RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA.

1 NAME OF THE CANDIDATE AND ADDRESS

Ms. BINCY BABU

1st YEAR M.Sc. NURSING STUDENT,

N.D.R.K. COLLEGE OF NURSING

B.M. ROAD HASSAN, KARNATAKA.

2 NAME OF THE INSTITUTION

N.D.R.K. COLLEGE OF NURSING, B.M. ROAD,

HASSAN, KARNATAKA.

3 COURSE OF STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSING

(OBSTETRICS AND GYNAECOLOGICAL NURSING)

4 DATE OF ADMISSION TO THE COURSE

15/06/2010

5 TITLE OF THE TOPIC “EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING

NATURAL REMEDIES FOR DYSMENORRHEA

AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH

SCHOOL HASSAN, KARNATAKA”

5.1 STATEMENT OF THE PROBLEM

“A STUDY TO EVALUATE THE

EFFECTIVENESS OF STRUCTURED TEACHING

PROGRAMME ON KNOWLEDGE REGARDING

NATURAL REMEDIES FOR DYSMENORRHEA

AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH

SCHOOL HASSAN, KARNATAKA”

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

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6 BRIEF RESUME OF INTENDED WORK

6.1 INTRODUCTION

“The god of heaven, who created us, has given us the simple things of nature for our healing, so we

should help our self with those natural remedies and try to bring back the sunshine into our life”1

The term adolescent comes from a Latin word “Adalescere” which means “to grow up”.

Within this development phase, physical, social and psychological issues are interwoven that

create unique characteristic, behaviors and needs. Adolescence seems to be a chaotic and at the

same time a vibrant period of human life. 2

According to Wolman, “adolescence is a transitional stage of development between

childhood and adulthood”. Inception of puberty declares the attainment of adolescence. Boys and

Girls face it entirely differently. Girls their reproductive system changes , they become hairy, voice

shrinks, lots of pimple on face and above all there is a onset of menstruation and it brings with it

menstrual cramps; which are known medically as dysmenorrhea. 2

Menarche is the transitional phase of life in girls. Young girls secrete small, rather constant

amounts of estrogen, a marked increase occurs between the 8-11yrs of age. More over increase

amount and variations in gonadotrophin and estrogen secretions develop into a cyclic pattern at

least a year before menarche or the first menstrual period.2

Menstruation is a periodic uterine bleeding that begins with the shedding of secretary

endometrium approximately 14 days after ovulation. Dysmennorhea or menstrual pain is the pain

in the lower abdomen before or during menstruation. The pain sometimes radiates to the lower

back or thigh area. Other symptoms may include nausea, loose stools, sweating, and dizziness.

During a woman's menstrual cycle, the endometrium thickens in preparation for potential

pregnancy. After ovulation, if the ovum is not fertilized and there is no pregnancy, the built-up

uterine tissue is not needed and thus shed. 2

Molecular compounds called prostaglandins are released during menstruation, due to the

destruction of the endometrial cells, and the resultant release of their contents. Release of

prostaglandins and other inflammatory mediators in the uterus cause the uterus to contract. These

substances are thought to be a major factor in primary dysmenorrhea. When the uterine muscles

contract, they constrict the blood vessels to the tissue of the endometrium, which, in turn, breaks

down and dies. These uterine contractions continue as they squeeze the old, dead endometrial

tissue through the cervix and out of the body through the vagina. These contractions, and the

resulting temporary oxygen deprivation to nearby tissues, are responsible for the pain or "cramps"

experienced during menstruation. 3

There are two types of menstrual cramps: Primary and secondary dysmenorrhea. Primary

dysmenorrhea which usually starts within several years after your first menstrual periods,

involves no physical abnormality. Hormone like substances called prostaglandins, which are

produced naturally in the body are thought to cause this cramps and be responsible for the pain and

inflammation. Secondary Dysmenorrhea, on the other hand, has an underlying physical cause such

as endometriosis, pelvic inflammatory disease, uterine fibroids, and uterine polyps. 3

Drugs are any supplement that contains chemicals or unnatural substances which alters our

brain chemistry, hormones or mentality. The point is that it triggers our brain into not sending

communications to our nerves; this allows us to think that everything is fine when it may not be.

