RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
KARNATAKA, BANGALORE.
ANNEXURE - II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / Name of the candidateand address(in block letters) / MS. JISSY JACOB
SAHYADRI COLLEGE OF NURSING,
SAHYADRI CAMPUS, NH-48, ADYAR,
MANGALORE-575007.
2 / Name of the institution / SAHYADRI COLLEGE OF NURSING,
SAHYADRI CAMPUS, NH-48, ADYAR,
MANGALORE-575007.
3 / Course of study and subject / M.Sc. NURSING, OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / Date of admission to course / 4.7.11
5 / Title of the topic:
EFFECTIVENESS OF REFLEXOLOGY ON PREMENSTRUAL SYNDROME AMONG STUDENTS IN SELECTED NURSING COLLEGES, MANGALORE.
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7. / INTRODUCTION
On the journey of life there are events that can change our life forever. One of the highest steps we will take in our amazing journey from girl to women is the first time we get period. The start of menstruation is a momentous event in a girl’s life. Some girls greet those first drop of blood with joy or relief ,while others feel be wildered, the arrival of the first period holds the same meaning for every girl; it is proof that she is becoming a women.
Menstruation is the physiologic discharge through the vagina of blood and mucosal tissues from the non pregnant uterus ;it is under hormonal control and normally requires usually at approximately four weeks intervals, except during pregnancy and lactation, throughout the reproductive period. Many girls and women have had to deal with one or more menstrual problems during their reproductive period. Premenstrual syndrome is one of the menstrual problems among women refers to symptoms that occur between ovulation and the onset of menstruation.
Premenstrual syndrome (PMS) is common among adolescents. It seems to be a burden and upsets their day to day life. There is no therapeutic cure, consuming medicines every month can lead to several adverse effects. Hippocrates describes premenstrual syndrome as “shivering lassitude and heaviness of the head devoted the onset of menstruation mistunes of vision is resolved by menstruation.” The PMS first described in 1931 was the premenstrual feelings of undesirable tension, irritability, and a desire to find relief by foolish and the considered action. Frank explains beautifully the severity of premenstrual syndrome and the behaviour response to cope or overcome them.1
PMS is a common disorder of young and middle age women characterized by cyclic occurrence in the lueteal phase of menstrual cycle of a combination of distressing physical, psychological and behavioural changes of a sufficient severity which results in deterioration of interpersonal relationship or interference with normal activities.PMS is one of the unresolved problems in spite of the fact it has been the subject of extensive discussion and study for many years. The first report on the prevalence was in 1997, it was described to occur in 15-100% of women of reproductive age with 5-10% reporting severe symptoms.2
The scientists at Cornel University in New York scanned the brains of 12 women who had consistently steady moods and did not suffer from PMS. They used a technique called functional MRI. The scientists looked at blood oxygen patterns in the women’s brain at 2 stages of their monthly cycle just before menstruation period and around a week after. The scan showed that all of the women in the experiment had more electrical activity in the frontal lobe of the brain during premenstrual period. The risk for severe PMS is higher in young women. One of the surveys of adolescents 88% reported moderate to severe symptoms.3
BRIEF RESUME OF THE INTENDED WORK:
6.1 Need for the study
Women require special need based health care programs as they pass through the reproductive period. Many women suffer varying degrees of discomfort in the days preceding the onset of menstruation. Premenstrual syndrome (PMS) is a group of symptoms linked to the menstrual cycle. Premenstrual syndrome is a collection of physical and emotional symptoms related to a woman’s menstrual cycle. PMS symptoms occur 1 to 2 weeks before menstruation starts. The symptoms usually subside after menstruation starts. PMS can affect menstruating women of any age and the effect is different for each woman. For some people, PMS is just a monthly bother. For others, it may be so severe that it makes it hard to even get through the day. Some symptoms are minor and can be endured while other symptoms are debilitating. 4
Reflexology is one of mild form of exercise by stimulating the function of the vital organ through, massage and applying pressure to reflexed points on the joints, foot and hand. Reflexologist believe that each point corresponds to difference body part and function. Reflexology is a therapy using the pressure points of the hands and feet which gives a reflex action through the nervous system of the body. Reflexology offers a natural approach to restoring balance and harmony within the body, mind, and spirit. Reflexology is an entirely natural treatment whose aim is to normalize and harmonize the functions of the body....”Bob Dalamore” 5
A survey was conducted on PMS prevalence and severity in an adolescent sample. Physical, emotional and behavioural symptoms were assessed by self report using PMS assessment form. It included 75 samples between the age group of 13-15 years and 16-18 years old. All participants reported at least one PMS of minimal severity. Many reported symptoms that they considered moderate (88%) severe( 77%) and extreme (56%).The most commonly reported symptoms were food carvings, breast swelling, dissatisfaction with appearance and other behavioural symptoms like missing the school, becoming violence, having thoughts of death or suicide, anger, sleep disturbance. 6
A survey was conducted in Nigeria to identify the prevalence and frequency of premenstrual syndrome in female undergraduate students. Sample of 262 subjects were selected between 16-31 years. Premenstrual syndrome was diagnosed using standard criteria(WHO1996) A Self Administered Questionnaire results revealed that 85.5% experience varying degree of symptoms of lower abdominal pain, pimples, puffy face, tender breast and depression (85.7%).7
This motivated the investigator to use reflexology for reducing the symptoms of premenstrual syndrome. It will be really helpful to women for the reduction of symptoms of pre-menstrual syndrome. As many of them go for pharmacological interventions to get rid of premenstrual syndrome, reflexology is an alternative therapy, which is cost effective and has no side effects, will aid in the pre menstrual syndrome.
