RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARANATAKA

SYNOPSIS

FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate Mrs. DEENA PAUL

2. Name of the Institution: Diana college of nursing

No.68, Chokkanahalli

Jakkur post,

Bangalore-560 064.

3. Course of Study and Subject: Masters of Science in NursingObstetrics & Gynecological Nursing

4. Date of Admission to the Course: 10-06-2009

5. Title of the topic: Assess the Effectiveness of Rose Oil Massage

among Nursing Students suffering form

dysmenorrhea residing at selected Hostels in

Bangalore.

6. Brief resume of the Intended Work

Introduction:

Adolescents are full of energy, have significant drive and new ideas. They are a

positive force for a nation and are responsible for its future productivity. Adolescence is a

transitional state of physical and mental human development that occurs between childhood

and adulthood. This transition involves biological, social and psychological changes, through

the biological or physiological ones are the easiest to measure objectively.1

Developmentally, puberty is accompanied by major physical and emotional changes

that alter a young person’s relationship and patterns of interactions with others. The transition

into adolescence begins the movement towards the independence from parents and the need to

establish one’s own values, personal and sexual identity, and the skills and competencies

needed to complete in adult society.2

Puberty begins with a surge in hormone production, which in turn causes a number of

physical changes. It is also the stage of life span in which a child develops secondary sex

characteristics.3

The major landmark of puberty for males is the first ejaculation, which occurs on

average at the age of 13. For females, it is menarche, the onset of menstruation, which occurs

on average between ages 12-13. The age of menarche is influenced by heredity, but a girl’s

diet and lifestyle contribute as well. Regardless of genes, a girl must have certain proportion

of body fat to attain menarche. By the age of 16, girls have usually reached full physical

development.4

Dysmenorrhoea is defined as difficult menstrual flow or painful menstruation. The

term, dysmenorrhoea is derived from the Greek words ‘Dys’ meaning difficult or painful or

abnormal, ‘Meno’ meaning month and ‘rrhea’ meaning flow.5

Dysmenorrhoea is a medical condition characterized by severe uterine pain during

menstruation. While most women experience minor pain during menstruation, dysmenorrhoea

is diagnosed when the pain is so severe so as to limit normal activities, or require mediction.6

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

nauseating burning or shooting pain. Dysmenorrhoea may precede menstruation by several

days or may accompany it, and it usually subsides as menstruation tapers off.7

If however there are certain disorders or abnormalities present in the uterus which

result in pain then this type of dysmenorrhoea would be termed as secondary dysmenorrhoea.

Primary dysmenorrhoea is diagnosed only of there are no disorders or abnormalities found.

There are several alternative remedies to treat dysmenorrhoea. It includes acupuncture,

yoga and mediation, herbs and nutritional supplements etc. Natural remedies includes

aromatherapy, Aromatherapy, ginger tea, exercises, dietary modification and life style

modification etc.

Aromatherapy is the practice of using volatile plant oils including essential oils for

psychological and physical well being. Essential oils, the pure essence of a plant, have been

found to provide both psychological and physical benefits when used correctly and safely.

Essential oils that are inhaled into the lungs offer both psychological and physical

benefits. Not only does the aroma of natural essential oil stimulate the brain to trigger a

reaction, but when inhaled into the lungs, the natural constituents can supply therapeutic

effect. Essential oils that are applied to the skin can be absorbed into the blood stream. The

constituents of essential oils can aid in health, beauty and hygienic conditions.8

Essential oils relax the stomach muscles, called antispasmodics, contain

physiochemical that ease muscle spasms and help to relax the uterus. A soothing abdominal

massage can go a long way in releasing pain and tension from lower belly.

6.1 Need For the Study:

Dysmenorrhoea means painful menstruation. This is perhaps the most common

problem affecting nearly 80% of women in their reproductive years. Reports of

dysmenorrhoea are greatest among individuals in their late teens and 20’s with report usually

declining with age.

The prevalence of dysmenorrhoea world wide is ranging from 15.9% - 89.5% with the

higher prevalence rates reported in adolescent population.

Dysmenorrhoea is the most common gynecologic complaint that affects half of female

adolescents today and represents the leading cause of periodic school or college absenteeism

among that population. To evaluate the menstrual problem specially dysmenorrhoea and its

severity, a cross section study, conducted o 107 female medical students indicates that the

prevalence of dysmenorrhoea was 73.83% approximately 4.67% of dysmenorrhic subjects

had severe dysmenorrhoea. (Dept of physiology, S.S.Medical College, Rewa, M.P).

