DISSERTATION PROTOCOL
1. / NAME OF THE CANDIDATE AND ADDRESS / V.USHARANID/o. R.VARATHARAJAN
3/295 MUTHURAMALINGAPURAM,
PADANTHAL POST,
SATTUR,626203
VIRUTHUNAGAR DIST
TAMILNADU
2. / NAME OF THE INSTITUTION / S.B. COLLEGE OF NURSING , YELAHANKA NEW TOWN,
BANGALORE-64
3. / COURSE OF STUDY AND SUBJECT / M. Sc. NURSING
(PSYCHIATRIC NURSING )
4. / DATE AND ADMISSION TO COURSE / 05 th June 2009
5. / TITLE OF THE TOPIC:
ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE REGARDING THE LEVEL OF ANXIETY AMONG INFERTILE COUPLES IN A SELECTED INFERTILITY CLINIC AT BANGALORE.
6: BRIEF RESUME OF THE INTENDED WORK
6.1: NEED FOR THE STUDY
Anxiety is a natural response to a perceived or imagined threat. It is as natural as many of the emotions that we go through in everyday situations. Anxiety acts like our body’s alarm system, warming us of possible dangers or difficulties 1.
Infertility is the state in which a couple desirous of a child, cannot conceive after 12 months of unprotected intercourse and it is a major life crisis for most couples. People usually assume that they are fertile and will be able to conceive when they want to. On learning that they are infertile, they go through traumatic phases beginning with disbelief and denial, frustration, guilt and only after considerable time, acceptance 2.
Anxiety is significantly greater in the partner with the fertility problem than in the other partner. Women were found to have a slightly higher anxiety when compare to men and most infertile couples wanted to have a child in order to fulfill the meaning of being a “family” and were anxious about the treatment 3, 4.
A study reported that following risk factors are increasing anxiety among infertile couples that are female sex, age over 30 years low level of education, lack of occupational activity, diagnosed in male infertility and infertility duration of 3 to 6 years 5. A control study was conducted among 156 infertile couples and so fertile couples. The infertile couples were subdivided based on their causes of infertility. It was organic, functional, or undetermined. In these the functional infertile subjects of the couples showed severe psychopathological and psychological features when compared to other couples 6.
Javitiri test tube baby centre, in Mumbai reported that 64% infertile women are having stress, anxiety and tension because of difficulty with conception and also reported reducing skills and abilities in their family roles 7.
According to WHO in world wide 60 to 80 millions infertile couples are there, and also estimated in India 10 to15% of couples were infertile. In America 1 in 6 couples have infertility problems, it was 15% and they have negative emotional responses, such as stress, anxiety and depression. In Europe, Canada and US the response of infertile husbands was different from that of their wives in self image, marital adjustment, and sexual relations. The differences in psychological distress, marital satisfaction and sexual satisfaction between Chinese infertile husbands and wives were evaluated 2, 8.
A cross sectional survey reported regarding relationship with anxiety, depression and duration of infertility. It was conducted among 370 female patients with different causes showing out of 370 samples 321 women were having anxiety and it has estimated 86.8%. In overall 60% of infertile couples were having psychological problems 9. A study stated that childless women were facing more consequences such as economic deprivation, marital disruption, verbal abuse and physical abuse and they felt guilt, worthless, and low self esteem and also reported threatened for divorce (20%) husband remarrying (38%) return to their parent home (26%) separation (68%). Victims faced severe mental stress, physical abuse (69.4%) and verbal abuse (58.8%) 10.
Nurses play a key role in preparing the infertile couples for investigation, scheduling them appropriately and supporting them during the waiting period for results. Nurses also need to work efficiently in providing supportive, educative and reconstructive psychotherapy through this nurse can bring their abnormal personality to normal 11.
Infertile couple’s anxiety is increase day by day. It is very difficult for the psychiatric nurse to gain more information about infertility with anxiety through in-service education and attending conferences. Hence, the investigator felt that there is a need to assess the level of anxiety among infertile couples and prepare self instructional module which will help to reduce their anxiety.
6.2: REVIEW OF LITERATURE
Infertility is a stressful life event and depressive symptoms are normal responses to the life crisis of the infertile couples. Grief reactions are common among infertile females and males, and the mourning process is considered important in order to resolve the infertility crisis 12.