Drugs have chemicals that fluctuate the actual chemical balance in the brain. This will often

subside your symptoms but will rarely fix it. Natural remedies do not alter hormone balance,

change chemical level in the brain or tricks your body. They are not synthetic or manmade; they

are simply from earth and are here to help with problems that we face. 4

Many girls describe dysmenorrhea as a “monthly dread” because their experience with it is

worse. Medicines which we take usually include NSAIDs. They provide symptomatic relief but

have increasing adverse effects with long term use. NSAIDs can have side effects of nausea,

dyspepsia, peptic ulcer, and diarrhea. Natural remedies do not alter our body mechanism and has

no adverse effects. People have been using herbs and plants as medicine since dawn. Prescription

drugs are fairly a new concept in terms of last century. For thousands of years many problems have

been fixed and cured by natural remedies. Scientist .has tried to duplicate natural remedies by way

of chemical and hormonal elements. Natural remedies are not only much safer than using drugs but

also a lot cheaper and above all nothing can get any simpler than these remedies. 4

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6.2 NEED FOR STUDY

“Adolescence is a period of storm and stress”

G. Stanley Hall4

“Human development process”, is the most mysterious part, nature has ever created.

Everyone agrees with it. While passing through the various stages under this “development

process”, adolescence perhaps is the most complicated phase, we ever experience. Bodily changes,

adjustment with the peer groups and many other things causes havoc in the adolescence period.

Both sexes have to cope up entirely differently. In girls there is onset of menstruation with it

comes the deadly menstrual cramps or dysmenorrhea.4

Dysmenorrhea can feature different kinds of pain, including sharp, throbbing, dull,

nauseating, burning, or shooting pain. Dysmenorrhea may precede menstruation by several days or

may accompany it, and it usually subsides as menstruation tapers off. Dysmenorrhea may coexist

with excessively heavy blood loss, known as menorrhagia. The main symptom of dysmenorrhea is

pain concentrated in the lower abdomen in the umbilical region or the suprapubic region of the

abdomen. It is also commonly felt in the right or left abdomen. It may radiate to the thigh and

lower back. Other symptoms may include nausea and vomiting, diarrhea or constipation, headache,

dizziness, disorientations, hypersensitivity to sound, light, smell and touch, fainting, and fatigue.

Symptoms of dysmenorrhea often begin immediately following ovulation and can last until the end

of menstruation. This is because dysmenorrhea is often associated with changes in hormonal levels

in the body that occur with ovulation. 5

Typical menstruation in adolescence includes moderate to severe pain in association with

a high number of menstrual symptoms, school absence and interference with life activities. It

should be effectively managed to minimize menstrual morbidity. In a cross sectional study done in

senior high school on girls aged between 15 and 19yrs a typical menstruation includes pain (93%),

cramping (71%), pre menstrual symptoms (96%) and mood disturbances (23%). This interferes

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with life activities and school absence. 36% of the girls missed schools during menstruation. The

report indicated moderate to high interference with four out of nine life activities. 6

For a quick relief from these menstrual cramps girls usually take NSAIDs or birth control

pills it will definitely cause side effects which might affect her future. A 2001 systematic review

found that no conclusions can be made about the efficacy of commonly used modern lower dose

combined oral contraceptive pills for primary dysmenorrhea. Norplant and Depo-Provera are also

not effective, since these methods often induce amenorrhea. A 2008 systematic review found

promising evidence for Chinese herbal medicine for primary dysmenorrhea. A double-blind,

controlled study indicated that treatment with an extract of guava leaf resulted in significant

reduction of symptoms. So, if from the starting itself we switch on to natural remedies it is

definitely going to alleviate the menstrual cramps or as we call it “The Deadly Dysmenorrhea”. 7

These natural remedies include:

EXERCISE - It relives cramps because it helps release beta- endorphins which are internal opiods

one’s own “human morphine”. It produces analgesia (pain relief) and helps to burn prostaglandins,

chemicals released during menstruation that cause muscle contraction much faster. 8

DIETARY PATTERN- If we talk about diet whole grain breads, pasta and cereals, fibers and

proteins and other carbohydrates helps reduce pain. Calcium has to be included in diet as it tends

to stabilize muscle tone. Fish oil also helps as two compounds eicosapentaenoic acid

docosahexenoid acid decrease prostaglandin levels. 9

AROMATHERAPY-A practice of using volatile plant oils for psychological and physical well-

being. They stimulate brain function and also absorbed through skin, where they travel through the

blood stream and promote whole body healing. As applied topically they do not alter metabolism.