In an epidomologic study of an adolescent population in U.S reported a prevalence of

dysmenorrhoea of 59.7% of patients reporting pain, 12% described as severe, 37% as

moderate and 49% as mild. Dysmenorrhoea caused 14% of patients to miss school frequently.

Dysmenorrhoea is associated with a negative impact on social, academic and sports

activities of many female adolescents. A study to determine the prevalence of dysmenorrhoea

among the Hispanic adolescents in U.S states that, among participants 85% reported

dysmenorrhoea. Of these 38% reported missing school due to dysmenorrhoea and 33%

reported missing individual classes. Activities affected by dysmenorrhoea included class

concentration (59%), sports (51%), class participation (50%) socialization (46%), home work

(35%), test taking skills (36%) and grades (29%).9

There are a number of ways to treat painful periods at home. Although it is not able to

treat the pain completely, these measures may help to ease or reduce it. The measures are

exercises, applying heat on the lower abdomen, massaging essential oils on the lower

abdomen, relaxation techniques, transcutaneous electronic nerve stimulation etc.

Massage aromatherapy is a type of alternative medicine that uses essential oils and

other aromatic plant compounds, which are aimed at improving a person’s health or mood. It

is believed that the inhalation of essential oils stimulate the part of brain connected to smell,

the olfactory system, a signal is sent to the limbic system of the brain that controls emotions

and retrieves learned memories. This causes chemicals to be released which makes the person

feel relaxed, clam or even stimulated. If the aromatherapy includes the massage it relaxes the

muscles.10

Aromatherapy can be used for stress, anxiety, insomnia, headaches, muscular aches,

menstrual problems, digestive problems, circulation problems etc. Aromatherapy generally

applied in three ways, i.e. aerial diffusion, direct inhalation and topical applications. The types

of aromatherapy are cosmetic aromatherapy, massage aromatherapy, olfactory aromatherapy.

Rose oil have a multiple aromatherapy applications due to their well know effects on

claming the senses and balancing the emotions. The use of roses strengthens heart, its cooling

and astringent actions and its effect on headaches and other pains like dysmenorrhoea. In

aromatherapy roe oil inspires emotional calm and stability without sedative effect. The aroma

is powerful and comforting its physical actions are mildly astringent and balancing.11

Massage can provide several benefits to the body such as increased blood flow,

reduced muscle tension and neurological excitability and increased sense of well being.

Massage can produce mechanical pressure helps to increase the blood flow. Lower abdominal

massage helps to relax the abdominal muscles helps to reduce dysmenorrhoea.

In today’s busy life, dysmenorrhoea is a serious problem affecting the adolescence and

its affects the day-to-day life. Sometimes adolescents are not willing to consult the medical

practitioner. They will treat by home remedies. Therefore aromatherapy is an effective

method for treating dysmenorrhoea at home.12

A randomized placebo controlled trial was conducted in Taiwan. The objective was to

explore the effect of massage aromatherapy on menstrual cramps and symptoms of

dysmenorrhoea. The result was the menstrual cramps were significantly lowered in the

massage aromatherapy group than in the other group. So this can be offered to women

experiencing menstrual cramps or dysmenorrhoea. 13

The investigator during her experience as nursing tutor found that many students miss

classes due to dysmenorrhoea. They also had difficulty in working in clinical setting during

menstruation. This motivated the investigator to conduct a study on massage aromatherapy in

alleviating the menstrual cramps of nursing students.

6.2 Review of Literature:

A literature review is a body of text that aims to review the critical points of current

knowledge and are methodological approaches on a particular topic.

The review of literature is presented of the topic is presented under the following sub

headings, Review of literature related to

1. The incidence and prevalence of dysmenorrhoea among adolescents .

2. The effects of aromatherapy on dysmenorrhoea.

3. The effects of essential oil massage on dysmenorrhoea.

1. Review of literature related to the incidence and prevalence of dysmenorrhoea

among adolescents:

