RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION 1. NAME OF THE CANDIDATE AND ADDRESS Ms. JEENA ALICE IYPE GOUTHAM COLLEGE OF NURSING, MANJUNATHNAGAR, WEST OF CHORD ROAD, RAJAJINAGAR,BANGALORE 10. 2. NAME OF THE INSTITUTION GOUTHAM COLLEGE OF NURSING, MANJUNATHNAGAR, WEST OF CHORD ROAD, RAJAJINAGAR, BANGALORE 10. 3. COURSE OF STUDY AND SUBJECT M.Sc. NURSING I YEAR OBSTETRICS AND GYNAECOLOGICAL NURSING 4. DATE OF ADMISSION TO COURSE 5. TITLE OF THE TOPIC A QUASI EXPERIMENTAL STUDY TO ASSESS THE EFFECTIVENESS OF COPING STRATEGIES ON TRIDIMENSIONAL PROBLEMS AMONG PREMENOPAUSAL WOMEN IN URBAN COMMUNITY, BANGALORE. 30.05.2007

6. 6.1.

BRIEF RESUME OF THE INTENDED WORK: NEED FOR THE STUDY:

The cyclical period of menstruation of a female ceases at the attainment of menopause. The physiological, emotional, psychological experience that every female undergo is innumerable. These changes are explicit well ahead of menopause. perimenopause is the phase in a womens life just before the onset of menopause, which is often a females menstrual cycle permanently ceases. The average age for women to begin experiencing premenopausal symptoms is 45, but women as young as 25 and as old as 70 can also exhibit signs of premenopause. The length of premenopause varies from women to women but typically lasts for 1 to 6years. Majorities of premenopauseal women experience changes in their menstrual cycle. Some women begin to have longer cycles and less frequent periods while some women even skip periods.1

Menopause is a time of both physical and psychological changes. Physical symptoms such as hot flashes, night sweats, weight gain, headache, vaginal dryness, and breast tenderness and sleep problems.2 Premenopause can also trigger a variety of emotional changes including anxiety, irritability, depression and a sudden inability to handle stress. These factors will affect the social life of the women. . These symptoms begin from premenopausal period itself. Different women behave differently to these changes and their coping level also different. 3

In the developed world mean life expectancy for women, since 1990 has increased from 50 to 81 years. The percentages of symptoms in USA are 77.9% mood swings, 75.9% decrease in energy, 73.4% sleeping disturbance, and 67.1% memory problems.4 In India percentages of symptoms are, fatigue and lack of energy 72.93%, headache 55.9%, hot flashes 53.86%, and weight gain 43.13%. In Karnataka, loss of interest 93%, pressure tightness in head 83%, and weight gain 67%, hot flashes 54%, insomnia 20.6%. 5

A study conducted to find the risk factor and symptomlogy of perimenopausal depression. To investigate the characteristic clinical features of perimenopausal depression, a drug free control group consisting of 48 premenopausal women with a diagnosis of major depression was formed. Findings 2

of the study suggest that vasomotor symptoms and socio economical status do not predict the severity and existence of perimenopausal depression. Episodes of major depression are not necessarily the normal result of such vasomotor symptoms. Therefore, the evaluation and management of perimenopasal depression should be carried out as carefully as is done in episodes of depression seen in the rest of womens life span.6

A study conducted to find the coping strategies of a person with specific events. The COPE scales were used to measure relatively stable dispositional coping tendencies, COPE scale was not only used for coping disposition but also assume that the strategies under consideration are used to varying degrees from situation to situation. The COPE thus should be applicable to assessment of situational or timelimited coping efforts as well as dispositional coping styles. Result shows that people rating may have greater internal consistency when rating specific behavioral situations than when rating general tendencies.7

Family is a group of biologically related individuals living together and residing under same roof. In a family mother is a person who plays an important role for functioning, maintaining peace and harmony in the family. If mother fall sick the whole function of the family get disturbed. Menopause is one of the major changes that mother undergoes. Prior to menopause many women experience physical, emotional and social changes. This ultimately disturbs the family process. It is very important to give coping strategies to the mother so that she can cope with her problems and will be able to maintain the normal function of the family. Family members will be able to recognize the changes in the mother and will be able to adjust with the changing behavior. In the view of the investigators experience working in community area she noticed many premenopausal women whose coping strategies related to their problems are very low. Therefore the investigator wants to assess and administer coping strategies among premenopausal women which will increase the coping level of the women and also the family members.

6.2.