The oils are not used in undiluted form. 10

HEATING PADS – It can be used as it dilates the blood vessels and relives from pain. If there is a

build up of blood in the pelvic region that is causing the pain, the application of ice is more

appropriate. 11

ACCUPRESSURE- It is a traditional healing practice that is based on the same principles as

acupuncture. Instead of applying needles to acupuncture points, pressure is applied. A point that

is often recommended by acupuncturists for menstrual cramps is called spleen -6. It is a simple

home remedy. 12

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These type of natural remedies can be applied in any setting by any persons, and require no

special training. So I want to educate the adolescence girls regarding natural remedies for

dysmenorrhea for dysmenorrhea through STP.

6.3 STATEMENT OF PROBLEM

“A STUDY TO EVALUATE THE EFFECTIVENESS OF STP ON KNOWLEDGE REGARDING NATURAL REMEDIES FOR DYSMENORRHEA AMONG ADOLESCENT GIRLS IN CKS GIRLS HIGH SCHOOL, HASSAN, KARNATAKA”.

6.4 OBJECTIVES OF THE ST UDY:-

1. To assess the knowledge of adolescence girls in experimental and control group regarding

natural remedies for dysmenorrhea before giving Structured Teaching Programme.

2. To develop and administer Structured Teaching Programme regarding natural remedies for

dysmenorrhea to adolescent girls in the experimental group.

3. To assess the knowledge of adolescence girls in experimental and control group regarding

natural remedies for dysmenorrhea after the administration of structured teaching

programme.

4. To compare the pretest and posttest knowledge in experimental and control group.

5. To associate the pretest and posttest knowledge of adolescent girls regarding natural

remedies for dysmenorrhea with selected demographic variable(age, education, media,

income, religion, magazine)

6.5 HYPOTHESIS

NULL HYPOTHESIS

Ho: There will not be any significant difference between the pretest score and posttest

knowledge score regarding natural remedies for dysmenorrhea among the experimental group.

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RESEARCH HYPOTHESIS

H1: There will be a significant difference between the pretest score and posttest knowledge

score regarding natural remedies for dysmenorrhea among the experimental group.

H2: There will be significant association between knowledge scores (pretest, posttest) with

selected demographic variables.

6.6 ASSUMPTIONS

1. STP will improve the knowledge of adolescence girls regarding Natural remedies for

dysmenorrhea.

2. Adolescent girls will use this knowledge in the future to manage dysmenorrhea.

3. Natural remedies does not cause any side effects as compared to medications

6.7 OPERATIONAL DEFINITIONS

EVALUATE-It refers to the process of judging or determining the worth or quality. In this study it

refers to the effectiveness of Structured Teaching Program by judging or determining the worth

regarding natural remedies for dysmenorrhea in adolescent girls

EFFECTIVENESS- It refers to improvement in the knowledge scores of adolescent girls

regarding natural remedies for dysmenorrhea after giving STP.

STRUCTURED TEACHING PROGRAM- It refers to set of systematically organized

instructions and discussions related to natural remedies for dysmenorrhea.

KNOWLEDGE- It refers to state of knowing and understanding of adolescent girls regarding

natural remedies for dysmenorrhea.

ADOLESCENT GIRLS- It refers to girls in the age group of 12-16years studying at CKS girl’s

high school, Hassan, Karnataka.

NATURAL REMEDIES-A therapeutic or preventive health care practice that are not practiced

in traditional medicinal communities and offer treatment that differ from standard medical

practice. In this study it refers to the exercise, dietary pattern, aromatherapy, heating pads and

acupressure.