A study was conducted in New Delhi related to the frequency of problems related to

menstruation and the effects of these problems on daily routine, it shows that 67.2% of the

girls was affected with dysmenorrhoea and 63.1% has one or the other symptoms of

premenstrual syndrome. Daily routine of 60% girls was affected due to prolonged bed rest

missed social activities, commitments, disturbed sleep and decreased appetite. 17.24% had to

miss a class and 35% had abstained from work.14

A cross sectional study was conducted in U.P with an objective to know the

prevalence of dysmenorrhoea,its relationship with mean age at menarchae various other

factors affecting it. 700 girls were selected from four different schools.Questionare was

prepared to determine the no of menstruating girls,the mean age at menarchae and the

prevalence and extend of dysmenorrhoea.Chi square and ANOVA test were done to estimate

the correlation between the prevalence and severity of dysmenorrhoea.Result was mean age

at menarchae came out to be 12.36±1.15 years.Out of 700 objects ,400 girls had attained

menarchae.Among the 400 post menarcheal girls 257(64.3%)suffered from different degrees

of dysmenorrhoea.Analysis of the results revealed no significant correlation between severity

of dysmenorrhoea and age at menarchae.15

A cross sectional study was conducted in Malasia with an objective to determine the

prevalence of dysmenorrhoea &its associated factors and its effects on school activities

among adolescent girls.A stratified random sampling of 300 female students(12-17 years

old)were selected.A self administerd questionare consisting of 20 items was used to collect

sociodemographic and menstrual data.Pain intensity for dysmenorrhoea was measured by

numerical rating scale.The prevalence of dysmenorrhoea was 62%.It was significantly higher

in the middle adolescent age group(p=0.003).The number of schools and class abscene

increased with increasing severity of dysmenorrhoea(p<0.05).The mean pain score was

significantly higher in girls who reported to be unable to participate in sports(p=0.05)and

withpoor concentration in class(p<0.05).Dysmenorrhoea among the adolescent girls had a

significant negative impact in their school performance and activities.16

2. Review of literature related to the effects of aromatherapy on dysmenorrhoea:

An evaluative study was conducted in U.k with the aim is to examine the contribution

of aromatherapy to reduce pain during dysmennorrhoea and as a tool to improve the quality of

midwifery care.Women were offered aromatherapy to relieve anxiety,pain,nausea or vomiting

and other symptoms associated with dysmenorrhoea.The result was more than 50% of women

rated it as helpful and only 14% found it is unhelpful.17

A quasi experimental study was conducted in U.K with an objective is to examine the

effectiveness of aromatherapy massage on women suffering with dysmenorrhoea.Women

who received aromatherapy massage were compared with a control group who did not receive

the treatment.16 women received 30 minutes aromatherapy massage and 20 were in the

control group.In the aromatherapy massage group there was significant reduction in the pain

level compared to control group.The result suggests that aromatherapy massage is an

effective intervention for dysmenorrhoea management.18

Aromatheraphy has been used as a part of an integrated multidiscipling approach to

dysmenorrhoea management. This therapy is thought to enhance the parasympathetic

response through the effects of touch and smell, encouraging relaxation at a deep level.

Aromatherapy uses included anxiety depression, hypertension, insomnia, migrane,

tension, stress related to hypertension, dysmenorrhoea, menstrual regulation and infertility

problems etc it is unlikely that most of the aromatherapy uses could be proven and massage

alone alleviates many stress conditions, including muscular and also some internal symptoms

such as dysmenorrhoea. 19

3. Review of literature related to the effects of essential oil massage for

dysmenorrhoea:

Essential oils are all useful for period of pain because of their antispasmodic and

relaxing properties. They can be used regularly in the bath, as a component of massage oil or

as a warm compress, but should not taken internally. These oils are not used “neat” and are

always diluted with other oils or water, massage into the lower abdomen and back when

dysmenorrhoea is a problem. Some women find it is useful to have hot bath first, then use the

massage oil. 20

Rose oil have a multiple aromatherapy applications due to their well know effects on

claming the senses and balancing the emotions. The use of roses strengthens heart, its cooling

and astringent actions and its effect on headaches and other pains like dysmenorrhoea . In

aromatherapy roe oil inspires emotional calm and stability without sedative effect. The aroma

is powerful and comforting its physical actions are mildly astringent and balancing.

A randomized placebo- controlled clinical trial was conducted in korea with the

objective is to explore the effect of aromatherapy on menstrual cramps and symptoms of

dysmenorrhoea. The subjects were 67 female college students. Subjects were randomized into

three groups :- (1) an experimental group (n=25) who received aroma therapy (2) a placebo

group (n=20) (3) a control group (n=22) Aromatherapy was applied topically to the

experimental group in the form of and abdominal massage using two droops of lavender, one

drop of clary sage and one drop of rose in 5cc almond oil. The placebo group almond oil only,

and the control group received no treatment. The menstrual cramps levels was assessed using

a visual analogue scale. Results was the menstrual cramps were significantly lowered in the

aromatherapy group than in the other two groups at both post –test time (first day Beta=-2.48,

