RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES, BANGALORE,KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

MS.V.VEDHASELVI

I YEAR M. Sc NURSING,

COMMUNITY HEALTH NURSING

(2008 –10 BATCH)

VARALAKSHMI COLLEGE OF NURSING ,

# 19, KIADB ROAD, CHOKKASANDRA,

T. DASARAHALLI,

BANGALORE -560057

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCE,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1 / NAME OF THE CANDIDATE AND ADDRESS / MS.V.VEDHASELVI
I YEAR M.Sc NURSING
VARALAKSHMI COLLEGE OF NURSING

NO19,KIADB ROAD,CHOKKASANDRA

T.DASARAHALLI
BANGALORE -560057
2 / NAME OF THE
INSTITUTION / VARALAKSHMI COLLEGE OF NURSING
NO19,KIADB ROAD,CHOKKASANDRA
T.DASARAHALLI
BANGALORE -560057
3 / COURSE OF STUDY AND SUBJECT / MASTER DEGREE OF NURSING,
COMMUNITY HEALTH NURSING.
4 / DATE OF ADMISSION TO COURSE / 30-06-2008
5 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE REGARDING HOME REMEDIES OF DYSMENORRHOEA.

6.BRIEF RESUME TO THE INTENDED WORK

INTRODUCTION

“IN THE MIDDLE OF ITS STREET AND ON EITHER SIDE OF THE RIVER WAS THE TREE OF LIFE, WHICH BORE TWELVE FRUITS ,EACH FRUIT YIELDING ITS FRUIT EVERY MONTH THE LEAVES OF THE TREE WERE FOR THE HEALING OF THF NATIONS”

-BIBLE,REV22.2

Change makes life more beautiful and worth living if one knows how to adopt oneself and adjust to the challenges presented by the situation, He or She can face any challenge in life. The changes are more frequent in girls than boys, girls mature earlier reach the period of rapid growth earlier than boys .The rapid growth and change in the physical structure is after the attainment of puberty.

The term Dysmenorrhoea derived from the Greek word “DYS” meaning difficulty /painful/abnormal,“MENO” meaning month and “rrhea” Meaning flow. Approximately 50% of all women experience Dysmenorrhoea , More than 50% of teenagers are affected by Dysmenorrhoea and 10% have severe symptom. This study offers a unique contribution to our profession regarding home remedies of Dysmenorrhoea and its discomfort.2

Puberty as well known as is the period of life in all women generally between the ages of 10 to 15 years . Here it is important to remember that the puberty represents the earliest time of reproduction 4 . In modern time for many girls physical problem can arise in relation with menstruation such as Dysmenorrhoea ,weight gain, headache ,backache, breast tenderness ,mood swings, depression etc.5

The WHO estimated that 80% of the population in developing countries uses traditional treatment for their primary health care needs .modern drugs and conventional medicine are often viewed as impersonal emphasizing crisis intervention, it is not only expensive but bring about side effects which are sometimes more dangerous than the disease itself. Home remedies are the commonly used treatment for Dysmenorrhoea.15

Home remedies are followed by a very good percentage of people from time immemorial .For treating various ailments if the remedies followed by an individual are helpful in relieving or during their particular ailments ,he will use the same remedy in future for the ailment . This information on home remedies will be poured on from generation to generation.

6.1 NEED FOR THE STUDY

Adolescence is regarded as a unique phase of human development .traditionally adolescence is a period of “stress and storm” a WHO expert committee has considered adolescence period between 10 to 20 yrs of age .most birth (95%) attain menarche between age group of 10 to 15 yrs .out of this about 50% menstruating women are affected with Dysmenorrhoea.15

Dysmenorrhea is a menstrual condition characterized by severe and frequent menstrual cramps and pain associated with menstruation. The following are the most common symptoms of dysmenorrhea. However, each individual may experience symptoms differently. Symptoms may include: cramping in the lower abdomen ,pain in the lower abdomen ,low back pain ,pain radiating down the legs ,fainting, headaches,weakness.The majority of the adolescence (60%) reported Dysmenorrhoea with 14% saying that they frequently missed school because of severe menstrual cramps1.