6.2 Review of literature
A randomized controlled study was conducted in California Graduate Institute, Los Angeles to determine the effectiveness of reflexology therapy on premenstrual syndrome. Thirty five women who complained of previous distress with premenstrual syndrome were randomly assigned to be treated by ear, hand, and foot reflexology or to receive placebo reflexology. Statistical analysis of the interaction effect showed that treatment varied significantly with peroid for total PMS scale(f=6.70,p<.01)somatic symptoms scale(f=8.71,p<.05) with regard to the total PMS scale of the true reflexology and placebo reflexology groups.There was a significant repeated measure analysis of variance group by peroid interaction effect with paired comparisons of the baseline and reflexology treatment peroids (f=13.2,p<.001) and the base line and post treatment peroids(f=7.7,p<.01). Thus the greater decrease in premenstrual syndrome by true reflexology was highly significant during the 8 weeks of reflexology sessions and for the next 2 months after treatment was terminated.8
An experimental study was conducted in Inje University, Busan, Korea to identify the effects of a self-foot reflexology massage on depression, stress responses and functions of the immune system of middle-aged women. The subjects consisted of 46 middle-aged women (40 - 64 years). Subjects were not treated for 4 weeks, subsequently they were trained in self foot reflexology massage for 2 weeks, and then they did their own daily for 6 weeks (2 days at the research center, 5 days at home). The outcome variables were measured 4 times, at baseline, pre training, after training, and after the intervention. The collected data was analyzed using repeated measure ANOVA by the SPSS/WIN program. There was a statistically significant difference in depression, perceived stress. The results suggest that a self-foot reflexology massage could be utilized as an effective nursing intervention to reduce depression and stress responses, and to strengthen immune systems in middle-aged women.9
A quasi-experimental study was conducted in Korea to identify the effects of foot reflexology on nausea, vomiting and fatigue in breast cancer patients undergoing chemotherapy. The subjects consisted of 34 patients with 18 in the experimental group and 16 in control group. A pretest and 2 posttests were conducted to measure nausea, vomiting and fatigue. For the experimental group, foot reflexology, which was consisted of 4 phases for 40 minutes, was given by a researcher and 4 research assistants. The collected data were analyzed by repeated measures ANOVA using the SPSS WIN 10.0 program. There was a statistically significant decrease in nausea, and vomiting in the experimental group compared to the control group over two different times. In addition, there was a statistically significant decrease in fatigue in the experimental group compared to the control group over two different times. Foot reflexology was effective on nausea, vomiting and fatigue in breast cancer patients receiving chemotherapy.10
A study was conducted in China to determine the effectiveness of foot reflexology in the treatment of hypermnorrhea. Twenty eight patients were selected for the study. In that twenty three (82.2%) of the patients reported that foot reflexology was effective, the symptoms were relieved and there was no occurrence during the observation. 11
6.3 Problem statement
Effectiveness of Reflexology on Premenstrual Syndrome among Students in Selected Colleges Nursing Mangalore.
6.4 Objectives of the study
The objectives of the study are to :
· assess the level of premenstrual syndrome among students before and after giving reflexology by using premenstrual syndrome rating scale.
· determine the effectiveness of reflexology on premenstrual syndrome.
· find the association between premenstrual syndrome with selected demographic variables.
6.5 Operational definitions
Effectiveness :
In this study, effectiveness refers to the extent to which the reflexology has produced desired effect on premenstrual syndrome among students as observed by scores obtained by modified premenstrual syndrome rating scale.
Reflexology:
In this study reflexology refers to applying pressure with thumb to the specific area of feet without the use of oil, cream or lotion for relieving the symptoms of premenstrual syndrome. It should be twice daily for four weeks for a duration of 10 to 15 minutes.
Premenstrual Syndrome:
In this study premenstrual syndrome is refers to a group of symptoms are experienced by the girls 1-2 weeks prior to menstruation characterized by physical, psychological, emotional, and physiological symptoms.
Students :
In this study, students refer to the girls in the age group of 17 to 20 years who show the modertae and severe symptoms of premenstrual syndrome.
6.6Assumptions
The study assumes that:
· premenstrual syndrome is distressing for many girls.
· alternative therapies helps to reduce premenstrual syndrome.
6.7 Delimitations
The study is delimited to;
· selected nursing colleges in Mangalore
· students experiencing distress because of premenstrual syndrome.
6.8 Hypotheses: (All hypothesis will be tested at 0.05 level of significance)
H1: the post intervention premenstrual syndrome score will be significantly lower than the mean pre intervention premenstrual syndrome score after reflexology among students,.