95%, cl -3.68 to -1.29 P<0.001, second day Beta = -1.97, 95% Cl-3.66 to -0.29, P=0.02 and

the severity of dysmenorrhoea (first day Beta= 0.31, 95% Cl = 0.05 to 0.57, P=0.02 second

day Beta 0.03, 95% Cl:0.10 to 0.56 P=0.006) than that found in the other groups. The findings

suggests that aromatherapy using topically with essential oils is effective in decreasing the

severity of menstrual cramps. 21

A randomized controlled trial was conducted in Taiwan with an objective of the use of

rose oil to alleviate menstrual pain has been a part of folk knowledge around the world. To

determine the effectiveness of using rose oil an intervention for reducing pin and psycho

physiologic distress in adolescents with primary dysmenorrhoea 130 female adolescents were

randomized assigned to an experimental (n=70) and a control (n=60) group. pre-intervention

and post intervention data at 1 month, 3months and 6 months were gathered on the

biopsychosocial outcomes of dysmenorrhoea. The results showed that compared with control

group, the experimental group perceived less menstrual pain, distress and anxiety and showed

greater psycho physiologic well being through time at 1,3 and 6 months after the

interventions. 22

A quasi experimental study was conducted to assess the effectiveness on selected

interventions on dysmenorrhoea among adolescent girls. The selected interventions were rose

oil application, brisk walking and pelvic floor exercise it was found that there was significant

reduction in pain after the intervention it was conduced that complementary therapies are very

effective in alleviating menstrual cramps as it has no side effects.

Statement of Problem:

Assess the effectiveness of rose oil massage among nursing students suffering form

dysmenorrheoa residing at Selected Hostels in Bangalore.

Objectives:

1. To assess the level of menstrual pain among nursing students before intervention.

2. To find out the effectiveness of rose oil massage among nursing students suffering

form dysmenorrhoea.

3. To find out the association between post test level of menstrual pain among nursing

students and demographic variables.

Operational Definitions:

a) Assess: - It refers to statistical measurement of level of menstrual pain among nursing

students as measured by visual analogue scale.

b) Effectiveness: It refers to the significant difference in the post test level of menstrual

pain among nursing students as determined by statistical measurement in the visual

analogue scale after rose oil massage.

c) Rose oil massage: It refers to the rubbing and kneading of abdominal muscles and

back by using rose oil for a period of 15miniutites among nursing students who are

suffering from dysmenorrhoea.

d) Dysmenorrhoea: It refers to the painful menstruation among nursing students

residing at selected hostel.

e) Nursing Student: - It refers to the girls studying GNM or Basic B.Sc nursing course

and residing at selected hostel.

Hypothesis:

H1: - There is significant difference in the level of menstrual pain among nursing students

before and after rose oil massage.

H2:- There is a significant association in the post test level of menstrual pain among nursing

students and demographic variables.

Assumption: -

1. Rose oil massage may alleviate pain among nursing students who are suffering from

dysmenorrhoea.

Delimitations:

The study is limited to

1. Nursing students residing at hostel.

2. Nursing students studying for GNM and basic B.Sc nursing.

Materials and Methods:

Sources of Data Data will be collected from nursing students

residing in selected hostels, Bangalore

Method of Data Collection.

Research Design:

Pre-experimental approach with one group

Pre-test and post test design will be used.

Setting Nursing hostel in Bangalore will be the

setting of the study.

Population Nursing students will be the population for

the study.

Sample Nursing students staying in selected hostel

will be the samples.

Sample Size 50 Nursing students will be the sample size of

the study

Inclusion Criteria Nursing students those who are

- willing to participate

-available at the time of data collection.

Exclusion Criteria Nursing students those who are

- With gynecological disorders and

undergoing treatment.

- Are under hormonal therapy.

Tool Visual analogue scale will be used to assess

the pain during menstruation

Rose oil will be used for massage to reduce

the menstrual pain

Data Collection - Prior to the data collection the

investigation will obtain permission

from the concerned authorities the

selected nursing hostel

- The investigators herself will do

further data collection before and after

intervention

Data Analysis and Data Presentation - Description and inferential statistics

will be used for data analysis

- The collected data will be presented in

the form of tables, diagrams and

graphs.

- Mean, median, mode or percentile

will be used for descriptive statistics.

- Paired‘t’ test will be used to assess the

effectiveness of rose oil massage and

chi square to associate the

demographic variables.

Ethical Committee

Title of the topic

“Assess The Effectiveness of Rose oil Massage Among

Nursing Students suffering form dysmenorrhea

Residing at Selected Hostels in Bangalore”.

