Level of Awareness of Level IV Nursing Students Regarding Polycystic Ovarian Syndrome

A Thesis Proposal Presented to The Family Clinic Colleges, College of Nursing

In Partial Fulfilment of the Requirement for the Subject Principles And Methods Of Research

Submitted to: Ms. Cleotilde C. Reyes

Submitted by: Group IV Garlejo, Maria Sabrina S. Golfo, Gellie Ann E. Guinto, Queen Anne S.

TABLE OF CONTENTS Title Page.......................................................................................................................................................i Approval Sheet............................................................................................................................................. ii Acknowledgement.......................................................................................................................................iii Table of Contents.........................................................................................................................................iv

Chapter I. THE TITLE AND ITS BACKGROUND Introduction.....................................................................................................................................3 Statement of the Problem...............................................................................................................4 Scope and Delimination...................................................................................................................4 Conceptual Paradigm.......................................................................................................................6 Theoretical Framework....................................................................................................................7 Definition of Terms..........................................................................................................................9

Chapter II. REVIEW OF RELATED LITERATURE AND STUDIES Local Literature..............................................................................................................................10 Foreign Literature..........................................................................................................................12

Chapter III. RESEARCH METHODOLOGY Research Design.............................................................................................................................14 Preparation of Instrument.............................................................................................................14 Validation of the Instrument.........................................................................................................15 Administration of Questionnaire...................................................................................................15 Sampling Technique.......................................................................................................................15 Treatment of Data.........................................................................................................................15 Bibliography Appendix A (Cover Letter) Appendix B (Approval Letter)

APPROVAL SHEET This research proposal entitled Level of Awareness of Level IV Nursing Students Regarding Polycystic Ovarian Syndrome . Prepared and submitted by Group IV in partial fulfilment of the requirements for the subject principles and method of research examined and is recommended for acceptance and approval for oral defense.

Ms. Cleotilde C. Reyes Adviser

ACKNOWLEDGEMENT The researchers would like to thank and express their gratitude for the following individuals and groups who participate in their study, had helped and supported them in making this thesis proposal possible and successful. First of all, they would like to thank Ms. Cleotilde C. Reyes, their research instructor. They wish to thank her for all she had taught to them, her patience and courage in teaching and understanding them if sometimes they can t comply with some related requirements to the subject. Acknowledgement is likewise given to their beloved dean, Flora B. Villalon R.N., M.A.N., Ed.D., for her approval on the title of their thesis proposal, for sharing her ideas and knowledge regarding their topic and how to plan it. They also want to thank their parent for their endless love and support, for teaching them good things that really matters in life. They thank them for their continued supervision and untiring support not only in financial matters but also for their studies that inspires them. The researchers would like to thank their classmates, schoolmates and friends for their unwavering loyalty, help and care. Also to their group mates who contributed their knowledge and share their ideas and thoughts making this thesis proposal possible. Most of all, they want to thank their beloved Almighty God, for showering those graces and blessings and whose infinite wisdom gave them the capability to come up with this thesis proposal.

