€¦ · Web viewThe word ‘menopause’ comes from the Greek words meno (monthly menses) and...
Transcript of €¦ · Web viewThe word ‘menopause’ comes from the Greek words meno (monthly menses) and...
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 NAME OF THE
CANDIDATE AND
ADDRESS
Ms. AMANDEEP KAUR
NO:5, NOOR BUILDING, RMV 2ND STAGE,
BHOOPASANDRA MAIN ROAD, BANGALORE – 94.
2 NAME OF THE
INSTITUTION
NOOR COLLEGE OF NURSING, NO.5,
BHOOPASANDRA MAIN ROAD,
RMV II STAGE, BANGALORE - 94.
3 COURSE OF THE
STUDY AND SUBJECT
M.SC. NURSING, 1ST YEAR,
OBG AND GYNECOLOGICAL NURSING
4 DATE OF ADMISSION 01/10/2011
5 TITLE OF THE TOPIC “A STUDY TO ASSESS THE EFFECTIVENESS OF
STRUCTURED TEACHING PROGRAMME
REGARDING KNOWLEDGE ABOUT MENOPAUSE,
AND COPING STRATEGIES AMONG
MENOPAUSAL WOMEN ATTENDING OPD IN
GENERAL HOSPITAL,YELAHANKA, BANGALORE”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Many myths have their origin in the mystery that surrounds women, her hidden
reproductive organs and her uniqueness in adding new members in society. Awareness
about her physiological changes is necessary for a woman as she is vulnerable to physical
and psychological stress. The individual’s age, physical, emotional status and
environmental influences the regularity of her periods. Women’s health care generally is
focused on the pregnant adult women; however childhood, menarche, pregnancy,
menopause and the postmenopausal years are defined by anatomic and physiologic
parameters.1
The word ‘menopause’ comes from the Greek words meno (monthly menses) and
pause (Pause), a pause in menstruation or more correctly, the cessation of menstrual cycle
menopause refers to cessation of menstruation permanently at the end of reproductive life
due to ovarian follicular inactivity. Menopause is a natural & normal part of ageing
except when brought about through surgery or as the result of medication or illness. For
some women, menopause can be a smooth and even liberating transition from
reproductive to non-reproductive years.2 For other women it can feel more like a
complete chemical and emotional sudden changes, for all women. Menopause raises
important health care issues and presents physical challenges, menopause causes short-
term changes and there are long term risks that can have a major impact on overall health
and quality of life. Consider menopause to be a call to action, it is a time to learn more
about one’s body, a process that can be invigorating and empowering. 2
Although menopause is a universal experience for women, the experience is not
universal the onset and duration is indefinite and end is unpredictable. The experience of
menopause various from women to women: and there is no fixed pattern and no chain of
events.
Kenneth stated that the age of menopause does not relate to the age of menarche.
Some of the factors which may influence the age of onset of menopause are socio–
economic factors, height, weight, race, poverty, and cigarette smoking.3
Susan stated that approximately 75% of women experience some adverse symptoms
during menopause that are caused to be loss of oestrogen. The most commonly reported
symptoms are hot flushes, and atrophic vaginitis. Other problems that may be associated
with menopause include osteoporosis, increased risk of vascular diseases, skin changes,
sleep disturbances, decreased libido and psychological difficulties.4
It is important that women during menopausal period should have adequate
knowledge regarding the menopausal transition that may enable them to accept inevitable
changes and losses & recognize qualities and capabilities. As menopause does cause
radical attractions in women’s physical functioning and can cause anxiety in women, who
do not understand the changes that are taking place.5
6.1 Need for the study
“Menopause threw a few little speed bumps in my way, but for the most part it
came and went quickly and today I feel better than ever”.
The term ‘menopause’ is used in the technical sense to refer to the ending of
menstruation, or monthly periods, but in general it embraces a wide range of symptoms
and accompanies the climacteric, or change of life. This usually occurs in a woman’s,
life between the early forties to the mid-fifties, and usually lasts two or three years.
During this time, the ovaries stop producing eggs, fertility declines and eventually
ceases6.
Several psychological factors are related to the process of physical change. A
woman may experience a fear of losing her appearance, uncertainty about her purpose in
life as a middle-aged woman, sadness at the passing of the fertile prime of life. These
feelings may even out weight the physical discomfort caused by the complex hormonal
changes.7
Women’s experience of the menopause varies greatly. Some may suffer, physical
and/or psychological symptoms, while others experience relatively little discomfort
and/or few psychological disturbances. Some women feel fit during the menopause, and
may welcome the cessation of the nuisance of monthly periods, and the ability to enjoy
their sex life.7
Maslow done a study on problems in women’s knowledge menopause as the
menopausal women need to make informed decisions about their own health. The
research agenda on menopause should include studies specifically intended to produce
the necessary information.
