Effect of Self Care Guideline on the Quality of Life among Women With menopausal symptoms

Introduction

 Women face specific issues arising from their physiological conditions. One of these issues is menopause transition period that is associated with complications. Some of these effects include vasomotor disturbances, hot flashes, night sweats, and psychological changes of mood disorders, depression, anxiety, loss of concentration, memory loss and irrigation, sexual dysfunction. (1)

Menopause does not really require medical treatment since it is a natural biological process. Treatments for menopause focus on relieving its symptoms and preventing any chronic condition that may occur during the postmenopausal years, such as heart disease and osteoporosis. Exercise, an appropriate diet, not smoking, and reduction of stress are also effective ways to make menopause more bearable and also facilitate in preventing the chronic ailments that may occur in the postmenopausal years.( 2)

Menopause is a stressful time for some women. However, strategies for managing stress can help women cope, not only with menopause, but with life and aging in general. Practices such as relaxation exercises, biofeedback, aerobic exercise, yoga, meditation, and breathing techniques are tools that enable these women to deal with stress in their lives.( 3)

Complications of menopause were  heart and blood vessel (cardiovascular) disease, osteoporosis, urinary incontinence, sexual dysfunction ,  due to vaginal dryness , and weight gain .( 4)

Health promoting lifestyle education is one of the most important factors in raising postmenopausal women’s awareness and improving their performance to improve their health status. All the researches in the field of menopause have also emphasized education of and care for postmenopausal women to prevent their problems (5).

The Orem's Model of Nursing. This theory originates from the totality paradigm based on human beings able to adapt to one’s environment. It is widely used in nursing literature and has displayed improved quality of care based on results from various randomized controlled trials  in the nursing discipline .It is particularly used in rehabilitation and primary care settings, where the patient is encouraged to be as independent as possible. (6)

Operational definition for guide line is a document with the aim of guiding decisions and criteria regarding diagnosis, management, and treatment in specific areas of healthcare. Such documents have been in use for thousands of years during the entire history of medicine .A healthcare provider is obliged to know the medical guidelines of his or her profession, and has to decide whether to follow the recommendations of a guideline for an individual treatment. ( 7)

Menopause symptoms are closely related to QOL of women during menopausal period and can influence QOL of women physiologically, psychologically, and socially.(8)

According to World Health Organization (WHO), QOL is individual’s perception of current life situation, in the cultural background and value systems in which she grew up and the relation of these perceptions with her respective goals, expectations, standards, and priorities.( 9 )

Quality of life is used in healthcare to refer to an individual’s emotional, social, and physical well-being, including their ability to function in the ordinary tasks of living .It is a term used most frequently in the context of medicine and healthcare, when the impact the disease may reduce health related quality of life. health related quality of life is defined as the impact of an injury or illness has on the QOL including the perception of his or her injury or illness or it is the ‘value assigned to the duration of life modified by impairments, considering the individual own sense of well-being and not the health care provider’s perception. (10).

Nurses have a vital role to play in helping women to cope during and after the menopause, offering individual assessment, education and support. All those involved in counseling such women must ensure that they know where to get up-to-date information and where to direct clients who are in need of further information. (11)

Significance:

Overall, by increasing life expectancy, more than one third of a woman's life is spent in menopause, which cause many physical and psychological changes in women (12).

A study of menopausal women revealed that 80 percent experienced no change in quality of life. Sixty-two percent had positive  feeling about menopause. Ten percent of women said they were irritable, fatigued, and had feelings of despair during the menopausal phase of their lives .( 13)

The transition through menopause is a life event that can profoundly affect quality of life. More than 80% of the women reported physical and psychological symptoms that commonly accompany menopause, with varying degrees of severity and life disruption few empirical studies, however, have examined the interrelated nature of symptoms associated with the menopausal transition and early postmenopausal and the effects of those symptom groups on quality of life . (14)

 Approximately 55% of women going through meno­pause don’t do anything at all to treat symptoms.  Approximately 75% of women experience hot flashes and night sweats at some point.( 15)

Aim of the study

was to evaluate the effect of  self-care guideline on quality of life among women with menopausal symptoms.

Hypothesis:

There is the positive effect of self-care guideline on the quality of life among woman with menopausal symptoms.

Subjects and methods  

Research design:

Quasi-experimental design was used to evaluate the effect of self-care guideline on quality of life among women with menopausal symptoms.

Setting:

The study was conducted in Obstetrics and Gynecology department at maternity and children’s hospital in El Minia city(hospital of obstetric &gynecology and children , university hospital(out patient clinic)

Subjects:

Any woman attending the study setting is eligible for inclusion in the study sample if she fulfills the following

Inclusion criteria:

• Woman age 45-65 years.
• Not using hormonal replacement therapy
• Minimum reading and writing is accepted.
• Free from medical conditions like diabetes, hypertension, cardiac disease and thyroid disorder
• Single or married

Exclusion  criteria

• Previous hysterectomy or mastectomy .
• Woman receiving chemotherapy or radiotherapy.

Sample size and type

Purposive sample of all women at menopausal stage  attending to gynecology clinic. At it least 100 women  were recruited in the study

Ethical considerations:

Each participant woman in the study was informed that her rights would be secured, informed about the nature, process, and expected outcomes of the study, reassured that the study procedures would be harmless, reassured that all data would be confidential and would be used only for the research purposes, and informed about her rights to withdraw at any time throughout the study.