1 CHAPTER I

THE PROBLEM AND ITS BACKGROUND

INTRODUCTION Awareness of the Level IV Nursing Students with regards of Polycystic Ovarian Syndrome ( PCOS ) will be the baseline of the researchers study. The study itself will help the researchers and the respondents to culminate the knowledge on how to assist and to give interventions on woman with Polycystic Ovarian Syndrome ( PCOS ). Polycystic Ovarian Syndrome (PCOS) is another type of cystic disorder that affects the ovaries. This complex endocrine condition involves a disorder in the hypothalamic-pituitary gland and ovarian network or axis, resulting in chronic anovulation and chronic androgen excess, along with multiple small ovarian cysts called polycystic ovaries. Onset of Polycystic Ovarian Syndrome (PCOS) maybe at menarche or later; it occurs in approximately 5% to 10% of women of childbearing age (Stankiewicz& Norman, 2006). The principal features are obesity, anovulation (resulting in irregular menstruation) or amenorrhea, acne, and excessive amounts or effects of androgenic (masculinising) hormones. The symptoms and severity of the syndrome vary greatly among women. While the causes are unknown, insulin resistance, diabetes and obesity are all strongly correlated with Polycystic Ovarian Syndrome (PCOS). Common symptoms of Polycystic Ovarian Syndrome (PCOS) include menstrual disorders mostly oligomenorrhea or amenorrhea, but other types of menstrual disorders may also occur. Infertility, generally resulting from chronic anovulation (lack of ovulation).Hirsutism symptoms of hyperandrogenorism, such as acne or hypermenorrhea.Approximately of patients with Polycystic Ovarian Syndrome (PCOS) (by the diagnostic criteria having evidence of hyperandrogenemia).Metabolic syndrome, characterized by central obesity, insulin resistance and other symptoms. Polycystic Ovarian syndrome (PCOS) can be present in any age during the reproductive years, due to its often vague presentation it can take years to reach a diagnosis. Serum insulin, insulin resistance and homocysteine levels are significantly higher in subjects. The syndrome acquired its most widely used name due to the common sign on ultrasound examination of multiple (poly) ovarian cyst. These cyst are actually immature follicles, not cysts (polyfollicular ovary syndrome would have been a more accurate name). The follicles have developed from primordial follicles, but the development has stopped arrested at an early astral stage due to the disturbed ovarian function. The follicles may be oriented along the ovarian periphery, appearing as a string of pearls on ultrasound examination. The condition was first described in 1935 by Dr. Stein and Dr.Leventhal, hence its original name is Stein-Leventhal Syndrome. A majority of patients with Polycystic Ovarian Syndrome (PCOS) have insulin resistance and/or are obese. Their elevated insulin levels contribute to or cause the abnormalities seen in the hypothalamic-pituitary-ovarian axis that leads to Polycystic Ovarian Syndrome (PCOS).

The researchers were interested to conduct a study regarding Polycystic Ovarian Syndrome (PCOS) to broaden the awareness of the readers, especially the level IV (four) nursing students. Researchers are also much interested in enhancing the skills and knowledge of nursing students regarding the appropriate care that must be delivered to those patients who suffers on the said syndrome.

2 STATEMENT OF THE PROBLEM The study will attempt to answer the following questions: Major Problem: This research proposal will discuss Level of awareness of Level IV NursingStudents Regarding PolycysticOvarian Syndrome Minor Problem: 1. What are the factors that affects the pathogenesis of polycystic ovarian syndrome a. Lifestyle; b. Heredity; and c. Age? 2. What level of awareness for Polycystic Ovarian Syndrome (PCOS) did level IV nursing students perceived with regards to; a. Management care; b. Complication; c. Medication? 3. What level of awareness for patients with Polycystic Ovarian Syndrome (PCOS) do level IV nursing students of Family Clinic Inc., - Colleges assessed as to: a. Knowledge; b. Skills; c. Attitude?

3 ASSUMPTION A1. There are different demographic profile of the respondents with regard to their age, gender, and civil status. A2. There are different level of awareness of the respondents in terms of management, complication and medication. A3. There are different level of awareness that affects the respondents with regard to knowledge, skills, and attitude.

SCOPE AND DELIMITATION The scope and delimitation of the study will discuss the subject matter and the respondents covered in the study. This study intends to know the Level of Awareness of Level IV Nursing Students of Regarding Polycystic Ovarian Syndrome. The researchers will conduct the study at Falilt Clinic Inc.-Colleges located at A.H. Lacson St. Sta. Cruz, Manila. The researchers will have NCM 103 students from Level IV based on the total population enrolled from the registrars office. The study will be conducted this 2nd semester of the school year 2011-2012. SIGNIFICANCE OF THE STUDY This topic will discuss the beneficiaries of the study regarding Polycystic Ovarian Syndrome and how will they benefit from the study. Nursing Students- will gain knowledge with regards to Polycystic Ovarian Syndrome. Management care, complications and its mechanism. This study will be a future reference as they venture their life in field of medicine. Patients- will give them the view of the study, format and importance with regard to how and why a certain study is conducted. Community- will also increase awareness, this will help them formulate solutions Clinical Instructor- can use this study as a basis to enhance and develop their teaching strategies, especially in nursing care to those patients with this kind of syndrome. Nurses- will give them the proper view on management care of clients Level IV Nursing Students- it will broaden their awareness and knowledge regarding the so called syndrome.