Infertility may have profound psychological effects. Partners may become more anxious to conceive, increasing sexual dysfunction; marital discard develops in infertile couples. Especially over pressure to make medical decision couples who have heart disease or cancer leads to clinical; depression and anxiety when they are trying to conceive even couples undertaking IVF face considerable stress. Emotional stress and marital difficulties are greater in couples where the infertility lies with male 13.
A comparative research study reported that psychological problem of infertility and infertile couples. It has estimated 35 to 44% of infertile women showed severe symptoms of depression while compare with 19.47% of fertile women. In the case of anxiety evaluation there was significant total prevalence among infertile women (15.53%) 5. A case control study was conducted to assess the relationship between psychiatric disorders and infertility. 81 infertile couples recruited from an infertility centre before fertility treatment and 70 fertile couples recruited from an obstetrics and gynecology, the occurrence of anxiety and depression was significantly higher among infertile subjects (16% Vs 2%) 14.
A study conducted among the infertile couples at stress has been identified in both the sexes. Anxiety and depression are mostly present in women compared to men. Men has tendency towards repress anxiety, women has higher defensive anxiety with numerous psychosomatic symptoms and also found infertile couples undergoing different treatment, they need psychological counseling and supportive psychotherapy 15.
A prospective study stated that psychological components were found to play a significant role in infertile couple. Both male and female partners were suffering due to infertility. Their personality and social behaviors are affected by infertility anxiety 16.
A cross sectional study was conducted at among 370 infertile female patients with different infertility causes, physical, psychological, social problems. The study estimated that 321 women (86.8%) had anxiety. The anxiety and depression were most common after 4-6 years of infertility and severe depression could be found for 7 to 9 years of infertility. So adequate attention is of great importance for their mental health and will improve quality of their lives 9.
Uppsala University Hospital conducted study in Sweden regarding prevalence of psychiatric disorders in infertile women and men undergoing IVF. Treatment based on the PRIME-.MD tool, participants were 545 couples attending a fertility clinic during a 2 years period. 431 couples were filled in the PRIME-MD patient questionnaire. It results that any psychiatric diagnosis was present in 30.4% of females and in 10.25% of males in the study samples. Any mood disorder was present in 26.25 of females and 9.2% of males. Any anxiety disorder was encountered in 14.8% of females and 4.9% males. Depression was prevalent in 10.9% of females and 5.1% of males 18.
A study investigated anxiety in 130 infertile women in China, the results showed that different levels of mental pressure were found in 83.8% of infertile women and moderate or severe types in 25%. There were depression and anxiety disorders in 33% (Hong Kong), in 32% (Scotland) of infertile women. The overall percentage of anxiety disorder in infertile women ranges between 67 and 84 % and also depression disorder ranges between 24 and 36%. The study concluded as 86.8% anxiety and 40.8% depression in infertile women 17.
In a study 94 male patients who participated in psychological couple counseling were compared to 134 un-selected infertility patients and counselor users showed that infertility patients have higher scores for depression and anxiety and found increasing level of distress, few feeling of being responsible for infertility and marital difficulties or relevant for the usage of couple counseling .
Husbands and wives of 108 childless couples participated in a study, which results that infertile women were more anxious, more depress and they are considered as needing emotional help and counseling in learning to live with their childless 19.
6.3: STATEMENT OF PROBLEM
Assess the effectiveness of self instructional module (SIM) regarding the level of anxiety among infertile couples in a selected infertility clinic at Bangalore.
6.4: OBJECTIVES OF THE STUDY
1. To assess the level of anxiety among infertile couples.
2. To evaluate the effectiveness of self instructional module (SIM) on the level of anxiety among infertile couples.
3. To determine the association between the level of anxiety of infertile couples with their demographic variables.
6.5: HYPOTHESIS
H0: There will be no significant association between the pre test and post test score of the level of anxiety among infertile couples.
H1: There will be a significant difference between the levels of anxiety of infertile couples with the demographic variable.
6.6: OPERATIONAL DEFINITION
ASSESS:
It refers to the measurement and examination of effectiveness of self instructional module on level of anxiety among infertile couples from the score based.
EFFECTIVENESS:
It refers to the quality of being or able to bring an effect or efficient of self instructional module to manage anxiety during infertility.
SELF INSTRUCTIONAL MODULE:
It is a self-instructional module which is well planned and prepared, those infertile couples to learn and gain more information by themselves to reduce anxiety.
LEVEL:
A position on a scale or degree of anxiety among infertile couples.
