RAJIV GANDHI UNIVERSITY OF HEALTH

SCIENCES, BANGALORE,KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

MS.V.VEDHASELVII YEAR M. Sc NURSING,

COMMUNITY HEALTH NURSING(2008 –10 BATCH)

VARALAKSHMI COLLEGE OF NURSING ,# 19, KIADB ROAD, CHOKKASANDRA,

T. DASARAHALLI,BANGALORE -560057

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCE,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

1NAME OF THE

CANDIDATE AND ADDRESS

MS.V.VEDHASELVII YEAR M.Sc NURSINGVARALAKSHMI COLLEGE OF NURSING NO19,KIADB ROAD,CHOKKASANDRAT.DASARAHALLIBANGALORE -560057

2 NAME OF THEINSTITUTION

VARALAKSHMI COLLEGE OF NURSING NO19,KIADB ROAD,CHOKKASANDRAT.DASARAHALLIBANGALORE -560057

3 COURSE OF STUDY AND SUBJECT

MASTER DEGREE OF NURSING,COMMUNITY HEALTH NURSING.

4DATE 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

United States ,its impaction ,acadamic performance ,school attendance ,sports and social

activities and its management.  Dysmenorrhea is highly prevalent among Hispanic

adolescents and is related to school absenteeism and limitations on social, academic, and

sports activities. Given that most adolescents do not seek medical advice for

dysmenorrhea, health care providers should screen routinely for dysmenorrhea and offer

treatment. As dysmenorrhea reportedly affects school performance and attendance, school

administrators may have a vested interest in 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 menstrual disorders on daily routine among unmarried undergraduate medical

students and their treatment-seeking behavior of 276 undergraduate girl students, 112

were sampled by stratified random sampling. All the consenting participants were given a

pretested semistructured questionnaire to collect their responses by personal interviews.

Premenstrual syndrome (67%) and dysmenorrhea (33%) were perceived by the study

subjects as the most distressing problems associated with menstruation. The most

common effect of menstrual problems on daily routine reported by the study subjects was

in the form of prolonged resting hours (54%) followed by inability to study (50%). More

than half (52%) of the subjects discussed their problems with their mother, and 60% of

the study subjects were opted for allopathic treatment 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 2 df = 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 Hispanic adolescents and is related to school absenteeism and

limitations on social, academic, and sports activities. Among participants who had had a

period in the previous 3 months, 85% reported Dysmenorrhea. Of these, 38% reported

missing school due to Dysmenorrhea during the 3 months prior 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 pain was significantly associated

with school absenteeism and decreased academic performance, sports participation, and

socialization with 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:

6.3.1 To assess the knowledge level regarding home remedies of Dysmenorrhoea

among Adolescence girls selected rural community area at Bangalore in

terms of pre test score.

6.3.2 To develope the Self Instructional Module on home remedies of

Dysmenorrhoea.

6.3.3 To assess the effectiveness of Self Instructional Module on home remedies of

Dysmenorrhoea among rural adolescence girls by comparing pre and post test

knowledge score.

6.3.4 To determine the association between the selected demographic variables

and knowledge regarding home remedies of adolescence girls

in selected rural community area.

6.4 HYPOTHESIS:

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 limited to 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 Health About 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-

hong,2000;7(8): 1449-1455.

4. Nair Parvathy, Grover Vijay L, Kannan AT. Awareness and practices of menstruation

and pubertal changes amongst unmarried female adolescents in a rural area of East

Delhi. Indian Journal of Community Medicine, April 2007 ;32 ( 2): 2007-08

5. D.Durain Primary dysmenorrhea: Assessment and management update .  Journal of

Midwifery & Women's Health. 49; (6):520 – 528

6.Chantay Banikarim, MD; Mariam R. Chacko, MD; Steve H. Kelder, PhD. Prevalence

and Impact of Dysmenorrhea on Hispanic Female Adolescents .Arch Pediatr Adolesc

Med. 2000;154:1226-1229.

7. Roger P. Smith, MD ,Heat Therapy ,www.female patient.com

8. Cheng JF, Lu ZY, Su YC, Chiang LC, Wang RY. A traditional Chinese herbal

medicine used to treat dysmenorrhoea among Taiwanese women .Journal of clinical

medicine .2008 Oct;17(19):2588-95s

9.Colleen O. Swank, MS , Carol A. Christianson, MS , Cynthia A. Prows, RN, MSN,

Elizabeth B. West, RNC, BSN , Nancy Steinberg Warren, MS.Effectiveness of a

Genetics Self-Instructional Module for Nurses Involved in Egg Donor Screening.

Journal of Obstetric, Gynecologic, & Neonatal Nursing.2008 June;30(6):617-625.

10 . Griffiths V. Traditional Chinese medicine: a case of dysmenorrhoea. Aust J holist

Nurse.2000Apr;7(1):42-3.

11. Proctor ML, Farquhar CM. Dysmenorrhoea. Clin Evid. 2006 , Jun;(15):2429-48.

12. Davies N,Gould D.Updating cardiopulmonary resuscitation skills: a study to examine

the efficacy of self-instruction on nurses' competence. J Clin Nurs.2000; 9:400-10

13. Artchuta Kameswararao Avasarala, Saibharghavi Panchangam.Indian journal of

community medicine,Dysmenorrhoea in different settings: Are the rural and urban

adolescent girls perceiving and managing the dysmenorrhoea problem differently? ,

2008 ;33 ( 4 ): 246-249.

14. Anamika Sharma, MBBS ,Devender K. Taneja, MBBS, MD,Pragya Sharma,

MBBS, MD,Renuka Saha, MSc Problems Related to Menstruation and Their Effect

on Daily Routine of Students of a Medical College in Delhi, India, 2008

Asia-Pacific Journal of Public Health. 2008;20(3) :234-241

15. www.whobulletien 1999;(5):13-15

9. SIGNATURE OF THE STUDENT :

10. REMARKS OF THE GUIDE : This study is apt study for the researcher to study about the home remedies of Dysmenorrhoea.

11 NAME AND DESIGNATION OF

11.1. GUIDE : Mrs. Amudha. Assot. Professor, Department of Community Health Nursing Varalakshmi College of Nursing Bangalore 11.2 SIGNATURE:

11.3 HEAD OF THE DEPARTMENT : Mrs.Amudha HOD, Associate Professor, Department of Community Health Nursing Varalakshmi College of Nursing Bangalore

11.4 SIGNATURE :

12.REMARKS OF PRINCIPAL : The Topic chosen by the researcher is appropriate to help the Adolescence girls.

12.1 SIGNATURE :