CONCEPTUAL PARADIGM Input

1. What is the demographic profile of the respondents with regard to: 1.a. Age; 1.b. Gender; and 1.c. Civil Status? 2. What level of awareness for Polycystic Ovarian Syndrome (PCOS) did level IV nursing students perceived with regard to: 2.a. Management care; 2.b. Complication; and 2.c. Medication? By using the process stated earlier, the answer to the minor problems are gathered such as the level of awareness of the respondents in terms of age; gender and civil status and how these awareness affect the respondents with regard to the management care, complication, and medication and medication. Lastly, the different effects that contribute to the Level IV Nursing Students with regard to the aspect of knowledge, skills and attitude.

Process

Output

The process to be used to be able to get the desired output is the QUESTIONNAIRE

3. What are the different effects that contribute to the level of awareness of Level IV Nursing Students of Family Clinic Inc.Colleges in terms of: 3.a. Knowledge; 3.b. Skills; and 3.c. Attitude?

THEORETICAL FRAMEWORK DOROTHEA OREM Theory of Self Care and Self Care Deficit. Each person has the need for self-care in order to maintain the optimal health and wellness. Each person possesses the ability and responsibility to care for themselves and dependents. Theory is separated into three conceptual theories which include: self-care, self-care deficit and nursing system. Self-Care is the ability to perform activities and wellness of mind, body and spirit. It is a learned behavior influenced by the metaparadigm of person, environment, health and nursing. Three components: universal self-care needs, developmental self-care needs, and health deviation. 1. Universal Self Care this includes activities which are essential to health and vitality. Eight elements identified these includes: air, water, food, elimination, activity and rest, solitude and social interactions, prevention of harm, and promotion of normality. 2. Developmental Self Care this include the interventions and teaching designed to return a person to or sustain a level of optimal health and well-being. Examples can include such things as toilet training a child or learning Healthy eating. 3. Health Deviation Self Care this encompasses the variations in self-care which may occur as a result of disability, illness, or injury. In other words, the person with variation is meeting self-care and maintaining health and wellness in a more individualized meaning. Self-Care Deficit- every mature person has the ability to meet self-care needs, but when a person experiences the inability to do so due to limitations, thus exists a self-care deficit. A person benefits from nursing intervention when a health situation inhibits their ability to perform self-care or creates situation where their abilities are not sufficient to maintain own health and wellness. Nursing action focuses on identification of limitation/deficit and implementing appropriate interventions to meet the needs of person. Nursing System is the ability of the nurse to aid the person in meeting the current and potential sell care demands. Three support modalities identified in theory including: total compensatory, partial compensatory, and educative/supportive compensatory. Support Modalities y Total Compensatory support encompasses total nurse care client unable to do for themselves. y Partial Compensatory supports involves both nurse and the client sharing in the self-care requirements. y Educative/Supportive Compensatory support elicits the help of the nurse solely as a consultant, teacher, or resource person. Client is responsible for their own self-care.

DEFINITION OF TERMS Researchers aim to increase the knowledge of their readers with regards on the different terms that are used in the study. Through the definition of the words in its simplest and most understandable way, readers will be able to enrich their vocabulary. Alopecia loss of hair from the head or body Amenorrhoea absence of menstrual period in woman of reproductive stage Androgen hormone that develops and maintains masculine characteristics Anovulatory - lack of ovulation leading to inability to achieve Cysts -a closed abnormal sac or vesicle which may develop in a structure or cavity of the body. Estrogen any of various steroid hormones that regulate female reproductive functions and secondary characteristics. Gynecologist physician who deals with diseases of women Hirsutism excessive hair growth especially in women Hyperandrogenism - the overproduction of the male sex hormone called testosterone which can cause abnormal hair growth. Insulin the hormone released by the pancreas, essential in regulating the metabolism of sugar in the body. Milieu the physical or social setting in which something occurs or develop in the environment

