INTRODUCTION:

“Like You Can’t Measure The Depth Of An Ocean, Exactly Like That You Can’t Measure My Hatred For You My Dear Every Months Dysmenorrhoea.”

-Amateur Ink

Menarche (say "MEN-ar-kee") is a girl's first menstrual period. A first period usually happens after breast, pubic hair, and underarm hair have begun to grow. Menarche is a sign of growing up and becoming a woman. It can happen as early as about age 9 or up to age 15. The first few periods are usually light and irregular. About 2 out of 3 girls have a regular pattern of menstrual periods within 2 years of menarche. During the teen years, periods may become longer and heavier.¹ The menstrual cycle is the regular natural change that occurs in the female reproductive system (specifically the uterus and ovaries) that makes pregnancy possible. The cycle is required for the production of oocytes, and for the preparation of the uterus for pregnancy.²

Up to 80% of women report having some symptoms during the one to two weeks prior to menstruation. Common symptoms include acne, tender breasts, bloating, feeling tired, irritability and mood changes. These symptoms interfere with normal life and therefore qualify as premenstrual syndrome in 20 to 30% of women. In 3 to 8%, they are severe. The menstrual cycle is governed by hormonal changes. These changes can be altered by using hormonal birth control to prevent pregnancy. Each cycle can be divided into three phases based on events in the ovary (ovarian cycle) or in the uterus (uterine cycle). The ovarian cycle consists of the follicular phase, ovulation, and luteal phase whereas the uterine cycle is divided into menstruation, proliferative phase, and secretory phase.³

Stimulated by gradually increasing amounts of estrogen in the follicular phase, discharges of blood (menses) flow stop, and the lining of the uterus thickens. Follicles in the ovary begin developing under the influence of a complex interplay of hormones, and after several days one or occasionally two become dominant (non-dominant follicles shrink and die)⁴. Approximately mid-cycle, 24–36 hours after the luteinizing hormone (LH) surges, the dominant follicle releases an oocyte, in an event called ovulation. After ovulation, the oocytes only Lives for 24 hours or less without fertilization while the remains of the dominant follicle in the ovary become a corpus luteum; this body has a primary function of producing large amounts of progesterone. Under the influence of progesterone, the uterine lining changes to prepare for potential implantation of an embryo to establish a pregnancy⁵. If implantation does not occur within approximately two weeks, the corpus luteum will involute, causing a sharp drop in levels of both progesterone and estrogen. The hormone drop causes the uterus to shed its lining in a process termed menstruation.⁶

Dysmenorrhea, one of the most frequently encountered gynecologic disorder, is one of the major health Issue that affect the quality of female adolescences daily life activities.⁷ Dysmenorrhea is the painful menstruation in which majority of women experiences some degree of cramping, especially in the first year of their reproductive life. Pain may radiate to back or lower legs. Pain may occur with menses or precede menses by 1 to 3 days. Pain tends to peak 24 hours after onset of menses and subside after 2 to 3 days.⁸ It is more common among those with heavy periods, irregular periods, whose periods started before twelve years of age.⁹

Menstruation is associated with nausea, vomiting, diarrhea, headache, weakness and fainting.¹⁰ Also it has a negative impact on the social, academics and sports activities of many female adolescents. Moreover, the study on a group of female’s students indicated that dysmenorrhea may have effect on quality of life, mental status and social role.¹¹Dysmenorrhea can be primary or secondary dysmenorrhea. Primary dysmenorrhea begins soon after a pre-teen or teen starts having periods. Pain is severe and frequent menstrual cramping caused by severe and abnormal uterine contractions and without underlying pathology. Secondary dysmenorrheal cramps caused by another medical problem such as endometriosis, pelvic inflammatory disease, uterine fibroids, etc. This condition usually occurs in older women.¹²

