PROFORMA FOR REGISTRATION
OF
SUBJECTS FOR DISSERTATION
KARTHIKA . S
1ST YEAR M.Sc NURSING
COMMUNITY HEALTH NURSING
2010-2012
SEA COLLEGE OF NURSING
K.R PURAM, BANGALORE-49
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF
SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / MS. KARTHIKA . S1ST YEAR MSC ( N )
SEA COLLEGE OF NURSING
BANGALORE-49
2 / NAME OF THE INSTITUTION / SEA COLLEGE OF NURSING
3 / COURSE OF STUDY AND SUBJECT / MSc NURSING
COMMUNITY HEALTH NURSING
4 / DATE OF ADMISSION TO THE COURSE / 03 – 05- 2010
5 / TITLE OF THE TOPIC / “
AN EXPERIMENTAL STUDY TO EVALUATE THE EFFECTIVENESS OF ACUPRESSURE ON MENSTRUAL PAIN PERCEPTION AMONG ADOLESCENT GIRLS WITH PRIMARY DYSMENORRHEA IN SELECTED SCHOOLS AT BANGALORE.
”
6 BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR THE STUDY
“A woman is the full circle. Within her is the power to create, nurture and transform.”
–Diane Marie child
Women are the root of the family as well as society. To bring forth productive and healthy family, the health of the women should be considered, not only after becoming women, but it starts from the stage of girl itself, that is the adolescence period. Women who fall on the reproductive age group especially adolescents are neglected in reality.1
Adolescence [10-19 yrs] is a period of growth which involves a stage of developmental transition and a bridge between childhood and adulthood. Nearly 10-20% of world population comprises of adolescents. In India one-fifth of the population [239 million] are adolescents between age group of 10-19 yrs.1 Female adolescents’ account for the same proportion for the total female population as male adolescents for the male population. The population survey in Karnataka shows that 21 % of the total populations are adolescents .2
Young adolescents face enormous challenges to learn from relationships, shape their identities and acquire social and practical skills, as they need to become active and productive adults. This is a period the adolescents’ progress from secondary sex characteristics to sex and reproductive maturity. The Action Program of International Conference on Population and development recognize that adolescents have a special need for sexual and reproductive services and information and these services must respect
the rights of adolescents to privacy. [Women coalition of ICPD, 2001]
Tanner and Marshall states that adolescent go through 5 stages of puberty. The last stage of puberty involves the growth spurt and menstruation. Menstruation is the hallmark of female pubertal development; it is a normal physiological cycle, common to all girls of reproductive age group. In some culture, menstruation is considered dirty and is not fit to take part in social and religious activity. 3
Nearly half of the adolescent girls are unaware of the phenomena of menstruation prior to its onset and are therefore scarred at the time of its onset and unaware to disclose the problems related to menstruation to anyone. The prevalence of dysmenorrhea is very high and at least 50% of the women experience this problem throughout their reproductive years. Painful menstruation also called as primary dysmenorrhea is characterized by spasmodic or colicky pain and is worse on I, II, III days of menses. It usually occurs in girls and young females and tends to decrease with increasing age. [Arminder Singh, 2005]4
Dysmenorrhea is a leading cause for short-term school absence in adolescent school girls. In many girls it has also decrease their quality of life. In India 67.2% adolescent girls suffer from dysmenorrhea and 60% of them have disrupted daily routines. A study conducted in USA showed that 58% of girls suffered from severe menstrual flow, smoking and depression are some of the risk factors for dysmenorrhea. [French, 2005]5
A cross-sectional study conducted in Goa also showed that there was linear association between the severity of pain and its impact on social disadvantage, co-morbidity, somatic syndromes and reproductive factors. The study concluded that the burden of dysmenorrhea is greater than any other gynecological complaints and is associated with significant impact. Most girls respond to primary dysmenorrhea by taking analgesics and anti-inflammatory drugs like mefenamic acid etc., But according to
V.R.Tindall, anti-prostaglandins like mefenamic acid though it is very effective for treating dysmenorrhea, it can interfere with the process of ovulation and causes primary infertility.6
Adolescent girls had been studied for menstrual problems and data were collected by personal interviews on a pre-tested semi-structured questionnaire. The result revealed that daily routines of the 60% girls were affected due to prolonged bed rest, missed school activities, disturbed sleep and decreased appetite. [7.24% had not been able to attend classes, 25% of them had to be abstained from work]. Hence there is a need to emphasize on designing menstrual health program for adolescent girls. [Sharma, 2007].7
A variety of non-pharmaceutical measures are being used for reducing the pain during menstruation such as relaxation therapy, breathing techniques, touch and massage, music therapy, application of heat and cold, acupressure and acupuncture etc [Gurates,2008]8
Many studies have proved acupressure helps in reducing the primary dysmenorrhea. Acupressure techniques are one of the popular ancient alternative and complementary therapies.
