RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE
Name of the candidate :Jaissy Joy
Address ; Jaissy Joy
Ajibhavan
Perumpetty P.O
Pathanumthitta (Dist)
kerala,India.
Name of the institution ; Smt Vasantha college of nursing, Bidar
Course of study ; Msc Nursing
Filed subject ; Obstetric and gynecology nursing
Date of Admission to course : 05/10/2010
Title of research topic: A study to determine the effectiveness of Structured teaching programme on dysmenorrhea among first year nursing students
A study to determine the effectiveness of Structured teaching programme on dysmenorrhea among first year nursing students.
INTRODUCTION
Teenage is a period of gradual development of secondary sexual
changessuch as breast development ,axialhair, changes in genital organs and
menstruation. Menstruation is a series of events occurring regularly in a female every 26
to 30 days through out the child bearing age of about 36 years where changes occur in
ovaries,uterus , and blood concentrationof hormone. Dysmenorrhea is painful and difficult menstruation. Primary dysmenorrhea is prominently confined to adolescent girls .It usually appears within 2 years of menarche. “Health is wealth”goes saying thus health has been given an important concern in our present day life since health is essential for happy content life as we all know ,a sound body in a sound mind .If we are healthy we are able to do our daily activities properly and satisfactorily ,and make judgment accordingly so by the Alma –Ata declaration much emphasis is being placed on health promoting and preventive health care.Although various education program and health education about dysmenorrheal has been initiated in subject curriculum,there is still necessity to set up proper education dispersing proper knowledge at proper age .Its important to, provide knowledge regarding the management of dysmenorrhea like relief measures and alternative measures other than analgesics,diet during dysmenorrhea ,adequate rest,and alteration in daily living activity.The prevalence of dysmenorrhea is estimated at 25% of women and up to 90% of teenagers,so its mainly a problem of this particular age group even though other group also suffer.Dysmenorrhoea is the most common of gynaecologic complaints.It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population.
, in contrast to an adult woman, whose cycles typicallyrange between 21 and 35 days. The mean duration of menses is 4.7 days; 89% of cycles last 7 days, the average blood loss per cycle is 35 ml. Recurrent bleeding in excess of 80 ml per cycle’s results in anaemia (4).Dysmenorrhea is the most common gynecologic disorder among femaleadolescents, with a prevalence of 60% to 93% (5–6). In the United States, dysmenorrheais the leading cause of recurrent short-termschool absenteeism (7). Several studies haveshown that adolescents with dysmenorrheareport that, it effects their academicperformance, social and sports activities (8) The etiology of primary dysmenorrhea is notprecisely understood, but most symptoms can be explained by the action of uterineprostaglandins, particularly PGF2- Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain.Menstrual disorders are a commonpresentation by late adolescence, 75% of girls experiences on problems associated with menstruation (1).Dysmenorrhoea is acommon problem in women of reproductive age. Primary dysmenorrhoea is defined as painful menses in women with normal pelvic anatomy, usually begins during adolescence(2). It is unusual for symptoms to start withinfirst six months after menarche. Affectedwomen experience sharp, intermittent spasmof pain usually concentrated in the suprapubicarea. Pain may radiate to the back ofthe legs or the lower back. Systemicsymptoms of nausea, vomiting, diarrhoea,fatigue, mild fever and headache orlightheadedness are fairly common. Painusually develops within hours of the start ofthe menstruation and peaks as the flowbecomes heaviest during the first day or twoof the cycle (3). It is usually possible todifferentiate dysmenorrhea from premenstrual syndrome (PMS) based on patientshistory. The pain associated with PMS isgenerally related to breast tenderness and abdominal bloating rather than a lowerabdominal cramping pain. PMS symptoms begin before the menstrual cycle and resolve shortly after menstrual flow begins (3).Painful menstruation with pelvic pathology is defined as secondary dysmenorrhea.During the first two year after menarche, most cycles are anovulatory. Despite this, they are somewhat regular within a rangeof approximately 21 to 42 days Alfa, thedisintegrating endometrial cells releasePGF2- Alfa as menstruation begins. PGF2- Alfastimulates myometrial contractions,ischemia and sensitization of nerve endings.These levels are highest during the first two days of menses, when symptoms peak (3)The risk factors for dysmenorrhea are; age<20 years, nulliparity, heavy menstrual flow,smoking, high/upper socioeconomic status;attempts to lose weight, physical activity,disruption of social networks, depression and anxiety (9) But several observational studies have found controversial results. Through this study we are trying to explore theproblem faced by female medical studentsduring menses (dysmenorrhea/absenteeism)and its correlation with biologic variables.