Poliot done a study to identify the women’s knowledge regarding menopause and
relationship between a women’s knowledge level and then background characteristics
among the women from the general urban population. On the average the women
responded correctly to 59% of the questions. The findings of the study showed that
younger women who were employed and women with higher level of education
performed better than the older, unemployed and less educated women8.
Hence, it is necessary for making the perimenopausal women aware of the need
for the advice or help regarding the change in their daily habits. A modular exercise
programme, the importance of annual bimanual examination, awareness about
osteoporosis, cancer screening and motivation of women to seek help without shame or
fear when needed would go along way. The experience of the investigator supports the
view that women lack the necessary information and awareness regarding menopause, its
related problems and their coping strategies. The factors like education, occupation and
income may have influence on knowledge coping the behaviour of the menopausal
women.
The above supported study and the experience of the researcher influenced the
investigator to develop a structured interview schedule on the management of menopause
for women and make the middle aged women aware of this knowledge to lead the old age
gracefully.
6.2 REVIEW OF LITERATURE
The literature review will be organized and presented under the following
headings.
1. Studies related to knowledge regarding menopause.
2. Studies related to physical, psychological problems of menopausal women.
3. Studies related to coping strategies regarding menopause
1. Studies Related To Knowledge Regarding Menopause.
Menopause means permanent cessation of menstruation at the end of reproductive life
due to ovarian follicular inactivity. The age of menopause ranges between 40 – 55 years,
average being 50 years. This covers a wide range of period between 5 – 10 years as on
either side of menopause. A study done on menopausal age in 563 Nigerian women and
identified the mean and median ages of menopause were 48.4 and 48.0 years
respectively.9
Moore explored that menopause is a natural process and with advancing age there is a
gradual depletion of ovarian follicles, which is responsible for production of oestrogen.
As production of oestrogen reduces, production of follicular stimulating hormone initially
increases causing rapid follicular development that results in shortened menstrual cycles.
Over a period of several years, oestrogen production gradually decreases to a level too
low to initiate a luteinizing hormone (LH) production, ovulation becomes irregular and
then there is a rise in LH, because there is no oestrogen feedback from the ovary.10
Sheriff stated that due to decrease or loss of oestrogen level in the blood, the
menopausal women experience disturbance in menstrual pattern, irregular menstrual
frequency, and ultimately amenorrhea, vasomotor instability, atrophic conditions and
health problems secondary to long term deprivations and oestrogen, the consequences of
which are osteoporosis, fractures and cardio-vascular disease.10
Stand berg identified from his study on women’s knowledge and attitude about the
climacteric period and its treatment. The result showed that 45% of the women felt
menopause is a sort of relief from child bearing. Approximately 60% had negative
attitude towards menopause, where as 80% of them wanted to know information more
about menopause.
Woods and mitchel conducted a study a “pattern of depressed mood in midlife
women” which revealed that depression is the most common mental health problem for
which women seek health information. They further stated that the women experiencing
depression during menopause is mainly due to endocrine changes that occur during
perimenopause. For management of these changes, the woman needs to put more effort to
maintain her own health and considering menopauses changes as a normal phenomenon,
will help the women to develop more coping abilities than considering them as
abnormal.11
Quinn commented that the ability to cope with stress can involve the perception or
understanding and her coping mechanism. Thus counseling women in the climacteric
must include assessment as to how much information the women has, her perception of
stressful experiences whom she can depend as far help and her ability to cope.
Menopause is a natural event, which involves physical, physiological and psychological
changes among women. According to the symptoms the menopausal period can be
divided into pre menopause, perimenopause and post menopause.12
The first and foremost sign of menopause is irregularities in the menstrual periods.