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DYSMENORRHEA- It refers to the pain or discomfort associated with menstruation.

6.8 CRITERIA FOR SAMPLE SELECTION

Inclusion criteria

The study will include adolescent girls who are

Aged above 12yrs and below 16yrs studying in CKS girls’ high school.

Have attained menarche.

Present during the study

Exclusion criteria

The study will not include adolescent girls who are

Aged below 12yrs and above 16yrs studying in CKS girls high school

Have not attained menarche

Not present during the study

.

6.9 LIMITATIONS OF THE STUDY

Study is limited to:

1. Adolescent girls aged between 12- 16yrs.

2. Sample size of 60

3. Period of 4-6 weeks

6.10 SIGNIFICANCE OF THE STUDY

Drugs are any supplement that contains chemicals or unnatural substances which alters our

brain chemistry, hormones. Drugs have chemicals that fluctuate the actual chemical balance in the

brain, they often subside the symptoms. Natural remedies do not alter hormone balance or change

chemical level in the brain. They are simply from earth and are here to help with problems that we

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face. So this study signifies the importance of imparting knowledge to adolescent girls regarding

natural remedies for dysmenorrhea.

6.11 CONCEPTUAL FRAMEWORK

Conceptual framework based on DOROTHEA .E. OREMS THEORY is planned for this

study.

6.12 REVIEW OF LITERATURE:-

Literature review is based on extensive survey of books, journals and internet search on the

related topics of research study. Review of literature is a systematic identification, location,

scrutiny and summary of written materials that contain information on research problem 13

A single blind randomized experimental study was conducted to examine the effects of

acupressure on menstrual distress in adolescence girls. Two instruments were used to collect data:

The visual analogue scale, the menstrual distress questionnaire scale. Girls received acupressure

intervention protocol for 20 mins and the control group didn’t receive any acupressure

intervention.During the six month follow up, acupressure reduced the pain, distress and anxiety

typical of dysmenorrhea.This controlled trial provides that acupressure therapy provides female

adolescents with dysmenorrhea benefits. 14

A quasi experimental study was done in university of Auckland, New Zealand on exercise

for dysmenorrhea. A search was conducted by using the methodology of the menstrual disorders

and sub fertility group. The selection criteria included randomized controlled trials comparing

exercise with a control or no intervention in women with dysmenorrhea. Trials were independently

selected and data extracted by two review authors They assessed the evidence for the effectiveness

of exercise in the treatment of dysmenorrhea.There appeared evidence from trial that exercise

reduced the menstrual distress and sustained decrease in symptoms over 3 observed cycles. 15

A Randomized placebo controlled trial study was conducted in Public Health College,

iksan; Korea the purpose was to explore the effect of aromatherapy on menstrual cramps in college

students. The subjects were 67 female college students who rated their menstrual cramps to be

greater on a point visual analogue scale. Subjects were randomized into three groups. 9

Aromatherapy was applied topically to the experimental group in the form of an abdominal

massage using one drop of lavender and rose in 5cc of almond oil. The Placebo group received the

same treatment with almond oil and the control group received no treatment. The menstrual

cramps were significantly lowered in the aromatherapy group than in the other two groups. These

findings suggest that aromatherapy is effective in decreasing the severity of menstrual cramps. . 16

A cross-sectional study was conducted by department of epidemiology and preventive

medicine, regarding intake of soy, fat, and dietary fiber and their biological effects on estrogen and

progesterone production and also the severity of menstrual pain. A total of 276 women’s from

three colleges and two nursing schools were selected. Intake of nutrients and foods including soy

products, fats and dietary fiber were estimated by a validated semi quantitative food frequency

questionnaire. The results proved that there is a marked improvement in menstrual pain. 17

A study was done to determine the frequency of dysmenorrhea in adolescence age and

investigate the correlation between menstrual factors and dietary habits and its pathology. The

sample was constituted from 356 students that were subjected to questionnaire, abdominal

ultrasound, and hormonal dosing. The frequency of dysmenorrhea was 85%.As far as dietary

habits, it was noted that a higher consumption of fish, eggs, fruits, and wine is correlated with a

lower frequency of dysmenorrhea. 18

A study was done in the Department of nursing, faculty of health sciences Ataluck