Women on an average undergoes 400 menstrual cycles prior to menopause.¹³ Prevalence rates reported for dysmenorrhea vary greatly from study to study. Globally, the prevalence rates have been reported to be as high as 90% and as low as 43%. In India it has also been observed that girls at their reproductive age fail to perform their activities of daily living effectively during the menstruation period.¹⁴ Majority of dysmennorrhoeic girls experience irritability (70.6%), emotional instability (44.5%), loss of interest in regular work (61.3%), disturbed sleep (55.5%) and reduced Appetite (52.1%) during menstrual period, which are significantly less in non-dysmenorrheal girls.¹⁵

Dysmenorrhea itself is not life threatening, but it has a negative. Impact on women day-to-day life. Moderate and severe pain interferes with women’s normal daily living activities, such as academics, office or clinical work, eating, sleeping pattern, etc.¹⁶ Studies have also shown that dysmenorrhea resulted in various symptoms like- tiredness, inability to concentrate in work, disturbed sleep, decreased appetite, missed social activities, decreased quality and absenteeism from work.¹⁷

Nursing students in the research settings consist of significant number of females in menstruating age groups (17-22 years) and a study on their dysmenorrhea status and its effect on their activities of daily living has not been undertaken so far.¹⁸

Maintaining proper hygiene during the menstruation period is important for the overall wellbeing and for the prevention of infection pertaining to reproductive health. It is an assumption that not much attention has been paid to address this phenomenon.¹⁹ Therefore, to flag the importance of this milestone of female life, this study was conducted in order to promote the health of nursing students by in depth exploration of the phenomenon of interest (Dysmenorrhea). The aim of the study is to unfold the phenomenon of dysmenorrhea by determining the perceptions, effects and its management among the nursing students of Army College of Nursing, Jalandhar Cantt (Punjab).

NEED OF STUDY:

Dysmennorhea is the most common gynecological disorder among females with prevalence of 60% to 93%. Several studies have shown that adolescent girls with dysmenorrheal report that it Effect academic performance, routine physical activities, eating and sleeping patterns. A dysmenorrhea incidence of 33.5 % was reported by Nag (1982) among adolescent girls in India. A study done in Sweden showed that more than 50% of all menstruating women experience some discomfort. It has also been reported by a senior obstetrician that probably 5-10% of girls suffer from severe spasmodic dysmenorrhea interrupting their educational and social life.²⁰

Another study was conducted by Anil in 2010 on dysmenorrhea among adolescent girls in Gwalior in India. An exploratory study technique with a co-relational approach was used and nine hundred and seventy adolescent girls of age 15-20 years studying in higher secondary school of Gwalior were taken for the study. The result Were the prevalence of dysmenorrhea in adolescent girl was found to be 79.67% most of them 37.96% suffered regularly from dysmenorrhea severity.²¹It not only disturbs their routine but also causes humiliating sufferings. It is common cause for sickness, absenteeism from classes and work by the female students. Today it is known that pain is due to release of prostaglandin in response to tissue destruction during the ischemic phase of menstrual cycle. Women with dysmenorrhea have high level of prostaglandin hormone believe to cause menstrual cramping

In the life period as a female facing a lot of problem and discomfort during menstruating period, four years of experiences in the colleges the researcher come across severe cases of dysmenorrhea. The personal experience, professional experience, advice from elders, availability of material has motivated an interest in us to carry out the study.²²

PROBLEM STATEMENT:

A Descriptive study to assess the prevalence of dysmenorrhea and its impact on the activities of daily living among the nursing students of Army College of Nursing, Jalandhar Cantt (Punjab), India.

OBJECTIVES:

· To study the prevalence of dysmenorrhea among nursing students of Army Colleges of Nursing.

· To find out the association of dysmenorrhea with various activities of daily living such as academic performance, dietary pattern, sleeping pattern, laundry, clinical duties and extra curriculum activities among nursing students of Army College Of Nursing.

· To prepare an information booklet for students regarding dysmenorrhea and its treatment.

ASSUMPTIONS:

1. The prevalence of dysmenorrhea will be high among nursing students of Army College of Nursing, Jalandhar Cantt (Punjab).

2. Dysmennorhea disturbs the activities of daily living of nursing students of Army College of Nursing, Jalandhar Cantt (Punjab).

OPERATIONAL DEFINITIONS:

· PREVALENCE: It is a term which means the degree to which dysmenorrhea is widespread among nursing students of age group 17-22 years studying in Army College of nursing, Jalandhar cantt.

· IMPACT: It is defined as consequences or influence of dysmenorrhea among nursing students of age group 17-22 years of Army College of nursing, Jalandhar cantt.

· DYSMENORRHEA: It is defined as painful menstruation which is characterized by abdominal pain, cramping, backache that interferes with the activities of daily living of nursing students of age group 17-22 years of Army College of nursing, Jalandhar cantt.

· ACTIVITIES OF DAILY LIVING: These are those routine activities that the nursing students of age group 17-22 years of age of Army College of nursing perform without any assistance. For example-academic performances, dietary pattern, sleeping pattern, laundry, clinical duties and extra curriculum activities.

· NURSING STUDENT: Nursing student is a person of 17-22 years of age, who is training or studying in Army College of nursing, Jalandhar cant, to be a nurse.

DELIMITATIONS:

The study will be delimited to nursing students of age group 17-22 in Army College of Nursing, Jalandhar Cantt (Punjab).

METHODOLOGY:

The methodology is the most important in research as it is the framework for conducting a study. It indicates the general pattern organizing the procedure to gather valid and reliable data or an investigation.

Research methodology is a way to systematically solve the problems. Research methodology includes steps, strategies for gathering and analyzing data in research.

Figure 2: Flow chart of methodology

RESEARCH APPROACH:

A quantitative research approach was used for the present study as the study aim to assess the prevalence of dysmenorrhea and its impact on activity of daily living among the students of Army College of nursing Jalandhar cantt Punjab.

RESEARCH DESIGN:

The selection of research design is the most important step as to provide the framework for the study. The research design incorporates some of the most important methodological decisions that the researchers makes in conducting the study. The Descriptive Research Design was used for the study.

RESEARCH SETTING:

The present study was conducted in Army College of nursing Jalandhar, Punjab.

TARGET POPULATION:

The target population was students of B.Sc. Nursing 1^st and 2^nd year of Army College of Nursing.

SAMPLE AND SAMPLING TECHNIQUE:

A total of 105 students were taken as a sample of study and non probability Convenient sampling technique was adopted to collect the data.

INCLUSION AND EXCLUSION CRITERIA:

Inclusion criteria for sampling:

The study will include the nursing college students:

· Those who are willing to participate.

· Aged between 17-22 years.

· Students of BSC Nursing 1^st and 2^nd year of Army College of Nursing.

EXCLUSION CRITERIA FOR SAMPLING:

· Those who are not willing to participate.

· Those who are absent during the data collection.

VARIABLES:

The socio-demographic variables which are included in the study are - age, religion, type of family, dietary pattern, body mass index.

SELECTION AND DEVELOPMENT OF TOOL:

The tool (Standardized Numeric pain rating scale and Self Structured Activities of Daily Living Scale) was constructed to assess the prevalence of dysmenorrhea and impact of dysmenorrhea on activity of daily living among the students of Army College of Nursing Jalandhar Punjab.

DESCRIPTION OF TOOL:

The tools that have been used are subjective pain scale and Activity Of daily living observational scale.

Numeric pain rating scale (NPRS):

the NPRS is a segmented numeric version of the visual analogue scale in which a respondent selects a whole number (0-10 integers) that best reflects the intensity of his/her pain is the tool that describes the level of pain

Criteria measure for NPRS:

S. No.	Level of dysmenorrhea	Score
1.	None	O
2.	Mild	1-3
3.	Moderate	4-6
4.	Severe	7-10

Activity of daily living (ADL) scale:

The tool that is used to assess the impact of Dysmennorhea on the activities of daily living (Academics, Dietary pattern, Sleeping pattern, Laundry, Extra-curriculum activities).

Criteria measure for ADL scale:

S. No.	Level of activities affected	Score
1.	Severely affected	0-4
2.	Moderately affected	5-8
3.	Mildly affected	9-12

VALIDITY OF TOOL:

To ensure validity of tool and content of standardized numeric pain rating scale and self structured activity of daily living scale, it was given to Principal (Army College of Nursing), panel of Army College of Nursing and then their useful and valuable suggestions were inculcated in the tool to modify.

PILOT STUDY:

Pilot study was conducted at Army College of Nursing, Jalandhar Cantt on the 15 March 2018. Permission was sought from the principal, Army College of Nursing. it was conducted on 12 subjects (1/10^th of the total sample population) of B.Sc. Nursing 3^rd year. Tool was distributed for assessing the prevalence of dysmenorrhea and its impact on the activities of daily living on the same day.

The aim of pilot study was used to check the reliability and feasibility of the research to be undertaken.

RELIABILITY OF TOOL:

The Numeric pain rating scale tool and activities of daily living scale for assessing prevalence and impact on daily activities of Dysmenorrhea was given to the students. The reliability of former tool (standardized) is 0.95 and that of the later tool is 0.78 which is checked through Karl’s Pearson Method. Validity of content was checked by 6 nursing experts of Army College of Nursing, Jalandhar Cantt.

Ethical consideration:

· A written permission was obtained from Principal of Army College of Nursing.

· The written consent was obtained from each sample after explaining the objectives, activity and duration of their involvement.

· The students were given authority to withdraw from the study.

Data collection procedure:

The data collection procedure was carried out on 19/04/2018. The sample consisted of 105 students. Non probability convenient sampling technique was used to select sample from the population. Permission was obtained from the Principal of Army College of Nursing.Numeric pain rating scale and activities of daily living scale was selected for data collection. The purpose of the study was explained to the nursing students. The time given was 15 minutes.

DATA ANALYSIS AND INTERPRETATION:

This chapter deals with analysis and interpretation of data obtained from a sample of 105 subjects of B.Sc. Nursing 1^st year and 2^nd year of Army college of Nursing. The analysis was done using various statistical measures.

ORGANIZATION OF FINDINGS:

The data collected from the nursing students has been organized and presented under following headings:

SECTION I: Frequency and percentage of the socio- demographic variables.

SECTION II: Analysis of Prevalence of dysmenorrhea.

SECTION III: Association between dysmenorrhea and various activities of daily living by using chi square test

SECTION I: Frequency and percentage distribution of socio-demographic variables.

In this section- demographic variable of the respondents has been displayed to show frequency distribution of the various attributes of demographic variables. Frequency and percentage have been calculated and the outcomes are as follows:

Table 1: Shows that nursing students were distributed into various categories according to age, religion, type of family, body mass index and diet.

S. No.	Socio-demographic variable	Frequency	Percentage
1	Age
	17-19 years	54	51.42%
	20-22 years	51	48.58%
2	Religion
	Hindu	88	83.81%
	Sikh	14	13.34%
	Muslim	03	2.85%
3	Type of family
	Nuclear	81	77.14%
	Joint	23	21.91%
	Extended	01	0.95%
4	Body mass Index
	Under weight	12	11.43%
	Healthy	81	77.14%
	Over weight	12	11.43%
5	Diet
	Vegetarian	47	44.76%
	Non-vegetarian	48	45.72%
	Eggitarian	10	9.52%

In the nutshell, it can be inferred that the most of the nursing students under this study were between the age group of 17-19 years i.e. 54 (51.42%). 88 (83.81%) were of Hindu religion, 81 (77.14%) were belongs to nuclear family, 81(77.14%) samples had healthy weight and 48 (45.72%) were having non-vegetarian diet.

N = 105

SECTION II: Analysis of prevalence of dysmenorrhea.

This section deals with analysis of prevalence of dysmenorrhea among nursing students as mentioned below:

Table 2: Shows distribution of level of dysmenorrhea among nursing students.

Sr. No.	level of dysmenorrhea	score	frequency	percentage
1	None	0	0	0%
2	Mild	1-3	60	57.14%
3	Moderate	4-6	22	20.96%
4	Severe	7-10	23	21.90%

Table 2 depicts the level of dysmenorrhea among nursing students, according to the Numeric pain rating scale score 0 (0%) is having no pain, dysmenorrhea. 60 (57.14%) is having mild level of dysmenorrhea, 22(20.96%) is having moderate level of dysmenorrhea and 23 (21.90%) is having severe level of

Figure 1: Showing prevalence of Dysmenorrhea

SECTION III: Association between dysmenorrhea and various activities of daily living by using chi square test.

This section deals with the finding of association between dysmenorrhea and various activities of daily living among nursing students

Inference:

The calculated X²value in all activities of daily living is more than the tabulated value of X²at 0.05 level of Significance. The Tabulated X² at df 2 for all activities is 5.99. Hence the calculated X² value is significant at P value less than 0.0001.

Therefore, there is extreme association between various activities of daily living and dysmenorrhea among the B.Sc. Nursing students of Army College of Nursing, Jalandhar Cantt, Punjab, 2018.

Formula used for association: X²=(O-E)²

X²=Chi Square

O =Observed frequency

E =Expected frequency

E = –––––––––––

Total frequency

df = Degree of freedom

(n-1)

DISCUSSION:

This study intends to assess the prevalence of dysmenorrhea and its impact on the activities of daily living among the nursing students of Army College of nursing, Jalandhar Cantt (Punjab) INDIA (2017-2018).

The findings of this study have been discussed with reference to the objectives along with findings of other study.

OBJECTIVE: To study prevalence of dysmenorrhea among nursing students of Army Colleges of Nursing.

In present study, 0 (0%) is having no pain, 60 (57.14%) is having mild level of dysmenorrhea, 22 (20.96%) is having moderate level of dysmenorrhea and 23 (21.90%) is having severe level of dysmenorrhea.

The above study is supported by following studies:

Sharma Anamika, SahaRenuka, Sharma Pragya (2016):

conducted a study on prevalence of dysmenorrhea and the effect of menstrual disorders on daily routine among the undergraduate medical students. Of 276 undergraduate girl students, 112 were sampled by stratified random sampling. All the consenting participants were given a pretested semi structured 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%).

Chaudhuri and Singh (2012):

Conducted a cross-sectional study to estimate the prevalence of primary dysmenorrhea, and to determine its impact on their routine life. They conducted study among 224 school girls in the standard VIII to X at selected schools of Chandigarh, India. The result revealed that the prevalence of dysmenorrhea was 59.82%. Sickness absenteeism due to dysmenorrhea was reported in 25.8% girls. According to visual analogue scale for pain scoring, 52.3% had moderate pain and 25% cases had severe pain. The menstrual distress questionnaire scores showed mood swings, irritability, difficulty in concentration and the poor school performances were identified as common problem. The authors concluded that dysmenorrhea is rapidly developing as a public health problem with its high prevalence. The degree of discomfort felt by the subjects as well as the reduction in their quality of life.

OBJECTIVE: To find out the association of dysmenorrhea with various activities of daily living such as, dietary pattern academic performance, sleeping pattern, laundry, clinical duties and extra curriculum activities among nursing students of Army College of Nursing.

In present study the activities affected among 105 samples were mildly 48, moderately 46 and severely 11. Thus it can be concluded that there was a significant association between activities of daily living and Dysmenorrhea.

The above study is supported by Kural Mool Raj, et al. (2015)-Conducted cross sectional study, data were collected among 310 girls (18 to 25 years) on age at menarche, presence and absence of dysmenorrhea, its duration, pre-menstrual symptoms, quality of life, physical activity, and dietary habits using a semi-structured questionnaire and the result was 84.2% (261) girls reported dysmenorrhea and 15.8% (49) reported no dysmenorrhea. Girls who had dysmenorrhea were 4.9 times more likely to be absent in college, 3.1 times more chance of reduced physical activity, 3.2 times more chance of loss of concentration and 2.4 times more likely to have poor work satisfaction compared with other girls with no dysmenorrhea (p< 0.05).

Chia, et al. (2013):

evaluated the prevalence of dysmenorrhea, its impact and management approaches among 240 undergraduates (128 medical and 112 no- medical) in Hong Kong university students by cross sectional questionnaire survey. The result showed that the prevalence of dysmenorrhea was 80% with mean pain score of 5.0, the common impact on daily life included reduced ability to concentrate or disturbance with study (75%) and changes in normal physical activity (60%). Only 6% sought medical advice, while 70% practiced self-management.

Santina, Wehbe and Ziade (2012):

did a cross –sectional study to find out the prevalence of Dysmenorrhea among 389 post menarcheal adolescent school going girls aged between 13-19 years in Sidon city and suburbs, Lebanon and explore its possible relationship with menstrual experience. Of these 161 (41.4%) were regularly or sometimes absent from school due to menstrual problems and 289 (74.3%) experienced dysmenorrhea. Three–quarters of these young women (75.2%) had scores indicating negative menstrual experience based on the Menstrual Experience and Behavior Questionnaire (MEBQ). The researchers concluded that better health education programmes focusing on menstruation are needed for female adolescents.

SUMMARY, CONCLUSION, IMPLICATION, AND RECOMMENDATION:

This chapter deals with brief accounts of the study including the conclusion drawn from finding, implications of the study for nursing education, nursing administration, nursing practices, nursing research, limitations and recommendation.

The study was undertaken by the investigator for assessing the prevalence of dysmenorrhea and its impact on the activities of daily living among the nursing students of Army College of nursing Jalandhar Cantt. (Punjab). The study was descriptive in nature and having 105 samples of nursing students. Students were selected by random sampling techniques.

Analysis and interpretations was done according to objectives of the study. Descriptive and inferential statistics was used in the data analysis. Pies and bar were used to depict the finding.

MAJOR FINDINGS:

Findings related to variables:

· Out of 105 subjects 51.42% nursing students were in group of 17-19 and 48.58% of students were in group of 22-22 years.

· 77.14% of students have nuclear type of family, 1.9% has joint family and 0.95% belongs to extended type of family.

· 83.8%of nursing students belongs to Hindu religion, 13.34% are Sikh and 2.85% of students belong to Muslim religion.

· Out of 105 subjects 11.43% of students are underweight, 77.14% are healthy and 11.43% students are overweight.

· 44.76% students are vegetarian, 45.72% are non-vegetarian and 9.52% are eggitarian.

Findings related to prevalence of Dysmenorrhea:

· It reveals that 0% of the nursing students have no pain.

· 57.14% of nursing students have mild level of pain

· 20.96% of nursing students have moderate level of pain.

· 21.90% of nursing students have severe level of pain.

Findings related to the association of dysmenorrhea with the activities of daily living:

The finding reveals that 48(45.71%) of activities of daily living are mildly affected, 46(43.80%) are moderately affected and 11(10.49%) of activities of daily living are severely affected.

CONCLUSION:

It has been concluded from the findings of the study that prevalence of dysmenorrhea among nursing students of Army College of nursing is 0% no pain, 57.14% Mild, 20.96% Moderate and 21.9% severe and association also have been found between the Activity of daily living and dysmenorrhea. Thus, dysmenorrhea has direct influence on the activities of daily living.

IMPLICATIONS:

The study findings have certain important implication for nurses i.e nursing education, nursing practice, nursing administration and nursing research as nurse act as care givers, educator, researcher, supporter and administration.

RECOMMENDATIONS:

Descriptive study can be converted into Explorative or Comparative study.

Maximum samples should be selected in the study.

The study can be replicated in other Institutions to validate and generalize its findings.

Similar study can be undertaken on general population in different settings like community, and schools.

SUMMARY:

The chapter suggested the way and Prevalence of dysmenorrhea and its impact on the activity of daily living. It also dealt with the summary, conclusion, implications and recommendations.

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Received on 15.07.2020 Modified on 13.08.2020

Int. J. Nur. Edu. and Research. 2020; 8(4):517-524.

DOI: 10.5958/2454-2660.2020.00115.5