The study was conducted to determine the prevalence of Dysmenorrhoea among Hispanic adolescence fastest growing minority group in the UnitedStates ,its impaction ,acadamic performance ,school attendance ,sports and social activities and its management. Dysmenorrhea is highly prevalent among Hispanicadolescents and is related to school absenteeism and limitationson social, academic, and sports activities. Given that mostadolescents do not seek medical advice for dysmenorrhea, healthcare providers should screen routinely for dysmenorrhea andoffer treatment. As dysmenorrhea reportedly affects school performanceand attendance, school administrators may have a vested interestin providing health education on this topic to their students.The above studies reveal that Dysmenorrhoea is a common problem among menstruating girls which has negative impact on their social ,physical and psychological well being.6

A study had been conducted on the incidence of Dysmenorrhoea among 1648 adolescence girls of Karnataka .the incidence of Dysmenorrhoea was 87% of these 46.69% had severe problems of perceived pain during menstruation.13

Dysmenorrhoea is defined as painful menses in women with normal pelvic anatomy, usually beginning during adolescence. It is characterized by crampy pelvic pain beginning shortly before or at the onset of menses and lasting 1 to 3 days. It not only disturbs their routine but also causes humiliating suffering. It is a common cause for sickness absenteeism from classes and work by the female student community.10 It is a public health problem with its high prevalence,suffering, and considerable economic losses. Most of the studies on Dysmenorrhoea have emphasized mainly on the drug management, while only a few stressed on cultural practices and the perceptions in different settings. It is well-known that every health problem not only presents itself with different epidemiological profiles in different population settings but is also perceived and managed differently. The Nurse should have the knowledge of these variations in its presentations and perceptions in different population settings, for example, in urban and rural settings, will be useful for its successful management.4

During the four years of experiences in the college ,the researcher come across severe cases of Dysmenorrhoea and regular absenteeism at classes and clinicals ,The personal experiences ,professional experiences ,advice from elders , availability of materials has motivated an interest in the investigator to carry out this study .

6.2REVIEW OF LITERATURE

Studies related to Dysmenorrhoea:

. Anamika Sharma et al conducted the study on the prevalence and the effect of menstrualdisorders on daily routine among unmarried undergraduate medicalstudents and their treatment-seeking behavior of 276 undergraduategirl students, 112 were sampled by stratified random sampling.All the consenting participants were given a pretested semistructuredquestionnaire to collect their responses by personal interviews. Premenstrual syndrome (67%)and dysmenorrhea (33%) were perceived by the study subjectsas the most distressing problems associated with menstruation.The most common effect of menstrual problems on daily routinereported by the study subjects was in the form of prolongedresting hours (54%) followed by inability to study (50%). Morethan half (52%) of the subjects discussed their problems withtheir mother, and 60% of the study subjects were opted for allopathictreatment for their menstrual problems.14

Atchuta Kameswararao et al had conducted the study regarding Dysmenorrhoea in rural and urban adolescent girls perceiving and managing the Dysmenorrhoea problem differently.And to study differences in epidemiological profiles, perceptions, socio economic losses, and quality-of-life losses and management of Dysmenorrhoea in different settings for effective management: A comparative cross-sectional study among adolescent school girls (101 girls in urban areas and 79 girls in rural areas) in the district of Karimnagar. A cross-sectional survey using a pretested questionnaire was conducted among 180 adolescent girls in urban and rural settings. The prevalence of Dysmenorrhoea is 54% (53% in girls in urban areas and 56% in girls in rural areas) (X 2df = 0.1, P = 0.05). Sickness absenteeism (28-48%), socio economic losses, and perceived quality of life losses are more prevalent among girls in urban areas than in girls in rural areas. Girls in rural areas resort to physical labor and other natural methods to obtain relief while the girls in urban areas are mainly depending on medications.13

Studies related to Home remedies regarding Dysmenorrrhoea

Cheng JF et al had conducted the study regarding A traditional Chinese herbal medicine used to treat Dysmenorrhoea among forty nine Taiwanese women”

( Si-Wu-Tang (SWT), ) .The experimental group was provided with 15 g of SWT daily for seven consecutive days, The results indicated that the decrease in menstrual pain levels and the duration of pain between the experimental group and the comparison group was not significant. However, the decrease in menstrual pain over the five menstrual cycles within the experimental group (from 2.07 to 1.42; 2.71 to 1.21; p < 0.05) and within the comparison group (from 1.94 to 1.23; 2.66 to 1.68; p < 0.05) were significant. Moreover, nurses should build up a partnership with their clients of Asian origins based on the use of an alternative therapy using different assessment criteria that are related to healing and recovery based on bodily constitution balance.8

