EFFECTIVENESS OF STRUCTURED TEACHING MODULE ON KNOWLEDGE AND PRACTICE ABOUT PREMENSTRUAL SYNDROME ITS CARE AMONG ADOLESCENT GIRLS IN SELECTED SCHOOLS OF HORAMAVU VILLAGE IN BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
MS. JHANSI RANI J.
NAVANEETHAM COLLEGE OF NURSING
BANGALORE
SEPTEMBER 2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1. Name of the Candidate : Ms. Jhansi Rani J.
M.Sc (N) I Year
Navaneetham College of Nursing
Banaswadi
Bangalore
2. Name of the Institution : Navaneetham College of Nursing
Bangalore
3. Course of Study & Subject : Master of Science in Nursing in
Community Health Nursing
4. Date of Admission : 10.12.2008
5. Title of the Topic : Effectiveness of structured
teaching module on knowledge and practice about premenstrual syndrome its care among adolescent girls in selected schools of Horamavu village in Bangalore.
6. BRIEF RESUME OF THE INTENDED WORK
6.1 Introduction:
Oh joy, its puberty...?young girls have a lot of confusion as their physical symptoms appear , Yet they adorn their face and smile with excitement once they attain their puberty, This shows that the teens have reached womanhood. Girls go through this initiation to become a responsible adult member of their community.
A menstrual cycle is one of the most natural things that happen to a woman's body initiating later an act of pregnancy and child birth. Premenstruation does not have to mean pain. It was believed in some cultures that when a woman was on her period, she was very powerful. But in the present decades, a girl during her premenstrual phase experiences more stress and pain that disturbs her daily routine. Such changes have taken place from the past due to young girls ignoring their health, good nutrition, and that more care is given to them only when these symptoms become severe.
Girls in urban areas have some knowledge about these physical changes due of mass Medias and better exposure. But this knowledge is lacking in rural adolescent girls due to ignorance and lack of exposure therefore when these symptoms appear it causes physical and mental discomfort. It raises a lot questions in their minds. Only few studies and articles are available on this syndrome. As these adolescent girls are future mothers, care should be initiated from this age itself. This will help to relieve their physical and psychological discomfort preparing them towards a healthy motherhood.
6.2 Need for Study:
Premenstrual syndrome [PMS] an common problem among young girls is characterized by occurrence of a constellation of symptoms temporally associated with the menstrual cycle.
Current Research Perspectives [CRP] of September 2001 stated that Premenstrual syndrome (PMS) refers to a group of menstrual related disorders that impairs a girl’s daily activity and relationships. It is estimated to occur in up to 40 percent of girls in their reproductive age, with 5 percent of these girls having severe impairment.
Brinda Karat of the All India Democratic Women's Association (AIDWA) in an article to The Hindu Volume 16 - Issue 7, Mar. 27 - Apr. 9, 1999 explains that the young girls due to their extenuating circumstance they always ignore their own health.
Jankharia[Mar1999] tells that girls from the lower socio-economic strata have a low bone mass because of poor nutrition during childhood and adolescence as PMS is associated with poor dietary habits.
Anne Walker[March 2000] has written that the investigation of premenstrual tension syndrome (PMTS) has been hampered by several methodological problems, particularly an inadequate definition of study subjects Premenstrual disorder (PMD) was not given much importance initially and that it have been studied extensively only over the last 20 years.
In the Journal of Affective Disorders [2005]Studies found that Women (62.8% of the sample) had a younger age at onset of the first major depressive episode as atypical symptoms that became a part of their Premenstrual syndrome. The most common symptom of PMS affects particularly in the form of stress (87.6%) and nervousness (87.6%).
Frank[1931] explained that over the recent decades, the number of symptoms ascribed to PMS grew to more than 150, of these; However in addition to irritability or depression and fatigue, which constitute the core behavioral manifestation, various other symptoms occur with sufficient frequency to merit their inclusion in syndrome. Labile mood with alternating sadness and anger and oversensitivity to environmental cues are seen in 75% of School girls with PMS which two thirds of girls with this disorder have episodes of crying during the luteal phase; fewer than 25% of these same group cry at any time during the follicular phase of the menstrual cycle. Fifty percent of these girls with PMS perceive more difficulty in concentrating and forgetfulness. Only 20-50% of adolescents reporting PMS retrospectively meet prospective diagnostic criteria.