CHAPTER II

REVEW OF RELATED LITERATURE AND STUDIES

This chapter will focus on the review of related literature both local and foreign, which will have relevance to the present study. This will be presented to strengthen the background and enrich the content of the study. These will found to be sufficient to represent the categories under study. LOCAL LITERATURE 1. According to Homburg, Roy (pp.527) Polycystic ovary syndrome (PCOS) is a common gynecologic endocrinopathy. The pathogenesis of PCOS is associated with both heredity and environment. PCOS has adverse impacts on female endocrine, reproduction, and metabolism. PCOS can impact womens reproductive health, leading to anovulatory infertility and higher rate of early pregnancy loss. PCOS has additional metabolic derangements, such as insulin resistance, impaired glucose tolerance, and dyslipidemia. The risks of diabetes, cardiovascular disease, hypertension, metabolic syndrome, and endometrial cancer among PCOS patients are significantly increased as well. 2. According to Korbonits, Marta (36:246 247) Polycystic Ovarian Syndrome (PCOS) is a complex metabolic disorder that is defined by irregular or anovulatory cycles, excess circulating androgens and morphological changes that are recognized as structural polycystic change within the ovary. A large body of evidence has arisen that demonstrates that PCOS is accompanied by insulin resistance and subject with PCOS are at higher risk of T2D and premature coronary artery disease. In addition to the effects on fertility in relation to PCOS, obese subjects have additional independent risk for infertility and pregnancy associated complications. Demonstration of the effects of metformin on hyperinsulinaemia, ovarian steroidogenesis and as an adjunct to clomiphene in the management of subfertility established a role for metformin in PCOS. Metformin appears to be safe to the fetus when taken for the purpose of inducing fertility. Improving insulin resistance either through behavioral means or metformin appears to have similar beneficial effects on the reproductive axis. There are few data regarding the effect of other modalities of weight loss through pharmacological and surgical treatment. Essentially, weight loss through medication as a means of treating PCOS is a largely unexplored area. According to self reporting, some previously subfertile women appear to have achieved successful pregnancy after surgical weight loss, and several series have reported reasonable perinatal outcomes after bariatric surgery in a population known to be at risk of obstetric complications. 3. According to Reuters, Thomson (5;882 883 )Polycystic ovary syndrome (PCOS) is the most common endocrinological problem affecting women with a prevalence estimated at 4-25% depending on the diagnostic criteria used. Patients with PCOS demonstrate a combination of characteristics which may include anovulation, oligomenorrhea or amenorrhoea, hirsuitism, acne, evidence of increased serum androgen levels and morphological changes in the ovary evident on ultrasonography. Approximately 50% of PCOS patients are obese; a much higher prevalence than the general population. There is also a metabolic element to the condition in the form of