Need for study
The incidence of dysmenorrhea is common in females in the late teens and twenties. About 40-70% of females suffer from dysmenorrhea and around 10 to 15% experience menstrual pain severe enough to interfere with their normal activities causing absence from school or work. As the nursing students stay in hostel away from their familiar home environment, there is a chance for dysmennorhic condition as anxiety and stress has a direct relationship with this condition. The first year nursing students are exposed to a new situation where they have to adjust with a different food items as well as with a different environment and they are at most risk for getting dysmenorrhea as they are in the late teen age stage and the late teenage is a stage where there is high risk for getting dysmenorrhea. The first year is the basic stage where they have to make foundation for their career and dysmenorrhic episode may disrupt this aim.This episodes also interfere daily activities as they are very painful and irritating. Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull, nauseating, burning, or shooting pain.Dysmenorrhea refers to the syndrome of painful menstruation. Its prevalence is estimated at 25% of women and up to 90% of adolescents.No significant difference exists in prevalence or incidence between races, though the most common causes of dysmenorrhea differ by age. Although it is not life-threatening, dysmenorrhea can be debilitating and psychologically taxing for many women. Dysmenorrhea may precede menstruation by several days or may accompany it, and it usually subsides as menstruation tapers off.Historical attitudes toward menstrual pain were often dismissive. Pain was often attributed to women's emotional or psychological states and misconceptions about sex and sexual behaviors. Dysmenorrhea may coexist with excessively heavy blood loss, known as menorrhagiaSecondary dysmenorrhea is diagnosed when symptoms are attributable to an underlying disease, disorder, or structural abnormality either within or outside the uterus. Primary dysmenorrhea is diagnosed when none of these is detected.
Adolescence is a transition period from childhood to adulthood and is characterized by a spurt in physical, endocrinal, emotional, and mental growth, with a change from complete dependence to relative independence. The period of adolescence for a girl is a period of physical and psychological preparation for safe motherhood. As the direct reproducers of future generations, the health of adolescent girls influences not only their own health, but also the health of the future population. Almost a quarter of India's population comprises of girls below 20 years. One of the major physiological changes that take place in adolescent girls is the onset of menarche, which is often associated with problems of irregular menstruation, excessive bleeding, and dysmenorrhea. Of these, dysmenorrhea is one of the common problems experienced by many adolescent girls.The prevalence in adolescent females has been reported to be 67.2% by one studyand 90% by another.Among adolescent girls, dysmenorrhea is the leading cause of recurrent short-term school and college absence in this group. The prevalence of dysmenorrhea is highest in adolescent women, with estimates ranging from 20 to 90 percent, depending on the measurement method used.About 15 percent of adolescent girls report severe dysmenorrhea, and it is the leading cause of recurrent short-term school and college absenteeism in adolescent girls in India.In women 14 to 20 years of age, attempts to lose weight are associated with increased menstrual pain independent of body mass index.Behavioral risk factors are of interest because of the potential to interveneMost adolescents self-medicate with over-the-counter medicines which is not a good thing it may cause many health problems, and few consult a physician about dysmenorrheal. In India the educational curriculum has very less to offer regarding sex knowledge and there is many misconception about the genital organs , and also the Indian society does not allow to speak or discuss about this type of topic, so the nursing students who come for nursing in the first years may have many misconceptions and may develop many problems both physically and psychologically, so it is very important to give them education on the dysmenorrhic episodes, its assessment and management.
2)REVIEW OF LITERATURE
A majority of women would have experienced some degree of menstrual cramping especially in the first years of their reproductive life.1,5,12 According to reports, the prevalence of dysmenorrhoea is very high; at least 50% of women experience this problem during their reproductive years.3,13,14 This problem not only causes discomfort in approximately one-fifth of the female population, but also causes many social, physical, psychologic and economic problems for women all around the world.14,15 The results of recent studies showed nearly 10% of females with dysmenorrhoea experienced an absence rate of 1 to 3 days per month from work or were unable to perform their regular/daily tasks due to severe pain.8Dysmenorrhoea is considered the main cause of absence from school, among young female students.