Acupressure can be adopted as nursing interventions to alleviate dysmenorrhea improve productivity, creativity, work performance and quality of life. It is a healing act using the fingers to skillfully press the points which stimulate the body’s natural self, creative abilities. When these trigger points are pressed, it releases muscular tension and promote circulation of blood and body’s life force energy to aid healing. Acupressure point called ‘SP6’ point is used for menstruation pain. This point is located in 4 fingers above the lateral medial malleolus bone. [Wong et.al, 2009]9
The community health nurse has an important task in conducting school health programme and educating adolescent girls as well as community regarding the various non-pharmaceutical measures and its effectiveness in controlling menstrual pain perception. In turn such education helps the adolescent girls to be equipped and empowered with knowledge and skills to face the future effectively.
During school health programme, the investigator observed that most of the girls were absent due to painful menstruation or primary dysmenorrheal. Hence based on the above information, the researcher is motivated to act on and implement the pain relief measures for adolescent girls and empower them to manage dysmenorrhea. Hence the study is intended to assess the effectiveness of acupressure on menstrual pain perception among adolescent girls in selected schools.
6.2 REVIEW OF LITERATURE:
Reviews form the basis of any study, hence the following reviews helps the researcher to conduct the study,
1. Literature related to prevalence and its effects of dysmenorrhea on adolescent
girls
2. Literature related to non-pharmacological intervention in pain relief for
dysmenorrhea
3. Literature related to acupressure for menstrual pain management in
dysmenorrhea.
I] Literature related to prevalence and its effects of dysmenorrhea on adolescent girls:
A study was conducted in West Indies to determine the prevalence of dysmenorrhea on Hispanic female adolescents shows that 85% of them reported dysmenorrhea, 38% reported missing school due to dysmenorrhea, 33% reported missing individual classes. Activities affected included class concentration [59%], sports [51%], class participation [50%], socialization [46%], and homework [35%], test-taking skills [36%], and grades [29%]. Treatment taken for dysmenorrheal included rest [58%], medications [52%], heating pad [26%], tea [20%], exercise [15%] and herbs [7%]. The study concluded that adolescent girls with dysmenorrhea are affected by lack of attendance to school, concentration and other daily activities.10
An explorative study was conducted to correlate the prevalence of dysmenorrhea and its associated symptoms among 970 adolescent girls of age group 15-20 yrs in Pre-university colleges of Gwalior. The results showed that 79.67% were found to be dysmenorrhic, among them 37.96% suffered regularly from dysmenorrheal severity. The three most common symptoms present in the three days are tiredness, depression and inability to concentrate in work consecutively.11
II] Reviews related to non-pharmacological pain relief intervention in primary
Dysmenorrhea
A study was conducted using quality assessment, data extraction and data translation by two review authors independently among 3475 women to determine the efficacy and safety use of Chinese herbal medicine versus placebo for primary dysmenorrhea.the study revealed that Chinese herbal medicine had significant improvement in pain relief [18 RCTs; RR 2.06; 95% CI 1.82 to 2.36] compared to the use of additional medications [5 RCTs, RR 1, 58, 95% CI 1.34 to 1.87]. The results also revealed that Chinese herbal medicine was more effective than, heat compression, acupuncture and other placebo.12
A study was conducted to observe the therapeutic effects in acupuncture treatment of primary dysmenorrhea with spinal Tui Na. It was revealed that the total effective rate was 93.3% in the treatment group, and 73.3% in the control group, with a significant difference between the two groups [p< 0.05]. It was concluded that acupuncture combined with spinal Tui Na has good prospects for treatment of primary dysmenorrhea. 13
III] Literature related to acupressure for menstrual pain management in
dysmenorrhea
An experimental study was conducted among 69 technical college female students in Taiwan to assess the effects of acupressure at the Sanyinjiao point on primary dysmenorrhea. Five instruments were used to collect pretest and post-test data at each session 1]visual analogue scale 2] short-form McGill Pain questionnaire 3]menstrual distress questionnaire 4] visual analogue scale for anxiety 5] the acupressure self- assessment form. Thirty-one [87%] of the 35 experimental participants reported that acupressure was helpful, and thirty-three [94%] were satisfied with acupressure. It was concluded that acupressure at SP6 can be an effective, cost-free intervention for reducing pain and anxiety during dysmenorrhea.14
An experimental study was conducted among 58 Korean young college women in two universities to evaluate the effects of the SP-6 acupressure on dysmenorrhea. The experimental group received acupressure within first 8hr of menstruation and the severity of dysmenorrhea was assessed prior to and 30min, 1, 2 and 3hr following the treatment. The results revealed that there was a significant difference in severity of dysmenorrheal between the two groups immediately after [F=18.50, P=0.000] and for unto 2hr [F=8.04, P=0.032] post treatment. It was concluded that acupressure to SP6 meridian can be an effective non-invasive nursing intervention for alleviation of primary dysmenorrhea, with effects lasting 2hr post treatment. 15
STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of acupressure on menstrual pain perception among adolescent girls with primary dysmenorrhea at selected schools in Bangalore”.