insulin resistance that may result in long-term morbidity (Rotterdam 2003). South Asian refers to those persons who originate from the Indian subcontinent (India, Pakistan, Sri Lanka, Bangladesh and Nepal). In a community-based study in the United Kingdom (UK), it was found that polycystic ovaries (PCO) were particularly common among women of South Asian origin (52%), compared to the prevalence of PCO observed in a predominately Caucasian population (22%) (Rotterdam2003). The South Asian population, in general, also exhibit a higher prevalence of insulin resistance and type 2 diabetes, which may increase long term morbidity among those with PCOS. Recent research indicated higher insulin concentrations and lower insulin sensitivity in South Asian women with PCOS compared to Caucasian women with PCOS. This research also concluded that South Asians presenting with anovular PCOS were significantly younger, had more severe hirsuitism and a higher prevalence of acanthosisnigricans than their Caucasian counterparts. 4. According to Runge, Marschall S. MD, PhD (2:pp.507) Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance). Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant. The exact cause of polycystic ovary syndrome is unknown. Women with polycystic ovary syndrome may have trouble becoming pregnant due to infrequent or lack of ovulation. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, such as type 2 diabetes, heart disease and stroke. 5. According to Ducluzeau,Pierre Henri (58:4146)Polycystic Ovarian Syndrome (PCOS) is the most common disorder of ovarian function in premenopausal women. PCOS is characterized by chronic anovulation and androgen excess with clinical manifestation of irregular menstrual cycles, hirsutism and/or acne. Insulin resistance with resultant of hyperinsulinaemia, irrespective of excess weight or frank obesity, has been reported in patients with PCOS and, as insulin has a direct effect on ovarian androgen production in vitro, insulin resistance may play a crucial role in the physiopathology of PCOS. Although in the molecular mechanism(s) of insulin resistant in PCOS is unclear, excessive insulin dependent serine phosphorylation of the subunit of the insulin receptor, as reported in some patients with PCOS, has been put forward as a new mechanism for insulin resistance.Insulin sensitising agents have recently been investigated of their role in the short term treatment of insulin resistant in PCOS. Control studies have shown that metformin administration, by promoting body weight loss, can decrease fasting and stimulated plasma insulin levels. However, other studies have shown metformin 500 mg 3 times daily to decrease insulin secretion and to reduce ovarian production of 17 hydroxyprogesterone with recovery of spontaneous or clomiphene induced ovulation, independently of weight loss. These findings suggest a new indication for metformin and present insulin sensitising agents as a novel approach in the treatment of ovarian hyperandrogenism and abnormal ovulation in PCOS. They also

suggest that long term administration of metformin might be helpful in treating insulin resistance, thus reducing risks of type 2 (non insulin dependent) diabetes and cardiovascular disease in these patients. FOREIGN LITERATURE 1. According to Asheim, Hansen ( 2:457) Polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome or functional ovarianhyperandrogenism, is a complex disorder that usually begins during puberty and affects women of reproductive age. Polycystic ovary syndrome is characterized in most cases by multiple small cysts that develop on the ovaries. Many women with PCOS also experience a variety of symptoms that are related to the underlying metabolic and hormonal disorders that are associated with PCOS and include:Insulin resistance - a condition in which the cells of the body become resistant to insulin (a hormone that regulates the levels of glucosebloodstream), Hyperandrogenism, anovulatory infertility. 2. According to Hill, John (1:576)Polycystic ovary syndrome (PCOS) is an endocrine (hormonal) disorder. Most often, symptoms first appear in adolescence, around the start of menstruation. However, some women do not develop symptoms until their early to mid-20's. Although PCOS presents early in life, it persists through and beyond the reproductive years. 3. According to Luiz, Albert (7:675) Polycystic ovary syndrome (PCOS) is the most commonly encountered endocrinopathy in women of reproductive age. It has significant reproductive and nonreproductive consequences.Women of any ethnic background can present with PCOS. Because patients with PCOS can present with an assortment of complaints such as menstrual disturbances, infertility, hirsutism, and acne, their point of entry into the medical system may be by way of a primary care physician, gynecologist, endocrinologist, or dermatologist. Thus, all these disciplines need to be familiar with this syndrome and its long-term consequences. 4. According to Schieder, Isidore (3:453) Endocrine disorder in women, characterized by high levels of male hormones (androgens) and infrequent or absent ovulation (reproductive system). It causes a high proportion of female infertility cases. Symptoms vary but often include increased serum concentrations of androgens, insulin resistance, hirsutism, acne, and obesity. Menstruation may be irregular, absent, or excessive. The ovaries are usually enlarged and contain cysts. The disease may remain undiagnosed until a woman tries to conceive. The underlying cause is not fully understood, and no genetic mutations have been associated with the syndrome. Many women with Stein-Leventhal syndrome are at an increased risk of developing metabolic disorders such as type II diabetes or lipid disorders such as atherosclerosis at an unusually young age. Treatment attempts to reduce androgen production. Infertility may be treated with clomiphene citrate or gonadotropins to induce ovulation. 5. According to Smeets, Vivian (10:378) Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance). Infrequent or prolonged menstrual

periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant. The exact cause of polycystic ovary syndrome is unknown. Women with polycystic ovary syndrome may have trouble becoming pregnant due to infrequent or lack of ovulation. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, such as type 2 diabetes, heart disease and stroke.