The other symptoms are hot flushes, genital changes, urinary changes, sexual changes,
and psychological changes. The management of these changes or coping ability includes
self care abilities of the woman as well as developing positive attitude or adjusting
towards menopause.11
Paul done a study in kerala to identify the problems of unmarried women, a sample of
100 women were selected, 50 unmarried women in menopausal period and 50 unmarried
women in pre-menopausal period who were living with them. From his study he
concluded that both the groups of unmarried women are religious sisters in menopausal
period and premenopausal period and had experienced problems related to menopause. If
they had sufficient knowledge and information about the changes menopausal period they
could have adjusted better and had a healthy living in their religious society.12
George SA, conducted a phenomenologic study to (a) examine and interpret the
reality of the menopausal transition as experienced by American women and (b) identify
common elements and themes that occur as a result of the complexities of this
experience. There were three major themes or phases: expectations and realization,
sorting things out, and a new life phase. They found that the data supports the premise
that the experience of menopause in American women is unique to each individual and
that the meaning or perspective differs among women. 13
2. Studies Related To Physical And Psychological Problems Of Menopausal
Women.
Lic, Samsioe G, Borgfeldtc, Lidfeldt J conducted a prospective population based
cohert study of 6917 Swedish women between 60 – 65 age group on menopausal related
symptoms and the back ground factors. Each woman completed a generic questionnaire
and underwent a personal interview that pertained to socio-demographic characteristics,
lifestyle, and current health related problems with these back ground factors the
frequency and intensity of hot flushes and vaginal dryness were determined risk factors
analysis was evaluated. They concluded the findings; a lower risk for hot flushes was
related to older age, high education vigorous physical exercises. The major risk factors
for vasomotor complainers were current weight gain. Part-time employment,
oophorectomy, unhealthy life style and concomitant health problems light smoking late
age of menopause; higher education and excessive weight reduced the risk of vaginal
dryness. However older age, marriage & chronic diseases negatively affected vaginal
complaints socio-demographic characteristics appear to be important modifiable
determinants for menopause related symptoms14.
Danaci AE, Oruc S, A diguel H, J conducted a study between the age of 40 – 60
years of 324 study subjects. The aim of the study was to examine the relationships
between the changes in sex hormones, sexual behavior, depression and anxiety levels of
women who were either the (35.8%) pre menopausal, (27.2%) perimenopausal or
postmenopausal period (37%) the findings revealed that the menopausal state did not
affect the sexual behavior and psychological state of women between 40 and 60 years but
increased in anxiety and depression scores affected the sexual life in a negative manner.15
HUKK, Boyko EJ, Scholes D, Normand E, urinary tract infection (UTI) in post
menopausal women A population based case control study of women aged between 55 –
75 years was conducted on 899 study subjects and 911 controls. The study revealed, the
risk factors of healthy community dwelling post menopausal women reflect the health
status of women as they transition toward old age. Sexual activity history of UTI treated
diabetes and incontinence were all associated with a higher risk of UTI.”16
Hunter MS, Liao KL analysed hot flushes and night sweats accompanying
menopause. They found that the frequency ratings correlated highly with prospective
daily monitoring. Depressed mood, anxiety and low self-esteem, but not frequency,
discriminated between those who regarded flushes as problematic and those who did
not.17
Wollersheim JP has claimed that clinical depression is manifest in the workplace
and adversely affects the employee's work satisfaction and performance. For most types
of depression, women are at a higher risk than men. He claims that though effects of
menopause can be manifest in the workplace, they are not associated with an increased
incidence of clinical depression.17
Pastore LM, Carter RA et al conducted a study to examine the prevalence and
correlates of self-reported urogenital symptoms (dryness, irritation or itching, discharge,
dysuria) among postmenopausal women aged 50-79 by cross-sectional analysis based on
n=98,705 women enrolled in the US-based Women's Health Initiative observational
study and clinical trials. They found an elevated prevalence of urogenital symptoms
among women who are Hispanic, obese, and/or diabetic.16
3. Studies related to coping strategies regarding menopause
Obermeyer etal. CM conducted a study an symptoms of menopause in women in
Beirut, Lebanon to assess the extent to which they suffer in the course of menopause
transition and to measure the medical management of menopause. A survey was carried
out on 293 women; the questionnaire collected information on the respondents, socio-
demographic characteristics, general health and reproductive health and also contained
questions on management of menopausal symptoms and their life style they identified
over a third of women seek help in dealing with the symptoms they experience, 15% use
hormonal replacement therapy (HRT) and 2% use calcium supplement.18
Hosc, Chen YM, Wool, Lamss conducted a coherent study to assess the
association of habitual dietary calcium intake and bone loss in early postmenopausal
Chinese women. The subjects were 48 – 62 years of age and within 12 years of natural
menopause. Four hundred fifty four healthy postmenopausal women were enrolled for
18 months cohert study. Dietary intake was assessed by the food frequency method, and
bone mass was measured using dual energy X-ray absorptiometry at baseline and 9 and
18 months. In conclusion, habitual dietary calcium intake had beneficial effect on bone
loss at the whole body and some regions of the hip. Findings suggest that an intake
exceeding 900 mg calcium per day was helpful in the prevention of cortical bone loss
among early postmenopausal Chinese women.19
Maequeena, choakka P, stated that management of depression in women depression is
more prevalent in women than in men, which may be related to biological, hormonal and
psychosocial factors. Four depressive conditions are specific to women: pre menstrual
dysphonic disorder (PMDD), depression in pregnancy, post partum depression and depression
related to perimeno pause or menopause. He stated that in perimenopause or postmenopausal
women with depression oestrogen may enhance the effects of anti depressant medications,
although a pooled analysis of data in women aged 55 years or over treated with venfaxine found
that remission rates were similar in those who were taking oestrogen and those who were not.