A study was conducted in the high school girls in masjed solaiman Khuzestan province in Iran, the result indicated that 85 respondents suffered (14.4%) from dysmenorrhoea which disturbed their daily activities and was unimproved by the use of analgesics. Conclusion was improved understanding of the pathophysiologyof dysmenorrhoea may result in the discovery of more effective treatment regimens
In addition to the subject of dysmenorrhea, pubertal hygiene is rarely discussed at home or in schools in most parts of Iran, especially in the regions where the current study has been conducted.This problem is observed particularly in traditional and poorly educated families, which could be mainly due to cultural restrictions, preventing sufficient information from reaching young girls. The combination of Eastern traditional culture and negative attitudes of school officials has had a strong impact on the discussion of the lack ofsex education and related issues for youngsters in schools, in the mass media, and within families, especially in the rural areas of Iran. This has prevented the flow of accurate and sufficient information regarding pubertal hygiene and has often led to superstitious perceptions and beliefs about dysmenorrhea and menstrual hygiene in the rural areas. A through literature review focusing on prior researches gives a strong foundation on which to base knowledge thus the survey of literature is one of the vital parts of any research endeavour.
Studies relevant to the knowledge of teenagers regarding dysmennorhea.
A study was conducted regarding theprevalence and severity of dysmennorhea: A problem related to menustration, among first second year female medical students.The study was conducted by Amit Singh, Dukhu Kiran ,Harminder Singh, and Pawan tiwari In this study; 107 participants completedthe questionnaire, of these 34.57% were fromGMC, Jagdalpur, 42.99% from IMS, BSSRand 22.42% from SSMC, Rewa. The meanage of the participants was 21(±2.74) years.The mean age at menarche was 12.5 (±1.52)years. Of the total participants, 44.85% were 20.56% had daily fast food habits in which16.82% participants were dysmenorrheapositive; and 20.56% had no such habit,(P=0.89). 53.27% participants did no physicalexercise; while 46.7% have 30 minutes ormore outdoor exercise activity, (P=0.39).18.56% participants had family history ofobesity, rest 81.30% were normal; 12.14%.Correlation of dysmenorrhea with biologicalvariables,subjects were underweight while 11.21%subjects were overweight; in underweightcategory 61.53%, while in overweight 91.67%subjects were suffering from dysmenorrhea and rest 76.63% were average, (P=0.22).44.85% participants in this study have blood belonged to lower socioeconomic status. Ageof menarche of maximum participants(47.66%) was 13 years. Prevalence ofdysmenorrhea was 73.83%; of these 6.32% severe, 30.37% moderate and 63.29% weremild grade. Among these subjects (n=79),following symptoms i.e., backache (62.0%),headache (26.58%), fatigue (70.88%) andvomiting/diarrhoea (6.32%) were reported. In107 participants, 60.74% were presented withPMS, symptoms consist of: breast heaviness(17.75%), abdominal bloating (12.14%),backache (25.23%), headache (13.08%),uneasiness (22.42%), and anxiety (8.41%). In 7.47% subjects, length of cycle was abnormal(4.67% had <20 days and 2.80% had >35 days);10.28% subjects had abnormal duration ofbleeding period; (of these, 1.86% subjects hadduration <2 days and 8.41% had >7 days);21.49% subjects were reported abnormalblood loss per cycle; (of these, 12.14% hadblood loss <30 ml and 11.21% had >100 ml).
The results of a recent clinical pilot study originally conceived anddeveloped by two National College of Chiropractic students, Katrina Kokjohn, D.C., and Della Schmid, M.S., D.C., "Pain and Prostaglandin Levels in Dysmenorrheic Women following Spinal Manipulation," indicates that menstrual pain decreased significantly for those treated by spinal manipulation.