Tool of Data Collection

1st part - Interviewing sheet: was designed by the researcher and it included data about women’s socio demographic data: economic state, occupation & educational level, menstrual status etc...

2nd part - Menopause specific quality of life questionnaire (MENQOL). It is a self-report measure assessing the presence and severity of menopause symptoms and the degree to which they adversely affect women’s life designed by (Hilditch and Lewis,2005).  It consists of 29 items divided into four domains: vasomotor (three items), psychosocial (seven items), and physical (16 items) and sexual (three items). The systematic scoring for each of the four.

3th- Diary sheet for every woman.

Pilot study:

A pilot study was carried out during three weeks on 10 women with menopausal symptoms. It was done to test study process and to evaluate the applicability and clarity of the tools, assessment of feasibility of fieldwork, identification of a suitable place for interviewing women, and to detect any possible obstacles that might face the researcher, and interfere with data collection. Necessary modifications were done based on the pilot study findings. The sample of women included in the pilot study was not included in the main study sample.

Fieldwork description:

Data collection for this study was carried out during March 2016 to December 2016, during morning shifts. The researcher attended the outpatient unit from 9:00 am to 2:00 pm, 3 days per week. Oral consent for participation in the study was obtained from every woman for ethical issues.

The researcher started to collect the data from woman by the pre-test on the first visit for follow up.

The researcher introduced herself to the woman in out- patient unit, and explained the purpose of the study was to obtain her consent for participation. Complete personal data were taken, then the effect of menopausal symptoms on health status (medical history) , to assess the  knowledge of women about menopausal symptoms.

Then Researcher apply posttest for assess the effect of menopausal symptoms on the quality of life and effect of guideline on women's quality of life as physical, psychological, motor and sexual condition of women.

Limitations of the study:

Some women refused to cooperate, other women didn't want to speak about sexuality.

Statistical Design:

The collected data were organized, tabulated and analyzed using statistical package of social science (SPSS) 17.0 programs. The data were presented in numbers and percentages. Mean and standard deviation were calculated for quantitative data. Chi-square (X2) test was used for qualitative data and both (T–Test and correlation coefficient) were used for quantitative data ,when P value was equal or less than .05 it was considered significant value.

Result

Part  1 :Demographic characteristics and history of the menopausal women.

Table(1): Distribution of the studied women according to their Demographic characteristics. (n=100)

Table (1) Illustrates that, The study included 100 menopausal women aged 45–65 years with a mean age of 53.6±5.3 years. Most women were married (54%);  4% illiterate and 68% were able to read and write ; 76% housewives.

Table(2):  Contentious,  Distribution of the studied women according to their Personal  habits.

Table (2) describes personal  habits of menopausal women :   It shows that  less/or more than two thirds had good body health (69% ),  61 % preferred Low fat  diet,  Also 60 % of them had  Stress and 63 %    had good dealing with anxiety. It is also clear that slightly less than one quarter (22%)of them had negative  opinion about  menstrual cessation.

Table (3): Effect of menopausal symptoms on total level of  quality of life of the studied women in pre test ( n=100). 

Table (3) describes  the effect of menopausal symptoms on total QOL (Mobility, Psychological,  Physical , Sexual conditions) of menopausal women in pre test. It was found that the highest mean score was related to   women Mobility(2.22±0.9),  as compared with the lowest mean score related to   women (Psychological  1.65±0.9l , Physical  1.49±1.0 ,  and  Sexual  1.49±1.0   respectively ).

Table (4): Effect of menopausal symptoms on total level of  quality of life of the studied women in post test ( n=100). 

Table (4) describes the effect of menopausal symptoms on total QOL (Mobility, Psychological, Physical, Sexual conditions) of menopausal women in post test. It was found that the mean score was reduced in post test relating to   women all QOL ( Mobility,  Psychological   , Physical   ,  and  Sexual    respectively ).

Figure(  1  ): Effect of menopausal symptoms on total mean score of  quality of life in Pre and post intervention

Figure  ( 2 ): Total level of  quality of life of menopausal women in pre and post Intervention

Table(5): Correlation between the quality of life of the studied women and some demographic variables. (n=100)

Concerning  the relationship between the quality of life and some demographic variables. Table (5 ) revealed a statistical inverse correlation of the quality of life in menopausal women with their age (P < 0.01 and r = −0.310). Also the same table showed that the quality of life in menopausal women varied according to their marital and occupational status (P < 0.01). It also  showed that the quality of life in menopausal women had statistically significant correlation with their educational level (P < 0.01 and r = 0.324).

Table(6): Correlation between the quality of life of the studied women and their level of chronic disease. (n=100).

Table (6 ) reveals that there was  a positive association between severity  of chronic disease and lower level of QOL during the menopausal period.

Table(7): Correlation between the quality of life of the studied women and their level of menopausal symptoms. (n=100).

Table (7 ) clarifies  that there was a strong association  between severity of menopausal symptoms as "vasomotor, somatic, , psychosomatic,  urogenital symptoms" and lower level of QOL during the menopausal period.

Table(8): Correlation between the quality of life of the studied women and their level of body activities. (n=100).

Table (8 ) illustrates that there was  a positive association between decrease in the level of body activities with their  Low  level of QOL