CHAPTER III

RESEARCH METHODOLOGY
This chapter will discuss and cover the methods and procedures of research that will be used in this study. Research Design The researchers will be using the descriptive research design for the study. Descriptive research is a grouping that includes many particular research methodologies and procedures such as observations, surveys, self-reports, and tests. It is more analytic. It often focuses on a particular variable or factor and may also operate on the basis of hypothesis (often generated through previous qualitative research.) This type of research involves the description, recording, analysis and interpretation of the problem pertained. This type of research of research will help the researchers tackle what is present or what exist with due respect to the current situation. By the use of this descriptive method, which primarily tackles the present, it clarifies knowledge that the researchers might not otherwise notice or even encounter. It can also be used at the initial stage of investigation to identify the variables that exist in a given situation and to describe the relationship that exists between these variables. It can only be used to formulate hypothesis which are subject to experimental investigation. Preparation of Instrument The researchers will write a letter addressed to the dean of college of nursing, seeking approval to conduct the survey in the school premises particularly to the nursing students. The researchers will formulate the questions based on the different literatures related to the problem. Upon completion of the questions, it will be forwarded to the adviser validation and approval. Any correction will be incorporated and finalization will be made to assure the reliance of questionnaires. Validation of the Instrument A dry-run or the pre-testing will be conducted to at least 10 students who are not included in the study. In order to test the validity and reliability of the questionnaire, they will be interviewed by the researchers to found out what is their assessment on the questionnaire. Those who will participate on the dry-run will not be included on the actual study. Administration of Questionnaire Copies of the questionnaire will be distributed personally by the researchers to respondents. After a day, all the copies distributed will be retrieved also personally by the researchers. In cases that a respondent failed to fill up or comply on the said day of collection of questionnaires, the researchers will give them an extension of another day. Sampling Technique

This study will use simple random sampling, which is the selection on random basis of elements from a sampling frame that enumerated the elements. Each has equal chance to be selected as subjects of the study. The researchers selected 10 level IV nursing students from Family Clinic Inc.- Colleges, which is the 10% of the total population of Level IV nursing students that is 104. Treatment of Data The researchers will be using a percentage and frequency method in the study. To get the percentage, the number of frequency will be divided on the total number of respondents then multiply by 100. Frequency and Percentage Formula Formula: Where: P- Percentage frequency N- number of respondents

BIBLIOGRAPHY 1. 2. 3. 4. Asheim, Hansen, The Obsterical Management, Penguin Press, USA, 2010, page 567 Ducluzeau,Pierre Henri Drug Supplements Vol.58, Adis Ltd., Spain, 2009, page 41 Hill, John, Human Anatomy Oak Ridge, Tennessee, 2000 page 576 Homburg, Roy Polycystic Ovary Syndrome, Blackwell Science, Philippines, 2007 page 527 5. Korbonits, Marta Obesity and Metabolism Vol.36, Karger Publishers, Philippines, 2008 pages 246 247 6. Luiz, Albert, Maternal Diseases University of Jordan, Amman, Jordan, 2000 page 675 7. Reuters, Thomson Health and Quality of Life Outcomes Vol.5, BioMed Central, Philippines, 2002 pages 882 883 8. Runge, Marschall S. MD, PhD Principles of Molecular Medicine 2nd Edition, Humana Press, Phillipines, 2005 page 507 9. Smeets, Vivian, Clinical Symptoms of Diseases,Clear Springs Press, Arizona, USA, 2009 page 378 10. Schieder, Isidore, Woman Worldwide Diseases University of New Castle, New South Wales, Australia, 2007, page 453