6.3 OBJECTIVES OF THE STUDY:
I] To assess the level of pain perception among adolescent girls with primary
dysmenorrhea before application of acupressure in experimental and control group.
ii] To determine the effectiveness of acupressure on menstrual pain perception among
adolescent in experimental and control group.
iii] To associate the level of menstrual pain perception with selected demographic
variable in experimental and control group.
6.4. HYPOTHESIS
H1: There will be reduction in the pain perception among adolescent girls who will be receiving acupressure.
H02: There will be no significant difference between the post-test scores and demographic variables.
6.5. RESEARCH VARIABLES:
1] Independent variable: Applying acupressure on SP6 point.
2] Dependent variable: menstrual pain perception among adolescent girls with primary dysmenorrhea.
3] Attribute variable: Age, religion, type of family, income of the family, food habits, and age at menarche, body mass index, and mother’s educational status.
6.6. OPERATIONAL DEFINITION
In this study, it refers to,
Effectiveness: desired menstrual pain perception of adolescent girls after receiving acupressure.
Acupressure: gentle pressure in the Sanyin Jiao point sp6 situated in the midpoint 4 fingers above the tip of medial malleolus bone for 15-20 mts during 48-72 hrs of menstruation that reduces the menstrual pain perception.
Menstrual pain: subjective experience of perceived pain by adolescent girls during menstruation of 48-72 hrs measured by visual pain scale.
Adolescent girls: girls with in age group of 13-15 yrs who attended menarche.
Primary dysmenorrhea: painful menstruation occurring without apparent cause usually after puberty and occurs with each subsequent period.
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA:
adolescent girls who are in the age group of 13-15 yrs studying in selected schools at
Bangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 RESEARCH DESIGN: Quasi-experimental pre-test, post-test design.
7.2.2 POPULATION: adolescent girls who are in the age group13-15 yrs who attained menarche in selected Schools at Bangalore.
7.2.3 SAMPLE SIZE : 60 adolescent girls
7.2.4 SAMPLING TECHNIQUE : non-random sampling
7.2.5 CRITERIA FOR SAMPLE SELECTION:
a] Inclusion criteria : I] Adolescent girls who are in the age group
13-15 yrs in selected schools at Bangalore.
ii] Adolescent girls those who have painful
menstruation for first 3 days of menstruation.
iii] Those who can communicate in Kannada,
Tamil and English
B] Exclusion criteria : I] Adolescent girls with other gynecological
Problems.
ii] Adolescent girls who have pain for other
physical ailments.
iii] Adolescent girls who are absent during
study.
7.2.6 RESEARCH SETTING : at selected schools in Bangalore.
7.2.7 TOOLS OF DATA COLLECTION: Structured Interview Schedule will be used to collect data in the following parts,
Part I: Demographic data
Part II: Structured menstrual problem Questionnaire.
Part III: visual analogue pain scale
Part IV: Structured acupressure procedure.
7.2.8 DATA COLLECTION PROCEDURE:
The investigator herself collects data by using structured interview schedule and as a pre-test, pain-intensity will be assessed before applying acupressure and post-test pain intensity will be assessed immediately after applying acupressure with visual pain scale.
7.2.9 DATA ANALYSIS METHOD:
a] DESCRIPTIVE STATISTICS:
Mean, standard deviation and percentage will Be used to assess the menstrual pain perception
b] INFERENTIAL STATISTICS:
1] Inferential statistics, paired‘t’ test and Independent‘t’ test will be used for the
effectiveness of acupressure on menstrual pain Perception.
2] Chi square test will be used to associate the pain perception with demographic
variables.