Name of the candidate

Mrs. DEENA PAUL

Course of the subject

Masters of science in Nursing

Obstetrics & gynecological nursing specialty.

Name of the guide

Prof. KALAIVANI

Head of the Department

Department Obstetrics and Gynecological Nursing

Diana College of Nursing Bangalore.

Ethical committee Approved

Member of Ethical Committee

1. Prof Veda Vivek

Principal and Head of the Department

Department of community health nursing

Diana College of Nursing Bangalore-64.

2. Prof. Elizabeth Dora

Head of the Department

Department of child health nursing

Diana College of Nursing Bangalore-64.

3. Prof. Kalaivani

Head of the Department

Department of obstetrics and gynecological nursing

Diana College of Nursing Bangalore-64.

4.Prof. Vasantha Chitra

Head of the Department

Department of medical surgical nursing

Diana College of Nursing Bangalore-64.

5.Dr. Prof. Rangappa

Biostatistician

Bangalore.

List of References:

3. B.T.Basavanthappa. Text Book of Midwifery and reproductive health, 1st Edition, New

Delhi, jaypee Brothers publisher. 2006.

4. D.C. Dutta, Textbook of Gynecology, New central book agency Calcutta 5th edition

2004

5. Diane M.Fraser, Margeret A. Cooper, Myles Textbook of Midwives, 14th Edition, 2003.

6. T.K.Indirani Text Book of Midwifery, 1st Edition, New Delhi, Jaypee Brothers, 2003.

7. Bhinde Patni, Levi Text Book of Obstetrics for Nursing and Midwifery 1st Edition, New

Delhi, jaypee brothers Publishers, 2000.

8. Helen Varney, Nurse Midwifery 2nd Edition, London Jones and Barlett Publisher 1987.

9. C.S.Dawn Text Book of Obstretic and Neonatology and reproductive Child Education

16th Edition , Kolkata.

10. Barclay J, Vestey j, lambery A, Balmer C, Reducing the symptoms of lymphoedema :

is there a role for aromatherapy ? Eur J oncol Nurse 2006 March 21

11. Imura M,Misao H,Ushijma H. The psychological effects of aromatherapy –massage in

healthy post partum mothers, J Midwifery womens Health. 2006 Mar-Apr, 21(2) e 21-7

12. Soden K, Vincent K, Craske S,Lucas C, Ashley S Palliat Med. 2004 Mar: 18(2) 87-92

A randomized controlled trial of aroma therapy massage on hospice setting.

13. H.Kuriyama, S.Watanabe, T, Nakay, M.Kira Immunological Benefits of aromatherapy

massage Evad. Based complement Altern Med, June 1,2005 2(2) 179-184

14. Cooke B, Earnst E, Aromatherapy a systemic revies Br J Gen proct 2000:50:493-496 –

2005

15. Shirly Price, len Price, Aromatheraphy for health professionals New York : 2nd edition

1999

16. Jane Bickle, clinical Aromatheraphy: 2nd edition ebinburn : NY 2003

17. Tori Hudson, women’s Encyclopedia for natural Medicine 1st edition, NY, MC,

Growhill 2007

18. Linda skid More – Roth Mosby’s handbook of herbs and natural supplements –editions

2, st Lousi sMo : Mosby 2004

19. Valerie ann worwood, The complete book of essential oils and aromatherapy, 1st

edition, san Rafael, New world library, 1991

20. Marlena Erick sen, healing with aromatherapy 1st edition, Los Angels : keats 2000

21. J. Buckle, clinical Aromatherapy: essential oils in practice, new york, Churchill

Livingstone 2003

22. Denise Tiran, Clinical aromatherapy in pregnancy and childbirth, 2nd edition, NY 2000

23. www.India.gov.in

24. www.google.com

25. www.naha.org

26. www.pubmed.com

27. www.medicine.com

9. Signature of Candidate

10. Remarks of the guide The research topic selected for the candidate is suitable is

suitable as it is related to dysmenorrhoea among

adolescence and the effectiveness of rose oil massage.

There is a need to assess the effectiveness of rose oil

massage on dysmenorrhoea among Nursing Students.

11.Name and Designation of

Guide (In Block Letters)

Prof: KALAIVANI

Head of the Department

Department of Obstetrics and Gynecological Nursing.

Diana College of Nursing, Bangalore

Head of the Department Prof. KALAIVANI

Head of the Department

Department of Obstetrics and Gynecological Nursing.

Diana College of Nursing, Bangalore

Signature

12. Remarks of the Chairman

& principal

The topic selected for the candidate is researchable and

feasible and forwarded for needful action

Signature