REVIEW OF LITERATURE: Review of literature for the present study has been organized under the following headings a) Studies related to physical problems in premenopausal women. A study conducted to examine reproductive health, use of estrogen, life style, experience of menopausal symptoms and work role related issue in a premenopausal women .The women received questionnaire covering socio demographic background reproductive health and gynecology characteristics, social and work role related issue as well as symptoms rating scale. They concluded that only vasomotor symptoms were significantly related to menopausal status. Psychosocial and life style variables as well as past or current reproductive health are more important determinants of womens psychological well being during transition to menopause than menopausal status.8 A study conducted on perception of women towards physiological problems faced during menopause .A sample of 30 married women between the ages of 39-50 years belonging to middle socio economic class. One group (n=14; 46.7%) had attain menopause and their menstrual period were stopped for at least 2 years and the other group (n=16; 53.33%) experienced irregular menstrual period and were undergoing menopausal changes. About 46.67% of the sample had attained menopause and the rest were undergoing it. Taking the last menstrual period as criterion, the age at menopause ranged from 38 years to 49 years with a median of 44.59 years .The exact age at which menopause occurs varies from population to population. It is generally stated that the average age at menopause falls between 40 to 50 years. In this present study the mean age at menopause was 44.59 years. They concluded that the menopause signals the end of a womens ability to reproduce. Therefore an understanding of menopause and how it causes changes in the womens body is not only relevant to the women but also to the providers of the health service.9

A study conducted to compare the prevalence and severity of sleep apnea between premenopausal and postmenopausal women to determine whether these 4

differences are affected by the body mass index (BMI) and neck circumference. Anthropometric measurement included height, weight and neck circumference. Sleep measurement included full nocturnal polysomnography. There were 797 premenopasal and 518 postmenopausal women. It was concluded that there might be functional rather than anatomic differences in the upper airway between premenopaual and postmenopausal women, Which may account for the observed differences in apnea prevalence and severity.10 b) Studies related to emotional problems in premenopausal women. A study conducted on the effects of pessimism trait anxiety and life stress on depressive symptoms in middle-aged women. The relative contributions of life stress, menopausal status and absence of stress on increase in depressive symptoms across 3 years were examined in a sample of 460 premenopausal women. The study confirms that middle-aged stress and both optimism and trait anxiety are important predictors of depressive symptoms during middle life.11 A study conducted on family and psychosocial heath status of mid working women .For this study 15 government recognized girls school of varanasi city were selected and lady in the age group 40-50 years were selected randomly from each school. Total number of subjects selected was 50(n=50). The collection of data was done during the year 2001-2002. They concluded that there is a need to pay proper attention during 40-50 years of age. Preferably working women requires more care due to her dual personality. It becomes difficult for her to manage all her activities with same efficiency as earlier, which may cause feeling of guilt, irritation, stress etc. Physical relaxation, emotional support and essential care are needed for healthy living. They should also think about some suitable modification in her life style and coping strategy. There is also need for a comprehensive study on various aspects of middle-aged women.12 c) Studies related to social problems in premenopausal women. A study conducted to find out the basis social process of the menopausal transition. Sixty one perimenopausal women experiencing changes in menstrual bleeding were interviewed by phone and were asked about the changes they were experiencing, how hey felt about the changes affected their cities. The result of this study emphases the need for a greater specificity in correlating womens feeling and behavior with particular changes as well as the need for a better understanding of the 5

ways in which social and cultural expectations influence womens feeling and behavior. 13 Researcher suggested that as a women nears menopause her relationship not just her hormones may also affect her sex life. Thats according to new studies on sexual dysfunction in women approaching menopause. The first study comes from researcher including John F Randolph Jr MD who studied an ethnically diverse group of nearly 3.300 women nearing menopause. The second study comes from researchers who included Clarisa Gracia MD, they studied sexual function and interest in more than 400 healthy women aged 35-45 years .The bottom lines from both studies say that hormones arent the only influence on womens sex life around the time of menopause motions and relationships may also matter.14 A study conducted on a prospective population based of menopausal symptoms. Objective was to identify symptoms that change in prevalence and severity during midlife and evaluate their relationships to menopausal status, hormonal levels and other factors .In a longitudinal population based study of 438 women observed for 7 years with an 89% retention rate. Annual measures included a 33-item symptoms checklist, psychosocial life style and health related patterns. Menstrual status, hormone uses blood level of follicle stimulating hormone and estradioal. They reported that although middle-aged women are highly symptomatic, the symptoms that appear to be specifically related to hormonal changes of menopause transition are vasomotor symptoms, vaginal dryness, and breast tenderness. Insomnia reflected bothersome hot flashes and psychosocial factors.15