University. The purpose of the study was to investigate the effectiveness of aromatherapy on

dysmenorrhea. It was a quasi - experimental study the participants applied both aromatherapy with

lavender oil and placebo massaged with liquid petroleum and it was tested with the help of visual

analogue scale. Results show that aromatherapy was effective for reducing dysmenorrhea.19

A cross sectional study with 1092 girls from 15 public secondary schools and 3 ethnic

groups were taken. Study was done in university of Malaya, Kuala Lumpur to determine the

prevalence of dysmenorrhea, its impact and treatment behavior of adolescent girls. Overall 74.5%

of the girls who had reached menarche had dysmenorrhea;51.7% of these girls reported that it

caused them to miss school; and 12% said that it caused poor school performance.. The result

showed that their is a need for specific education regarding menstruation and its management in

the school. 20

A study was done in Japan to test the efficacy of heat and steam for the relief of symptoms

of dysmenorrhea in young women. Thirty four female university students were enrolled in the

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study. Subjects documented symptoms of dysmenorrhea on a self recording form using 4 score

scale. They were told to apply heat on the abdomen or lumber region for 1-2hrs on the first,

second, and third days of menstruation. By applying heat subjects felt relief of abdominal pain.

The results showed that heat and steam pads are useful non-pharmacological methods to relieve

symptoms of dysmenorrhea. 21

A randomized control study was done to compare exercise with a control or no intervention

in women with dysmenorrhea. The search was conducted using the methodology of the menstrual

disorder and sub fertility group. Trials were independently selected and data extracted by two

review authors. It was found that the women’s, who underwent exercise regimen got relief from

cramping, lower abdominal pain. Physical exercise has been suggested as a non- medical approach

to the management of dysmenorrhea.22

A prospective daily reporting study examined the relationship between exercise

participation and menstrual pain, physical symptoms and negative mood. The women’s who

participated in exercise reported less pain and a conclusion was made that those who undergo

moderate exercise regimen reported to have less menstrual cramps. 23

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCES OF DATA

This data will be collected from the adolescent girls who are aged between 12-16yrs

studying in CKS girl’s high school, Hassan, Karnataka.

7.2 RESEARCH DESIGN

A Quasi- experimental design is planned for the research study.

Schematic plan of the study

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Key words

O1 = Pretest knowledge regarding natural remedies for dysmenorrhea.

X = Structured teaching programme on natural remedies for dysmenorrhea

O2 = Post test knowledge regarding natural remedies for dysmenorrhea.

_ = No intervention.

No Randomization.

7.3 METHOD OF DATA COLLECTION

Structured questionnaire regarding natural remedies for dysmenorrhea.

7.4 SAMPLING PROCEDURE

1. Population – Adolescent girls 12-16yrs studying in CKS girls’ high school, Hassan,

Karnataka.

2. Sample - Adolescent girls between the age group of 12-16yrs, who fulfilled the

inclusion criteria.

3. Sample size -.60.

4. Sampling technique – Non probability convenient sampling method

5. Research setting- The present study will be conducted in CKS girls’ high school,

Hassan, Karnataka.

EXPERIMENTAL GROUP

O1 X

O

2

CONTROL GROUPO1 _

O2

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8. VARIABLES

Independent variable - Structured teaching programme regarding natural remedies for

dysmenorrhea

Dependent variable - Knowledge of girls regarding natural remedies for dysmenorrhea.

Extraneous variable - Age, education, income, religion, source of information

(Media,magazine).

9. PLAN FOR DATA ANALYSIS

Descriptive and inferential statistics is planned as follows.

Descriptive statistics:

To describe knowledge and sociodemographic variables in number[n], frequency[f],

percentage[%], mean and standard deviation[SD]

Inferential statistics:

To associate the sociodemographic variables with knowledge using chi-square test.

To find out the significant difference between both pretest and post test knowledge score

using paired’t test.

10. PILOT STUDY

10% of sample size is planned for the pilot study.