A study about adjustment of Indian girls in relation to premenstruation also showed their maladjustment mainly in the areas of education and health. Their complaints of severe stomach ache during premenstruation suggested even need for a medical help.
Veena Kumari et.al.[August 1998] in her article Effects on Raven's Standard Progressive Matrices test” tells about the Effects of time-pressure stress on Raven's Standard Progressive Matrices performance in 64 low and 64 high-trait anxious female subjects, tested either during premenstruation And predicted that menstrual cycle variation would interact with stress-induced arousal/emotion and individual differences in reactions to aversive stimuli, as measured by trait anxiety. Their predictions were confirmed by Stress × Menstrual Phase and Trait Anxiety × Menstrual Phase interactions, it pointed the effects on cognitive performance also.
The earliest recorded reference to PMS Hippocrates described the symptoms as only “headache” and “a sense of heaviness.” But Later, Pliny described the marked behavioral changes as follows:
“On approach of a woman in this state, grass withers away, garden plants are parched up, new wine becomes sour, and the fruit will fall from the tree beneath which she sits.”
Ellen W Freeman [June 2003] explained that the Health Promotion and Risk Behaviors, Environmental factors, Women’s Health, and Mental Health Promoting healthy lifestyles and decreasing risk behaviors has impact on overall quality of a girls health.
Anne Walker [March 2000] has written that the women with premenstrual distress frequently consult practitioners in several disciplines. Alternative treatments are frequently used instead of, or along with, conventional therapies. A willingness to discuss and incorporate safe alternative treatments will help the physician establish a position of advocacy for the young girl’s total well-being.
A major CME Program [2007] on Dysmenorrhea. concluded that, the future researchers should be able to organize a multidimensional continuum, including not only inflammatory models but also central nervous system-based pain disorder models for understanding these symptoms and prepare alternate approaches for girls with Premenstrual syndrome.
Physicians and social workers who work with girls with PMS believe that the cultural and social changes influence them far better than hormonal changes. Continued research in this area is clinically important as patients with increasingly divergent ethnic and cultural backgrounds seek treatment for a range of depressive and anxiety disorders.
In September 2001, National Institute of Nursing Research identified that research into adolescence health had been undervalued in the past. But Care and prompt treatment of physical and mental manifestations of PMS help performing their regular roles and can have greater impact on their lives.
The investigator has found during the school health programmes that the adolescent girls during the premenstrual period have been absent for a period of not less than two days. It has been noticed that these children are unable to attend regular classes during this period.
Also the investigator from her personal experience identified that this syndrome has been a cause of both physical and psychological discomfort that has led her to take a deep study on identification of prevalence, severity and to find the solution to such kind of syndrome, for adolescent girls residing in rural areas (Horamavu) of Bangalore.
6.3 STATEMENT OF THE PROBLEM:
“Effectiveness of structured teaching module on knowledge and practice about premenstrual syndrome its care among adolescent girls in selected schools of Horamavu village in Bangalore”
6.4 OBJECTIVES OF THE STUDY:
a. To asses the existing knowledge (pretest) of Premenstrual syndrome and its care among adolescent girls
b. To develop an structured teaching module on care of premenstrual syndrome among adolescent girls
c. To implement structured teaching module among adolescent girls
d. To evaluate the (post test) effectiveness of structured teaching module
e. To associate knowledge between the pretest and post test with demographic variables
6.5 OPERATIONAL DEFINITIONS:
Effectiveness: outcome of the interventions measured in the terms of
Numerical scores
Structured teaching module It is a set of information consists of the different aspects of pre menstrual syndrome
Knowledge expertise, and skills acquired by a person through experience or education; the theoretical or practical understanding of a subject
Practice translating an idea into action;
Premenstrual syndrome is a collection of physical, psychological, and emotional symptoms related to a woman's menstrual cycle
Care the work of providing treatment for or attending to someone or something
Adolescent girls is a transitional stage of physical and mental human development that occurs between childhood and adulthood
6.6 Assumptions:
The investigator assumes that these structured teaching modules will improve the knowledge on care of premenstrual syndrome among adolescent girls in selected High schools
6.7 Delimitations:
· The study is delimited to 60 samples
· The duration of study is delimited to 4 weeks
· It is conducted only in 3 selected schools
7 REVIEW OF LITERATURE
Katherine D. Hoerster a et.al [April 2002] conducted a study where Sixty-seven women students who were attending a university in southern India and 61 women students who were attending a liberal arts college in New England volunteered to participate in this study. The women supplied demographic information, information about their knowledge and levels of preparedness prior to menarche, and sources of their information about the menstrual cycle. They also completed the Menstrual Attitude Questionnaire (Indian version), the Pre-Menstrual Distress Questionnaire, and a test of knowledge about the menstrual cycle. American women scored significantly higher than Indian women on the knowledge test, and they also reported that they had better preparation for menarche than Indian women did.
