years respectively. Mean age of study participants was calculated to be 16.2 years. Dysmenorrhea (67.2%) was the commonest problem and (63.1%) had one or the other symptoms of Pre-menstrual syndrome (PMS). Other related problems were present in 55.1% of study subjects. Daily routine of 60% girls was affected due to prolonged bed rest, missed social activities/commitments, disturbed sleep and decreased appetite. 17.24% had to miss a class and 25% had to abstain from work. Mothers and friends were the most common source of information on the issue.8
A sudy conducted by Aggarwal K, Kannan I, Puri A, Sharma in Delhi on Dysmenorrhea in adolescent girls in a rural area of Delhi : A community based survey, A cross sectional study was caried out to determine the prevalence of dysmenorrhea in adolescent girls in a rural area of Delhi. The mean age of menarche was 12.8 years in dysmenorrhic girls. The prevalence of dysmenorrhea was found as high as 70.8% among 96 girls of adolescent age group. The dysmenorrhea was significantly correlated with mean duration of menstrual flow with reportedly high use of sanitary pads.9
A study conducted by M. Akerlund, Stromberg, M. L. Forsling on primary dysmenorrhoea and vasopressin. The purpose of the study is to find out the circulating concentrations of arginine vasopressin on day 1 and on day 5 to 7 of the menstrual cycle were measured by radioimmunoassay in six women with primary dysmenorrhoea and five controls. The plasma concentrations of progesterone and oestradiol on day 1 of the cycle were also measured, and no significant difference between the two groups was seen. In women with dysmenorrhoea the vasopressin concentration on day 1 was 0.400.038 (SE) μU/ml which was significantly higher than the concentration in normal women on the same day of the cycle 0.20±0.063 (SE) μU/ml (p <0.01). The plasma concentration of vasopressin in normal women on day 5 to 7 was 0.68 0.119 (SE) μU/ml which was significantly higher than on day 1 (p <0.01).10
A study conducted by Sioban D. Harlow, Meekyong Park on a longitudinal study of risk factors for the occurrence, duration and severity of menstrual cramps in a cohort of college women, the purpose of the study is to To describe how menstrual cramps vary from cycle to cycle within a woman over time. To examine the influence of weight and lifestyle factors on occurrence, duration, and severity of menstrual pain. Menstrual pain occurred during 71.6% of observed menstrual bleeds, most commonly beginning the first day of menses. The median duration was two days. Sixty percent of women reported at least one episode of severe pain, while 13% reported severe pain more than half the time. Earlier age at menarche and long menstrual periods increased the occurrence, duration and severity of pain. In smokers, cramps tended to last longer.11
A study conducted by Alicia M. Weissman, Arthur J. Hartz, Michael D. Hansen, Susan R. Johnson on The natural history of primary dysmenorrhoea: a longitudinal study The purpose of the study is to describe the prevalence, severity, course and predictive factors of primary dysmenorrhoea in women of all reproductive ages. In 1985, 80% of respondents were >25 years old and 60% were parous. There were few changes over six years in the prevalence of mild (51% to 53%), moderate (22% to 20%) or severe dysmenorrhoea (4% to 2%). After adjusting for dysmenorrhoea in 1985, each live birth during follow up (OR = 0.20, 95% CI = 0.08 to 0.53) and older age (OR = 0.92, 95% CI = 0.86 to 0.98) were associated with less dysmenorrhoea in 1991.12
A study conducted by A-H. El-Gilany, K. Badawi and S. El-Fedawyon Epidemiology of dysmenorrhoea among adolescent students in Mansoura, Egypt, the purpose of the study is to examine the prevalence, determinants, impact and treatment practices of dysmenorrhoea, we studied 664 female students in secondary schools in urban and rural areas. Data was collected through a self-administered questionnaire. About 75% of the students experienced dysmenorrhoea (mild 55.3%, moderate 30.0%, severe 14.8%). Most did not seek medical advice although 34.7% treated themselves. Fatigue, headache, backache and dizziness were the commonest associated symptoms. No limitation of activities was reported by 47.4% of student with dysmenorrhoea, but this was significantly more reported by students with severe dysmenorrhoea. Significant predictors of dysmenorrhoea were older age, irregular or long cycle and heavy bleeding.13
A study conducted by Mary Ann Lumsden on dysmenorrhoea, the purpose of the study is to assess thedysmenorrhoea. Dysmenorrhoea means painful menstruation and is a symptom complex with cramping lower abdominal pain that may radiate to the back and leg, gastrointestinal symptoms and general malaise. It is an extremely common complaint and causes considerable morbidity in a proportion of women. It can result from identifiable pathology (secondary dysmenorrhoea) or there may be no obvious cause (primary dysmenorrhoea). Primary dysmenorrhoea occurs most frequently in young women and usually starts within a year or two of the menarche. It is most likely caused by increased prostaglandin production within the uterus and associated uterine hyper-contractility. Other uterotonins discussed are vasopressin and endothelin, both of which may play a role.14
A study conducted by TIJ Hillen, SL Grbavac, PJ Johnston on primary dysmenorrhea in young western australian women: prevalence, impact, and knowledge of treatment The purpose of the study is to explore the prevalence of dysmenorrhea among senior high school girls in Perth, Western Australia, its impact on school, sporting, and social activities, students’ management strategies, and their knowledge of available treatment.A total of 388 female students in Grades 11 and 12 at three metropolitan secondary schools completed an anonymous questionnaire administered during class time. The following definition of dysmenorrhoea was used: any type of pain or discomfort associated with menstrual periods including cramps, nausea, and headaches.The reported prevalence of dysmenorrhea among these girls was 80%; 53% of those girls with dysmenorrhea reported that it limited their activities.15
Literature Related to Home Remedies in Reducing Dysmenorrhoea
A study conducted by S. N. OSTAD, M. Soodi, M. Shariffzadeh, N. Khorshidi and H. Marzban on the effect of fennel essential oil on uterine contraction as a model for dysmenorrhea, pharmacology and toxicology study.Increasing the ectopic uterine motility is the major reason for primary dysmenorrhea. This motility is the basis for several symptoms including for pain is the main complaints of patients with primary dismenorrhea. There are several mechanisms, which initiate dysmenorrhea. Therefore, different compounds can be employed to control its symptoms.16
A study conducted by Serap Ejder Apay MSc, Sevban Arslan PhD, Reva Balci Akpinar PhD on the effect Of Aromatherapy Massage On Dysmenorrhea In Turkish Students. The purpose of this study was to investigate the effect of aromatherapy massage on dysmenorrhea. The study used a quasi experimental design with the subjects as their own control. Every participant applied both aromatherapy massage with lavender oil and placebo massage with odorless liquid petrolatum [soft paraffin]. The population comprised 438 midwifery and nursing students.17
A study conducted by Lan Lan Liang Yeh, Jah-Yao Liu, Kao-Si Lin, Yu-Shen Liu, on a randomised placebo-controlled trial of a traditional chinese herbal formula in the treatment of primary dysmenorrhoea.Most traditional Chinese herbal formulas consist of at least four herbs. Four-Agents-Decoction (Si Wu Tang) is a documented eight hundred year old formula containing four herbs and has been widely used to relieve menstrual discomfort in Taiwan. However, no specific effect had been systematically evaluated. We applied Western methodology to assess its effectiveness and safety for primary dysmenorrhoea and to evaluate the compliance and feasibility for a future trial.18
A study conducted by FarzanehKashefia, SamanehZiyadloub, MarjanKhajeheic, Ali RezaAshrafd, AliReza Fadaeee, Peyman on effect of acupressure at the sanyinjiao point on primary dysmenorrhea: a randomized controlled trial. Eighty-six students participated in the study. All participants met the inclusion criteria. The study group received acupressure at Sanyinjiao point, while the control received sham acupressure. The severity of dysmenorrhea was assessed at the following time periods: prior to the intervention, 30min, 1, 2 and 3h following the intervention. Data were analyzed using SPSS. The acupressure caused decline in the severity of dysmenorrhea immediately after intervention in both groups during their first menstrual cycle, although, there difference was not significant (p0.05).19