A prospective study was conducted on“Prevalence of dysmenorrhea in female students in a Chinese university”. The prevalence of dysmenorrhea was 56.4%. 64.7% ofthe dysmenorrheal students had mild dysmenorrhea,28.8% moderate dysmenorrhea and 6.5% unbearabledysmenorrhea . 3.67% of the 2640 students hadpre-menstrual dysmenorrhea and 1.10% had onlypre-menstrual pain without pain during menstruation. Anaverage of 8.0% of dysmenorrheal students took medicine; the percentages of students taking medicine with mild, moderate and unbearable dysmenorrhea were 4.0%,13.3% and 23.7%, respectively
Patricia Brennan, Ph.D., dean of research at National Collegeof Chiropractic supervised the research team responsible for the project. Onthe first day of their period, the 38 women participating in the trial received either spinal manipulation or a "sham" adjustment that did not have a therapeutic effect on the spine. The women were asked to fill out a menstrual distress questionnaire and rate their pain on a visual analogue scale, and blood was drawn and tested both 15 minutes before treatment and 60 minutes after treatment. The results of the questionnaires showed the greatest reduction in perceived pain among the women receiving spinal manipulation when compared to the women who received sham adjustments. Visual analogue scale scores indicated that both abdominal and back pain decreased almost twice as much in the spine manipulated group compared to the sham group. A reduction in blood levels of prostaglandins was noted in both groups that will require further investigation. Whether or not these differences are scientifically significant can only be established through additional testing A study was conducted on “Attitudes of female Adolescents About Dysmenorrhea and Menstrual Hygiene in tehran suburbs” by Mohammad Poureslami PhD, Farzaneh Osati-Ashtiani PhD, in Iran University of Medical Sciences, Tehran, Iran.The results were Seventy-seven percent of the subjects claimed that they had adequate knowledge of dysmenorrhea. But only 32% of these practiced personal hygiene, such as taking a bath, and used hygienic materials (i.e. sterile pads). About 33% of the subjects, avoided any physical activity or even mild exercise during menstrual period. Over 67% of the girls reported taking palliative medicine for their menstrual pain without consulting a doctor. Fifteen percent of the subjects stated that dysmenorrhea had interfered with their daily life activities and caused them to be absent from schoolfrom between 1 to 7 days a month. The prevalence of dysmenorrhea in this study was 71%.
Statement of the problem
A study to determine the effectiveness of structured teaching programme on management of dysmennorhea in first year nursing students at Smt.Vasantha College of nursing,Bidar.
OBJECTIVES OF THE STUDY
1)To assess the level 0f knowledge offirst year nursing students regardingdysmenorrhea and its management.
2)To determine the effectiveness of structured teaching programme on management of
dysmennorhea among first year nursing students .
3)3.To find the association between pretest level of knowledge and selected
socio-demographic variables.
OPERAIONAL DEFINITION
1)Teenagers:- Teenage is the period which links childhood to adulthood .it is the period of gradual development of secondary sexual character.
(D.C.Dutta)
2) Dysmennorhea:-Dysmennorhea is the painful and difficult menstruation.
3) Management:-The use of available resourse to achieve predetermined goals.
4) ) Structured teaching programme:-It is a systematic ,organized teaching programme
on legal responsibilities in patient care to the nursing students.
5) Knowledge:-Candidates range of information regarding legal and ethical responsibilities and their ability to recall this knowledge while responding to structured questionnaire regarding legal responsibilities.
ASSUMPTIONS
Thefirst year nursing students may have less knowledge regarding dysmennorhea and its management, and after structured teaching programme they will gain knowledge.
DELIMITATIONS
The study is limited to first year nursing students who are studying inSmt.VasanthaCollege of nursing, Bidar.
PROJECTED OUTCOME
The findings of the study will reveal the existing knowledge and knowledge after structured teaching programme, of first year nursing students regarding dymennorhea and its management.
HYPOTHESIS
1)There may be significant increase in post test score after the teaching programme.
2)There may be relationship between knowledge of first year nursing students and demographic variables.
RESEARCH METHEDOLOGY
RESEARCH DESIGN
Pre-experimentaldesign study will be used for this study.
SETTING
The study will be conducted in,SmtVasanthaCollege of nursing, Bidar.
POPULATION
Population in this study will include nursing students studying in SmtVasanthaCollege of nursing, Bidar.