Chantay Banikarim MD et al Conducted a study on Dysmenorrhea is highly prevalent among Hispanicadolescents and is related to school absenteeism and limitationson social, academic, and sports activities. Among participants who had had a period in theprevious 3 months, 85% reported Dysmenorrhea. Of these, 38%reported missing school due to Dysmenorrhea during the 3 monthsprior to the survey and 33% reported missing individual classes.Activities affected by Dysmenorrhea included class concentration(59%), sports (51%), class participation (50%), socialization(46%), homework (35%), test-taking skills (36%), and grades(29%). Treatments taken for Dysmenorrhea included rest (58%),medications (52%), heating pad (26%), tea (20%), exercise (15%),and herbs (7%). Fourteen percent consulted a physician and 49%saw a school nurse for help with their symptoms. Menstrual painwas significantly associated with school absenteeism and decreasedacademic performance, sports participation, and socializationwith peers (P<.01). 6

Proctor ML, reported that women who followed a low-fat vegetarian diet for two menstrual cycles experienced less pain and bloating and a shorter duration of premenstrual symptoms than those who ate meat. Women who are losing too much blood, however, may need meat to help maintain iron levels. Choosing more fish and eggs may be a helpful alternative.More than that study has reported less menstrual pain with a higher intake of omega 3 fatty acids (fat compounds found in oily fish, such as salmon and tuna). In one study, supplements of fish oil also appeared to reduce heavy bleeding in adolescent girls.Treatment followed by taking dietary adjustments starting about 14 days before a period may help some women with certain mild menstrual disorders, such as cramping. The general guidelines for a healthy diet apply to everyone; they include eating plenty of whole grains, fresh fruits and vegetables, and avoiding saturated fats and commercial junk foods.11

Studies related to self-instructional module

Christianson ca et al conducted a study to evaluate the effectiveness of a self-instructional module in increasing nurse’s knowledge of genetics with 65 registered nurses working at reproductive health centers.The interventions used were a 22 pages self-instructional booklet on genetic risk assessment. There was a significant increase of 20.8% in participants' mean knowledge score on the posttest (M= 89.0%, SD= 8%, range = 67%-100%) as compared with the pretest (M= 69.0%, SD= 12%, range = 42%-92%), based on paired t-test analysis (t= 11.74, SE= .426,p<.0001)..this study concluded that a genetics self instructional module for registered nurse was effective in increasing knowledge of basic human genetic concepts and risk assessment.9

Daviese N et al conducted a study to examine the efficacy of self-instruction module on nurses competence on Updating cardiopulmonary resuscitation skills .Self-instruction has been suggested as one alternative to formal retraining programmes. A quasi-experimental design utilizing random allocation of matched subjects to one experimental and two control groups was adopted with a sample of 20 undergraduate nursing students. The subjects' CPR ability was assessed concurrently using a resuscitation manikin and an observational checklist. Subjects undertaking self-instruction produced significantly (P < 0.05). The time spent in self-instruction module was evaluated positively by the students.

STATEMENT OF THE PROBLEM

The Effectiveness of Self-Instructional Module regarding Home Remedies of Dysmenorrhoea among Adolescent Girls in selected rural community area at Bangalore.

6.3 OBJECTIVES:

6.3.1To assess the knowledge level regarding home remedies of Dysmenorrhoea among Adolescence girls selected rural community area at Bangalore in terms of pre test score.

6.3.2To develope the Self Instructional Module on home remedies of Dysmenorrhoea.

6.3.3To assess the effectiveness of Self Instructional Module on home remedies of Dysmenorrhoea among rural adolescence girls by comparing pre and post test knowledge score.

6.3.4To determine the association between the selected demographic variables

and knowledge regarding home remedies of adolescence girls

in selected rural community area.

6.4HYPOTHESIS:

H1: The mean post test knowledge score of home remedies regarding

Dysmenorrhoea is significantly higher than the score mean by pretest

knowledge

H2: There is significant association between the selected demographic

variables such as age, age at menarche, menstruation cycle, duration of

menstruation, education, problems of menstruation and home remedies of

Dysmenorrhoea.

6.5 OPERATIONAL DEFINITIONS:

ASSESSMENT

Refers to the organized systematic variables process of collecting information about home remedies of Dysmenorrheoa from adolescence girls in a selected community.

EFFECTIVENESS:

Refers to the extent to which the self Instructional Module on home remedies on Dysmenorrhoea achieves desired effect in improving the knowledge of rural adolescence girls as evident from gain in knowledge scores.