They concluded that management of women depression can be done safely and effectively using
antidepressants throughout the life cycle.20
Glazer G, Zeller R et al conducted a study to examine predictors, moderators, and
outcome variables associated with the transition to midlife in Caucasian and African
American women in a sample of 160 midlife women. They found that consistent
predictors of anxiety were loss of resources, coping effectiveness, and education.
Consistent predictors of depression were loss of resources and education.19 Health
promoting activities were consistently predicted by attitude toward menopause and
coping effectiveness. Stress is a better predictor of negative health outcomes than
menopausal status.20
Caltabiano ML, Holzheimer M conducted a study to examine the direct and
indirect influences of dispositional factors, namely optimism, health-related hardiness
(HRH) and sense of coherence (SOC), on the symptom experiences of peri - and
postmenopausal women. Indirect effects of dispositional factors were examined via
attitudes to the menopause and coping (emotion-versus problem-focused). 176 peri- and
postmenopausal women recruited from menopause clinics and family planning centers in
Queensland, Australia were surveyed. The results indicated that optimism and SOC affect
menopausal health directly, as evidenced by fewer symptoms reported by women scoring
highly on these dispositions. Any indirect effect of HRH, optimism and SOC appeared to
be exerted via problem-focused coping rather than emotion-focused coping or through
attitudes. The authors concluded that dispositional factors are important to the experience
of the menopause and how women adopt to their midlife transition. They recommend that
psychologists and professionals working in menopause clinics may need to promote
feelings of optimism and a sense of coherence in menopausal women, to facilitate better
adaptation to this important transitional phase in women's lives.21
Banister EM performed a ethnographic study of women's midlife experience of
their changing bodies, wherin 11 participants voiced their uncertainty and confusion
around bodily changes, responses exacerbated by the lack of consistent health-related
information in this area. The author claimed that midlife women's experience of
confusion may reflect a much broader problem, the locus of which is not so much in the
women themselves, but rather in negative societal attitudes about aging women.22
Ballinger CB in a review of mental health aspects of menopause, emphasis is laid
on the psychiatric morbidity that precedes any somatic menopausal symptoms. Only
sweating and hot flushes are directly related to the menopause. Complaints such as
irritability, headaches, fatigue, depression, and ''mental imbalance'' increase prior to the
menopause and decrease after it. Various situational factors have been considered as
possible precipitants of emotional disturbances: a child marrying, or having 3 or more
children. Estrogens do improve symptoms of flushes, dryness and sweats. Women who
come for treatment of menopausal symptoms may frequently be suffering from
depression which makes toleration of these symptoms more difficult.23
Skrzypulec V, Drosdzol A, Ferensowicz J evaluated quality of life of women in
the climacteric period with the use of an individually developed questionnaire of a
transitory period. They concluded that application of HRT in women after menopause
contributes to an improvement of the general quality of life, of mood and vitality. Women
subject to the therapy constitute a minority. Thus, HRT should be promoted in order to
improve the life quality of women in that period so difficult for them. The transitory
period questionnaire is a good work tool, which allows to determine the necessity of the
therapy application and to monitor its course.24
Gonzalez M, Viafara G et al assessed the prevalence of female sexual dysfunction
in premenopausal and postmenopausal women with and without hormone replacement
therapy (HRT). They found that menopause affects in a negative manner some domains
of female sexual function. HRT improves some factors of the sexual function during
menopause but it not improves desire and arousal which were the most affected domains.