d) Studies related to effectiveness of structured teaching programme. A study was conducted to assess the effectiveness of self instructional module on knowledge of health care providers regarding protection against hospital acquired infection. It reveals that mean score of subjects obtained for overall knowledge in pretest was 47.2 and 69.4 in the post test. The improvement mean score for overall knowledge was 22.2 with t value 13.21 which was statistically significant p<001. It showed that the module is effective.16 A study was conducted to evaluate the effectiveness of planned teaching 6

programme on selected aspects of reproductive health among the rural adolescent girls. Findings of the study shows that; in the pre test, 19.77% of the subjects had poor knowledge, whereas post test scores showed that 96.5% of the subjects had knowledge and 3.49% of the subjects had an average knowledge regarding reproductive health.. Thet value of 31.30 was significant at 0.0001 level of significance. Hence the research hypothesis is accepted. Thet test showed that there was statistically significant association between the knowledge of adolescent girls and selected demographic variables. The findings of the study reveal overall pre-test knowledge about reproductive health was poor. There was a need for planned teaching programme. Posttest results showed significant improvement in knowledge of reproductive health. This planned teaching programme is an effective method to increase the knowledge about reproductive health among rural 6.3. adolescents.17 STATEMENT OF THE PROBLEM: A quasi experimental study to assess the effectiveness of coping strategies on tridimensional problems among premenopausal women in urban community, Bangalore. 6.4. OBJECTIVES OF THE STUDY: 1. To assess the pretest level of coping on physical, emotional and social problem among premenopausal women. 2. To determine the effectiveness of coping strategies among premenopausal women by comparing pretest and posttest scores. 3. To explore the association between coping strategies and demographic 6.5. variables among the premenopausal women. OPERATIONAL DEFINITIONS: 1. Effectiveness refers to changes in the scores of coping level as determined by the difference in posttest scores with pretest scores. 2. Coping strategies refers to process of contending with life difficulties of premenopausal in an effort to overcome or work through them. 3. Tridimensional problems refers to the problems faced by the premenopausal women related to three dimensions of nursing care physical, emotional and social. 4. Premenopaual women refers to the women whose menstrual cycle permantly ceases are between the age group of 40 to 45 years. 7

6.6.

HYPOTHESIS: H1: There will be significant difference between the scores of coping level among the subjects exposed to teaching than those who are not exposed.

6.7.

ASSUMPTIONS: 1. Premenopausal women will be able to identify physical, emotional and social problems. 2. Premenopausal women will be willing to express their knowledge related to the problem. 3. Premenopausal women vary in the coping ability.

6.8.

DELIMITATIONS: 1. The study is delimited to physical, emotional and social dimensions. 2. The effectiveness of coping strategies is measured only once in the post test.

6.9.

PROJECTED OUTCOME: 1. The study will help the premenopausal women to get prepared for menopausal changes. 2. The study will generate new and potentially more cost effective teaching methods and their effect on premenopausal learning outcome and behavior including the transfer of knowledge.

7. 7.1

MATERIALS AND METHODS SOURCE OF DATA

Premenopausal women of age group of 4045years, Bangalore.

7.2

METHODS OF COLLECTION OF DATA

7.2.1 .

SAMPLE CRITERIA: INCLUSION CRITERIA Women: 1. Between the age group of 4045years. 2. In the urban community. 3. Who will give consent for the study. 4. Able to understand and speak English or Kannada. EXCLUSION CRITERIA Women: 1. Not willing to participate in the study. 2. Attained menopause. 3. In the rural community area. 4. Cannot understand and speak English or Kannada.

7.2.2 . 7.2.3

RESEARCH DESIGN

The research design adopted for the study is Quasi Experimental design

VARIABLES UNDER STUDY: INDEPENDENT VARIABLE DEPENDENT VARIABLE ATTRIBUTE VARIABLE Age, parity, socioeconomic condition, and education. Study will be conducted in the selected urban community. SAMPLING TECHNIQUE The sampling technique adopted for the study is Convenience sampling technique. 9 Tridimensional problems Coping strategy.

7.2.4 . 7.2.5 .

SETTING

7.2.6 .

SAMPLE SIZE

The proposed sample size of the study is 40. Both experimental and control group comprising of 20 each.

7.2.7 .

TOOLS OF RESEARCH

Structured questionnaire related to coping strategies will be developed by the investigator from review of literature and expertise opinion. The same tool is used for pre test and post test.