In September 2001, an International multidisciplinary group of experts evaluated the current definitions and diagnostic criteria of PMS and premenstrual dysphoric disorder (PMDD) and hoped that the criteria proposed by this group will become widely accepted and eventually be incorporated into the next edition of the World Health Organization's International Classification of Diseases (ICD-11). They also hope that the proposed guidelines for quantification of criteria will be used by clinicians and investigators to facilitate diagnostic uniformity in the field of treatment
Rapkin AJ, Mikacich[2006 Jan] tells that it is estimated around 60-80% of menstruating women experience some degree of premenstrual symptomatology; Though these diagnoses are not frequently made in the adolescent group, the literature suggests that a similar proportion of teens would also meet criteria for PMS/PMDD. In adolescents, treatment should begin with education and lifestyle changes; however, many of the treatments used commonly in adults can also be employed safely in severe adolescent case
Janowsky DS,et.al[2002 Dec] In their book “Historical studies of premenstrual tension up to 30 years ago: implications for future research” narrates that the biology and treatment of premenstrual tension syndrome has advanced significantly in the past 30 years. Newer research expands on earlier literature that has been accumulated only before 1972.
Limosin F, Ades J. [1983] describes the numerous, but heterogeneous studies that have been performed about premenstrual syndrome, with finally a lack of credibility and interest among practitioners. In 1983 in the United States, the National Institute of Mental Health conference devoted to this topic proposed the first diagnosis criteria, requiring a prospective and daily assessment of the symptoms. In 1987, the American Psychiatric Association, in the DSM III-R, introduced the Late Luteal Phase Dysphoric Disorder diagnosis that became in 1994 in the DSM IV the Premenstrual Dysphoric Disorder, with the same diagnosis criteria.
Dr. Md Abedur Rahman in his article “Sufferings before menstruation: what to do?” tells that Mood swings, tender breasts, a swollen abdomen, food cravings, fatigue, irritability and depression. These are the symptoms that occur just before the menstrual period. These symptoms may vanish after the menstrual flow starts. He explains that adequate care and life style adjustments can help you reduce or manage the signs and symptoms of premenstrual syndrome.
TiemstraJ D,et.al[2001 Nov-Dec] tells that Medical cares are necessary when symptoms constitute a severe and disabling disorder. In the same way, the efficiency of the contraceptive pill w as not demonstrated Hormonal therapy in the management of premenstrual syndrome.
Thirty-three research-based articles (1992–1999) were reviewed for relevance by the science team as part of the fifth research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses gives an overview of information on the prevalence of premenstrual symptoms. Overall, at least 40% of women experience some cyclical premenstrual symptoms. Although most women rate their symptoms as mild, approximately 2%-10% report severe symptoms. Prospective studies of premenstrual symptoms indicate that retrospective reports are reasonably accurate among women who experience moderate to severe symptoms.
Rapkin AJ, Mikacich [2008 Oct;]in his book reviews the current knowledge about the prevalence, diagnosis, and management of premenstrual syndromes in adolescents. Premenstrual disorders likely start in the teen years. At least 20% of adolescents may experience moderate-to-severe premenstrual symptoms associated with functional impairment. Current treatment includes lifestyle recommendations and use of pharmacologic agents.
Rausch JL, et.al [1993 Dec;]. In his article on Treatment of premenstrual mood symptoms tells that for the sake of improvement in therapeutic approaches for women has been given a specific consideration. Treatments studies for premenstrual mood symptoms have included conservative, supportive, nutritional, psychotropic, hormonal, and anovulatory measures.
7.1 Conceptual Theoretical Framework