ANXIETY:
It is an emotional subjective feeling of apprehension, tension, fear of an infertility related to infertility problem.
INFERTILITY:
It refers as a failure to conceive within one or more years of regular unprotected coitus.
COUPLES:
Men and women who are married and attending an infertility clinic.
6.7: ASSUMPTION
1) The infertile couples will have degree of anxiety and it will vary from one individual to another.
2) The infertile couples will have some techniques to reduce the anxiety.
3) Self Instructional Module will enhance more information to reduce the level of anxiety among infertile couples.
7: MATERIALS AND METHODS
7.1: SOURCES OF DATA:
Infertile couples, who are attending a selected infertility clinic, Bangalore.
7.2: METHODS OF DATA COLLECTION:
Data will be collected by investigator herself by using structured interview schedule.
7.2.1: RESEARCH DESIGN AND APPROACH:
The research design adopted for this study is quasi experimental design in which one group of pre and post test approach without control group.
7.2.2: SETTING:
This study will be conducted in selected infertility clinic at Bangalore.
7.2.3: POPULATION:
The population of the present study will be infertile couples.
7.2.4: SAMPLE SIZE:
Sample size will be 50.
7.2.5: SAMPLING TECHNIQUE:
Purposive sampling technique will be used to select the samples for the study.
7.2.6: SAMPLING CRITERIA:
INCLUSION CRITERIA:
Clients who are,
Ø attending infertility clinic.
Ø available during the data collection procedure.
Ø able to understand and speak in Kannada and English.
Ø willing to participate.
EXCLUSION CRITERIA:
Clients who are,
Ø not infertile.
Ø not available during the data collection procedure.
Ø not able to understand and speak in Kannada and English.
Ø not willing to participate.
7.2.7: DATA COLLECTION TOOL:
Five point (Likert’s) rating scale will be used for the level of anxiety among infertile couples. The data will be collected in the month of September /October 2010.
7.2.8: DATA ANALYSIS METHODS:
1. Appropriate description and inferential statistics will be used for data analysis and presented in the form of tables, graphs and figures etc.
2. The effectiveness of pre and post test scores of anxiety will be analyzed by paired ‘T’ test.
3. The significant of relationship between the selected demographic variables and level of anxiety scores will be analyzed by using chi-square test.
7.3: DOES THE STUDY REQUIRED ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY.
- NO –
7.4: HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION? IN CASE OF 7.3
Required ethical clearance will be obtained from the concerned authority before the main study.
8: LIST OF REFERENCES:-
1. Akiskal HS, “Anxiety”, Journal of Psychiatry”, 51 (3): 345-348.
2. Sparsha, “Factors in women responsible for infertility”, Articles Knowledge sharing health, (2009), 56 on line.
3. Dhaliwal LK, Gupta, “Psychological aspects of infertility due to various causes”, Journal of fertile women, (2004), 49 (1): 44-8
4. Virutamasen P, “The determinant factors and the anxiety level of infertile couples during the treatment of in vitro fertilization and embryo transfer at Chulalongkorn Hospital, Bangkok”, Journal of medical association, (2003), 86 (5): 425-9.
5. Drosdzol A, Skrzypulec, “Depression and Anxiety among polish infertile couples”, Journal of Psychosomatic obstetric and Gynecology, (2009), 30 (1): 11-20.
6. Fassino S, Piero A, “Anxiety, Depression and anger suppression in infertile couples”, Journal of Human Reproduction,(2002), 17 (11): 2986-94.
7. Power W, “Infertility problem in couples with temporarily migrant male partner”, Journal of Obstetrics and Gynecology of India, (2008), 22-28.
8. Lee TY, Sun GH, “Psychosocial response of Chinese infertile husbands and wives”, Journal of Andros, (2000), 45 (3): 143-8.
9. Fatemeh Ramezanzadeh, “A survey of relationship between anxiety, depression and duration of infertility”, Journal of Obstetrics and Gynecology, (2005), 2 : 59-63
10. Neelo far sani, Tazeen sered Ali, “The cultural politics of gender for infertile women in Karachi, Pakistan, Indian Journal, on line(2009), 25-29
11. Gupta, “Maternal and child health nursing”, 3rd edition, Lippincott. 126-7.
12. Williams and Zapper, “Prevalence of psychiatric disorders in infertile women and men under going in vitro fertilization treatment”, Journal of Obstetrics and Gynecology, (2006), 2 : 59-63.