7.2.8 .

COLLECTION OF DATA

The investigator following the survey in urban community will administer the structured questionnaire tool to assess pretest knowledge of coping strategies related to physical, emotional and social problems. Following it a planned teaching on coping strategies will be given to premenopausal women. Subsequently post test using the same structured questionnaire is administered after four days. The

7.2.9 .

proposed study duration is of 30 days. METHODS OF DATA ANALYSIS The investigator will analyze the data AND PRESENTATION obtained by using descriptive and inferential statistics. The plan of data analysis will be as follows: 1. Organize the data in a master sheet/ computer. 2. Assessing the pretest coping strategies women 10 on will premenopausal interpret by

descriptive statistics such as

mean. 3. Effectiveness and control of group coping will be strategies between experiment analyzed byt test. 4. Association of coping strategies with selective demographic variables will be done by Chi Square (2 ).

7.3.

DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS OR ANIMALS? IF SO, PLEASE DESCRIBE BRIEFLY. Yes, the study will be conducted on premenopausal women age group of 4045 years, Bangalore.

7.4.

HAS

ETHICAL

CLEARANCE

BEEN

OBTAINED

FROM

YOUR

INSTITUTION IN CASE OF 7.3? Yes, informed consent will be obtained from the community leader and subject. Privacy, confidentiality and anonymity will be guarded. Scientific objectivity of the study will be maintained with honesty and impartiality.

8.

LIST OF REFERENCES: 1. What is premenopause. Available from: URL: http://www.wisegeek.com/what-is-premenopause.httm. 2. Andrew and Mc Carthy. Textbook of obstetric and gynecology. Edinburgh, Churchills living stones,1998;243-44. 3. William W Hurd. Novaks gynaecology.12 th ed. Pennsylvania, Awaverly co. 1999,981-87. 4. Khan CG, Hussein and Haled JS. Age at menopause and menopausal transition: prospectus of Indian rural women. [Serial online] Available from:URL:http://www.pubmed.com. 5. Sharma S et al. menopausal symptoms in urban women. [Serial online] 11

2007; 9(1): Available from:URL:http://www.pubmed.com. 6. Eraaslan O Ozturk. The risk factors and symptomatology Available of perimenopause. [Serial online] 2006: from:

URL:http://www.pubmed.com. 7. Carver S Charles. Assessing coping strategies a theory based approach. Journal of personality and social psychology. [Serial online] 1999:56(2):267-83. 8. Collins A, Landgren BM. Reproductive health, use of estrogen and symptoms in perimenopausal women; a population-based study [serial online] 1994: Available from: URL:http://www.pubmed.com. 9. Nager Shipra and Dave Parul. Menopause middle age, menstruation, socioeconomic group. [Serial online] 2005;7(3):173-75 Available from:URL:http://www.pubmed.com. 10. Dancey R David. Impact of menopause on the prevalence and severity of sleep apnea [serial online] 2007;120(1):151: Available from: URL:http://www.pubmed.com 11. Bromberger JT. A longitudinal study on the effects of pessimism trait anxiety and life stress on depressive symptoms in middle-aged women, psychological aging. [Serial online] 1996. Available from: URL:http://www.pubmed.com 12. Singh M, PhD .Family and psychosocial status of mid working women .The internet journal of 3rd world medicine ISSN. [Serial online] 2003:URL:http://www.pubmed.com. 13. Kittal A. Linda .The basic social process of the menopausal transition [serial online] 2006: Available from: URL:http://www.csrlink.net.com. 14. Chang Louise et al. Relationship and other factors led to dysfunction in middle-aged women [serial online] 2006: Available from: URL:http://www.medicinenet.com/scripit/main/art.asp articlekey. 15. Deenerstein C.A prospective population based study on menopausal symptoms. Obstetric and gynecology [serial online] 2000 September; 96(3):351-8: Available from: URL:http://www.pubmed.com. 16. Gowda SN. A study to assess the effectiveness of self instructional module on knowledge of health care providers regarding protection against hospital acquired infection in selected hospital,banglore 17. Jayalakshmi I. A study to evaluate the effective ness of planned teaching 12

programme on selected aspects of reproductive health among rural adolescent girls, RGUHS, Bangalore. 2003. 18. Basavanthappa BT. Nursing research, 2nd edition. New Delhi: Jaypee brothers medical publishers: 2006. 19. Mahajan BK. Methods in Biostatistics. 6th ed. New Delhi: Jaypee brothers medical publisher 2006.

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