11. ETH ICAL CONSIDERATION

1. Does the study require any intervention to be conducted on adolescent girls studying in CKS

girls’ high school?

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Yes

2. Does ethical clearance will be obtained from your institution?

Yes

3 Does the consent will be taken from the CKS girls’ high school?

Yes

12. LIST OF REFERENCES (VANCOUVER STYLE)

1. www.google.com

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2. Irene M Bobak and Margaret Duncan Jensen, “Maternity and gynecological care”; 5 th edn,

Published by Mosby, Page No 1018-1019.

3. Adele Pillitteri, “Maternal and child health nursing, Care of the child bearing and child rearing

family”, 4th edn, Published by Lippincott Williams and Wilkins, Page No 905-910

4. Rashmi Barua, “Adolescence- A period that really matters”; Sept 24 2008, ezinearticles.com.

5. Melissa Conrad Stoppler, “Menstrual cramps (Dysmenorrhea)”; 1996-2010 Medicine. Net.Inc

6. Parker MA, Sneddon AE, Arbon P, “The MDOT study: determining typical menstrual patterns

and menstrual disturbance in a large population based study of Australian teenagers”; Department

of Australian Capital Territory, Jan.2010

7. Zhu X, Proctor M, Wu E, “Chinese herbal medicine for primary dysmenorrhea”; Cochrane

database of systemic reviews 2008, Oct 17 2007.

8. Liu Yung Ye Beatrice, “Exercise for dysmenorrhea”; Aug 6, 2001.

9. Womenshealth.about.com.

10. Einav Keet, “Aromatherapy massage for menstrual pain”; Natural solution magazine, Nov 7

2008

11 Roger P Smith, Andrew M Kaunitz, “Patient information: Painful menstrual periods

(Dysmenorrhea)” www.acog.org.

12. Ehow Contributor, “How to treat menstrual cramps with acupressure”; www.ehow.com.

13. Wiki.answers.com

14. Chen HM, Chen CH, “Effects of acupressure on menstrual distress in adolescent girls”; Chung

Hwa University of Medical Technology, Tainan, Taiwan

15. Brown J, Brown S, “Exercise for Dysmenorrhea”; Obstetrics and Gynecology, University of

Auckland, FMHS, Auckland, New Zealand, 2010 July

16. J Altren, “Effect of aromatherapy on symptoms of dysmenorrhea in college students”; Wong

Wang Public Health College, Iksan Korea, 2006 July-August Page 535-541.

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17. C Nagata, “Association of menstrual pain with intakes of soy, fat and dietary fiber in Japanese

women”; Department of Epidemiology and Preventive Medicine,Gifu University Graduate School

of Medicine, 29 June 2004.

18. Carlo   Balbi , Rosalia   Musone , Agostino   Menditto , Luigi   Di Prisco , Eufemia   Cassese ,

Maurizio   DAjello , M.D et al, “Influence of menstrual factors and dietary habits on menstrual pain

in adolescence age”; Volume 97 Pages 143-148, August 2000

19. Serap Ejdar Apay , Sevban Arslan,”Effect of aromatherapy massage on dysmenorrhea in

Turkish student”Department of nursing, Faculty of health sciences, Ataturk University, Erzurun,

Turkey,22 April 2010.

20. Wong LP,Khoo EM , “Dysmenorrhea in a multiethnic population of adolescent Asian girls”;

Medical Education and research development Unit, University of Malaya, Kuala Lumpur, 2010

Jan.

21. Dr Takayoshi Hosono, “Effects of a heat and steam generating sheet on relieving symptoms of

primary dysmennorhea in young women”; Department of Biomedical Engineering, Journal of

Obstetrics and Gynecological Research Vol:36, No: 4, August, 2010 Page 818 -824.

22. Maryam Rostami, Zahra Abbaspour, Shahnaz Najjar, “Effect of exercise on Dysmenorrhea”

Azad University of Iran, Behbahan Iran

23. Mindy High Tower BA, “Effects of exercise participation on menstrual pain and symptoms”;

Women and Health, Vol 26(4) 1997.

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