H2: there will be a significant association between pre intervention score and selected demographic variables among students.
MATERIALS AND METHODS
7.1 Source of data
The data will be collected from students who show the symptoms of premenstrual syndrome in selected colleges Mangalore. Karnataka.
7.1.1 Research approach:
Quantitative research approach is selected for the study.
7.1.2 Research design
The research design selected for the study is non equivalent control group pre test post test design.
Pre-test / Treatment / Post-test
E / O1 / X / O2
C / O2 / - / O2
E-Experimental group
C-Control group
O1-Assessment of premenstrual syndrome before giving reflexology.
X –Administration of reflexology on premenstrual syndrome.
O2-Assessment of pre menstrual syndrome after giving reflexology.
7.1.3 Setting
The study will be conducted in selected nursing colleges Mangalore.
7.1.4 Population
The population for the study includes students who are in age group of 17 to 20 years who shows the symptoms of premenstrual syndrome in selected colleges Mangalore.
7.2 METHOD OF DATA COLLECTION
7.2.1 Sampling procedure
Purposive sampling technique will be used to select the samples.
7.2.2 Sample size
The sample size for the study comprises of 40 students in that 20 in experimental group and 20 in control group who are suffering from premenstrual syndrome in selected Nursing Colleges Mangalore.
7.2.3 Inclusion criteria
Nursing college students who are:
· willing to participate in the study.
· available at the time of data collection.
· having regular menstrual cycle(28-30 days) .
7.2.4 Exclusion criteria
Nursing college students who are
· suffering from mild symptoms of premenstrual syndrome.
· on other interventions for premenstrual syndrome.
7.2.5 Instruments used
· Demographic Performa
· Modified Premenstrual Syndrome Rating Scale.
7.2.6 Data collection methods
· The investigator will obtain formal permission from the concerned authority.
· The purpose of the study will be explained to the students and informed written consent will be obtained from them.
· Demographic Performa will be collected.
· Assess the severity of premenstrual syndrome by the administration of modified premenstrual syndrome rating scale to all the students.
· Identify the students who have moderate and severe symptoms of premenstrual syndrome.
· Administer reflexology from the 4th day of menstruation and continues for four weeks to the students who have moderate and severe symptoms of premenstrual syndrome.
· The effectiveness of reflexology on pre menstrual syndrome will be assessed by using modified premenstrual syndrome rating scale on next menstrual cycle.
7.2.7 Data analysis plan
· Demographic data will be analysed using descriptive statistics such as percentage mean, median and standard deviation.
· Effect of reflexology on premenstrual syndrome will be analysed by paired “t” test.
· Chi-square test will be used to find out association between pre test intervention premenstrual syndrome score and selected demographic variables of nursing students.
7.3 Does the study require any investigations or interventions to be conducted on
Patients or other humans or animals?
Yes.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes. Ethical clearance will be obtained from the institutions.
· Formal administrative permission will be obtained from concerned authorities.
· Informed written consent will be obtained from participants
REFERENCES:
1. Anson, O. Gender differences in health perceptions and their predictors: Social Science & Medicine. (1993). 36, 4. doi:10.1016/0277-9536(93)90404-R
2. Freeman EW. Premenstrual syndrome and premenstrual dysphoric disorder: definitions and diagnosis. Psychoneuroendocrinology. 2003. August; 28 (supl3):25-37.
3. Tenkir A, Fisscha N, Aycle B. Premenstrual syndrome: prevalence and effect on academic and social performance of students. African Journal of Health development 2002;17(3)181-188.
4. Frackiewiz EJ , Shiovitz TM. Evaluation and management of premenstrual syndrome premenstrual dysphoric disorder. J AM Pharm Association.2001 4:437-447.
5.premenstrual syndrome (internet).available from: http://pre-menstrualsyndrome-pms.blogspot.com/
6. Kunz K, Kunz B. The Complete Guide to Foot Reflexology (Revised). Albuquerque, NM: Reflexology Research, 1993
7. Christine S, Clekner SM, Doughty A,Geoseman J premenstrual symptoms: prevalence and severity in an adolescent sample. Journal of adolescent health 1998:22(5); 403-408.
8. Antai. AB Udizia,EK anem E, okon U Umoiyono A. PM syndrome:prevalence in students of university of Calbar, Nigeria.
9. Oleson T, Flocco W. Randomized controlled study of premenstrual symptoms treated with ear, hand, and foot reflexology. Obstet Gynecol 1993 Dec;82(6):
906-11.
10. Lee YM. Effect of self-foot reflexology massage on depression, stress responses and immune functions of middle aged women. 2006 Feb;36(1):179-88.
11.Won JS, Jeong IS, Kim JS, Kim KS.,"Effect of Foot Reflexology on Vital Signs, Fatigue and Mood in Cancer Patients receiving Chemotheraypy," J Korean Acad Fundam Nurs. 2002 Apr;9(1):16-26. Korean.
12.Zhixing Wu Foot reflexology in the treatment of hypermenorrhea. Massage Therapy Journal 2002 Mar:8(6):20-22
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