There is a negative association between age and female sexual response in middle-aged
women.25
Duffy R, Wiseman H, File SE have found that significant cognitive
improvements in postmenopausal women can be gained from 12 weeks of consumption
of a supplement containing soya isoflavones that are independent of any changes in
menopausal symptoms, mood or sleepiness.25
Messina M, Hughes C have claimed that the available data justify the
recommendation that patients with frequent hot flushes consider trying soyfoods or
isoflavone supplements for the alleviation of their symptoms.26
6.3 Statement of the problem
A study “to assess the effectiveness of structured teaching programme
regarding knowledge about menopause, and coping strategies among women
attending OPD in general hospital, Yelahanka, Bangalore”
Objectives of the study
1. To assess the pretest level of knowledge regarding menopause among menopausal
women.
2. To evaluate the effectiveness of structured teaching programe regarding
menopause among Menopausal women.
3. To find association between pre test and post test level of knowledge regarding
menopause among Menopausal women with their selected demographic variables.
Operational definitions
1. Assess : It is a statistical measurement of knowledge regarding menopausal
period observed by structured knowledge questionnaire
2. Effectiveness: It is significant difference between pre and post test knowledge of
menopause among menopausal women
3. Structured teaching programme: It is systematically developed instructions
design for menopausal women in order to provide information regarding
knowledge and management of menopausal problems.
4. Menopause: It is the point in a women’s life when menstruation stops
permanently.
5. Menopausal women: They are women who report cessation of menstrual flow
for twelve months continuously.
6. Knowledge: The numerical course obtained by study subjects on menopausal
knowledge assessing tool.
7. Coping strategies: The set of activities carried out to overcome menopausal
related problems is called coping strategies.
HYPOTHESES
H1 – The post test knowledge score of menopause women regarding menopause
will be significantly higher than their mean pre-test knowledge score
H2 - The level of knowledge of menopause women regarding coping strategies of
menopause will have significant association with their selected demographic
variables.
6.6 Assumptions:
1. Menopausal women with adequate knowledge about the menopause brings down
their emotional disturbances.
2. Awareness about problems related to menopause improves adjustment of
menopausal women.
3. Menopausal women make use of both healthy and unhealthy coping strategies.
DELIMITATIONS
The study is limited to
1. Menopausal women attending OPD at general hospital, Yelahanka, Bangalore
2. The period of the study 4 weeks
7. MATERIAL AND METHOD
7.1 Sources of Data
The data will be collected from menopausal women attending OPD at general
hospital Yelahanka, Bangalore
7.1.1 Research approach
Evaluative research approach
7.1.2 Research design
Pre– Experimental one group pre and post – test research
Design i.e.
E = 01X 02; E = Experimental group
S.T.P = Structured Teaching Progarmme
O1 = pre-test, O2 = Post – test
7.1.3 Setting of the Study
The study will be conducted in OPD’s at Yelahanka, Government Hospital
Bangalore,
DESCRIPTION OF VARIABLES
7.1.4 Dependent variables
Knowledge about menopause.
7.1.5 Independent Variables
Structured teaching programme
7.1.6 Attribute Variables
Age, education, religion, occupation, income, marital status etc
7.1.7 Population
In this study the target population consists of menopausal women between the age
group of 40 to 55 years.
7.1.8 Sample
Menopausal women who fulfill the inclusion criteria will be the sample of this
study.
7.1.9 Sample sized
Sample consist of 50 menopausal women aged between 40-55 years
7.1.10 Sampling Techniques
Non probability convenient sampling technique
7.1.11 SAMPLE CRITERIA
INCLUSION CRITERIA
Those women age of 40-55 years
Those women with the menstrual cessation for the last 1 year
continuously.
Those women who understand English, Hindi, Kannada
Those women who are present at the time of data collection.
Those who are willing to participate to the study
EXCLUSION CRITERIA
Those menopausal women having systematic illness.
Those women age group of below 40 and above 55 years.
Those menopausal women who are undergone hysterectomy.
Those menopausal women who are terminally ill.
7.2 METHODS OF DATA COLLECTION
A structured interview schedule will be used for the data collection.
Description of the tool
Structured knowledge questionnaires will be prepared it consist of
Demographic data, which contained age, religion, education, occupation, income
Structured knowledge questionnaires regarding menopause
Method of Data Analysis
The data will be analyzed using a descriptive and inferential statistics.
Descriptive statistics
Frequency and percentage distribution will be used to analysis the demographic
data of menopausal women
Mean and standard deviation will be used to assess the level of knowledge
regarding menopause
Inferential statistics
Paired‘t’ test to assess the effectiveness of structured teaching progrmme on
knowledge regarding menopause among menopausal women.