SELF INSTRUCTIONAL MODULE:

It refers to any learning material developed for the purpose of achieving the specified objective .In this study SIM refers to an Independent Teaching material, which has organized content that enhances the knowledge regarding home remedies of Dysmenorrhoea.

KNOWLEDGE:

knowledge refers to the expressed view of facts regarding home remedies of Dysmennorhea among adolescence girls by assessing through questionnaire in a selected community..

HOME REMEDY:

It refers to the home preparations for Dysmenorrhoea which are following

traditionally in practice .

DYSMENNORHEA

Described as painful menstruation and Discomfort during menstruation .pain is the spasmodic cramp like feeling or sensation that occurs in hypo gastric region (the lower middle of the abdomen )which radiates to the back and thigh during menstruation.

Discomfort related to symptoms like headache ,nausea , vomiting ,diarrhea, frequency of micturation ,fatigue, giddiness and irritability.

ADOLESCENCE GIRLS

The Adolescence girls refers to female between the age group of 10-19 years in selected community area.

6.6 DELIMITATIONS:

1.The study is limitedto Adolescence girls those who attended menarche

2. The study is limited to literate Adolescence girls

6.7 ASSUMPTIONS:

Adolescence girls may have adequate knowledge regarding home remedies of Dysmenorrhoea through traditional practices in home, magazine, media and through friends etc.

Adolescence girls may not have adequate knowledge regarding home remedies of Dysmenorrhoea.

6.8 VARIABLES

Research variables are the concepts at various levels of abstraction that are

manipulated and collected in a study. Independent variable :

Self Instructional Module Home Remedies on Dysmennorhoea.

Dependent variable

Knowledge regarding home remedies of Dysmenorrhoea

Extraneous variables

Age, Age at menarche, Menstruation cycle, Duration of menstruation,Previous Experience,Education,Problems of menstruation and Home Remedies ofDysmenorrhoea.

7.0 MATERIALS AND METHODS:

7.1 SOURCE OF DATA:

Data will be collected from rural adolescence girls those who attended menarche

in selected community area

7.2 METHOD OF COLLECTION OF DATA:

structured knowledge questionnaire and self instructional module on home remedies Dysmenorrhoea.

7.2.1 RESEARCH DESIGN:

A quasi-experimental research design .

7.2.2 RESEARCH APPROACH:

An evaluative research approach

7.2.3 SETTING OF THE STUDY:

This study will be conducted in selected rural area

7.2.4 POPULATION:

The population of present study comprises of adolescence girls who have attended menarche .

7.2.5 SAMPLE SIZE:

The sample of the study consist of 100 adolescence girls in selected settings

7.2.6 SAMPLING TECHNIQUE:

Non-probability purposive sampling

7.2.7 SAMPLING CRITERIA:

INCLUSIVE CRITERIA:

Adolescence Girls

  • who are willing to participate
  • who has attended the menarche.
  • Age group between 13 yrs to 18 yrs
  • who can follow Kannada and English .

EXCLUSIVE CRITERIA:

Adolescence Girls

  • who are not willing to participate
  • who has not attended the menarche.
  • who cannot follow Kannada and English
  • who have pathological Dysmenorrhoea

7.2.8 DATA COLLECTION TOOL:

Structured Knowledge Questionnaire.

It consists of two parts ; Part I and Part II Part I : Demographic variables like age, education, age at menarche , menstruation cycle , duration of menstruation ,problems during menstruation . Part II : Knowledge questionnaire on Home Remedies of Dysmennorhoea

7.2.9 DATA ANALYSIS METHOD

The data analysis through descriptive and inferential statistics.

Descriptive statistics : Frequency ,mean ,mean percentage and standard deviation of complete demographic variables.

Inferential statistics : Paired “t” test to compare pre and post test knowledge scores . Non parametric chi-squre(χ2) test will be used to find out the association between selected variables with knowledge scores on such as age, age at menarche, menstruation cycle, duration of menstruation, education,problems of menstruation and home remedies of Dysmenorrhoea

7.3 DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMAL?

-YES –

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Permission will be obtained from

-The research committee of the Varalakshmi College of Nursing

8 .LIST OF REFERENCES:

1.Aggarwal.k Dysmenorrhoea in adolescent girls in rural area of Delhi. Indian journal of

public health .1999;31(3): 84-86.

2. UhrWomen's HealthAbout Cures.The Difficulty with Dysmenorrhoea (Painful

cramps) January 2008;17:44 .

3. DR.kitty k.c.chan premenstrual tension in general practice. the university of hong-