Chi – square test to find out the association between the knowledge on
menopause among menopausal women with their selected demographic variables
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMANS
OR ANIMALS?
-YES-
Structured teaching programme will be conducted and knowledge level will be assessed.
No other investigation or intervention will be conducted on the subjects.
7.4 HAS ETHICAL CLEARANCE HAS BEEN OBTAINED FROM YOUR
INSTITUTION?
- YES-
Permission will be obtained from concerned authority in the general hospital Yelahanka,
to conduct the study. A written consent will be obtained from the participants for their
willingness to participate in the study.
8. LIST OF REFERENCES
1. Abdellah, F.G and Levin E., Better Patient care though nursing research, New
York; Macmillan Publishing Company 1986.
2. Best, W.J., and kahan J.V., research in Education, New Delhi: Prentice Hall of
India Pvt Ltd., 1995.
3. Burns, N., and Grove, S.K. The practice of nursing research conduct, critique and
utilization, Philadelphia, W.B Saunders Company, 1993.
4. Bobak, Jensen Maternity Gynaecology Care, 5th Edition. Mosby – St. Louis 1993,
1257p-1267p
5. Dutta, D.C., Text Book of Obstetrics, including Perinatology and Contraception.,
Calcutta; New central book agency,1998.
6. Dewhurst. Textbook of Obstetrics and Gynaecology for Postgraduates, 6 th
edition ,Blackwel Science 1999, 441p-461p
7. Hawkins and Bourne Shaw’. Textbook of Gynaecology 10th edition (1994) ,
Churchill Livingstone Pvt. Ltd., New Delhi, .54p- 58p.
8. Hacker – Moore Essentials of Obstetrics and Gynaecology, 3 rd edition ,
Harcourt Brace and Co., Asia Pvt. Ltd., 1998, 602p-609p
9. Jeffcoate, N.S., Principle of gynecology, Edinburgh, Butter worth and
Copublishers, 1983,
10. Kenneth J.R., Ross. S.B., and Robert L.B., Kistner”s Gynaecology, Harcourt
Brace and company 1998.
11. Kerlinger, F.N., Foundations of Behavioral Research New York: Holt, Rinchart
and Winston Inc., 1973.
12. Kothari, C.R, Research Methodology Methods and Technology, Bangalore:
Wishwa Prakashan Publishes, 1999.
13. Leon, S., Robert H .G. and Nathan G.K., Clinical Gynaecology and Infertility, A
Walter’s (Kluwer) 1999.
14. Polit, D.F. and Hungler, B.P., Nursing Research Principles and Methods,
Philadelphia: Lippincott Company, 1999.
15. Roberts, C.A., and Burke, S.O, A quantitative and qualitative approach, Boston;
Jones and Barett Publishes, 1989.
16. Reader Martin Konaiak – Griffin – Maternity Nursing, 18th edition. Lippincott,
1997), Philadelphia, 177p-186p
17. Speroff, L. The Menopause: A signal for the future, New York: Raven press 1-8,
1994.
18. Shaw’s Text Book of Cynaecology., Howkins and Bourne Eleventh edition., B I
Churchill Livingstone, New Delhi. 1995 pg. 53 – 58
19. Stanhope, M., and Lancastor, J., Community Nursing Process and Practice for
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20. Treece, E.W., and Treece J.W., Elements of Research is Nursing. St. Louis: The
C.V Mosby Company, 1982.
21. Tindall VR, Jeff Coates, Principles and Gynaecology 5 th edition 1987, Buttorworth –
Heinemantt – 88 – 93 PP.
22. Chen – YL, Voda – A M and Mansfield – P.K. 1998. “Chinese midlife women’s
perceptions and attitudes about menopause “. Menopause, 5 (1): 28 – 34.
23. Dumbell, L.M.J. 1995, “A positive approach to menopause ( CD – ROM ) “.
Canadian Nurse, 91 (7): 47 – 48.
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Knowledge about physical and emotional changes associated with menopause”
women’s Health, 29 (2) 37 – 51.
25. Frey, K.A. 1981 “Middle aged women’s experience and perception of
menopause” Women’s Health, 6(1): 25 – 36.
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Electronic Soures
27. www.nifl.gov
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31. www.nichy.ord .
32. www.yahoo.com
9. SIGNATURE OF THE
CANDIDATE
10. REMARKS OF THE GUIDE
11.
11.1 NAME AND
DESIGNATION OF THE
GUIDE (IN BLOCK
LETTERS)
11.2 SIGNATURE
11.3 CO –GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT