PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE KNOWLEDGE REGARDING COMMON

PSYCHOLOGICAL PROBLEMS AFTER MENOPAUSE, AMONG

PREMENOPAUSAL WOMEN RESIDING IN SELECTED RURAL

AREAS AT TUMKUR WITH A VIEW TO DEVELOP AN

INFORMATION BOOKLET”

SUBMITTED BY: - Mr. SAIJU M RAJAN

Ist YEAR M.Sc. NURSING,

PSYCHIATRIC NURSING

SRI RAMANAMAHARSHI COLLEGE

OF NURSING, TUMKUR

2012 - 2014.

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE,

KARNATAKA

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 NAME OF THE CANDIDATE

AND ADDRESS.

MR. SAIJU M RAJAN

SRI RAMANA MAHARSHI COLLEGE OF

NURSING

TUMKUR.

2 NAME OF THE INSTITUTE SRI RAMANA MAHARSHI COLLEGE OF

NURSING, TUMKUR

3 COURSE OF STUDY AND

SUBJECT

1st YEAR M.Sc NURSING

PSYCHIATRIC NURSING

4 DATE OF ADMISSION TO

COURSE

30.06.2012

5 TITLE OF THE TOPIC

“ASSESSMENT OF KNOWLEDGE

REGARDING COMMON PSYCHOLOGICAL

PROBLEMS AFTER MENOPAUSE, AMONG

PREMENOPAUSAL WOMEN RESIDING IN

SELECTED RURAL AREAS AT TUMKUR”

2

6. BRIEF RESUME OF INTENDED WORK

INTRODUCTION

“Pre menopausal women stand at a cross road, facing the possibility of living the remainder of their lives.”

Science is the search for truth. Psychiatry refers to a field of medicine focused

specifically on the mind, aiming to study, prevent, and treat mental disorders in humans.

Menopause literally means the "end of monthly cycles" (the end of monthly periods aka

menstruation), from the Greek word pausis (cessation) and the root men- (month).

Menopause is an event that typically (but not always) occurs in women in midlife, during

their late 40s or early 50s, and it signals the end of the fertile phase of a woman's life.

However rather than being defined by the state of the uterus and the absence of menstrual

flow, menopause is more accurately defined as the permanent cessation of the primary

functions of the ovaries the ripening and release of ova and the release of hormones that

cause both the creation of the uterine lining, and the subsequent shedding of the uterine

lining (a.k.a. the menses or the period).This transition from a potentially reproductive to a

non-reproductive state is the result of a reduction in female hormonal production by the

ovaries. The functional disorders often significantly speed up the menopausal process and

create more significant health problems, both physical and emotional, for the affected

woman.

Menopause is a major turning point in the life of a woman directly related to

her womanhood. Beginning of menopause marks the end of youth in a woman. It is the

stage after which a woman is incapable of bearing a child. Menopause is caused when the

production of estrogen hormone in the body is significantly decreased. Menopause is a

stage of life not a disease. The exact age of menopause differs from woman. In normal

women, menopause occurs somewhere between 45 to 50 years of age. In specific cases if

there are surgical operations in the body like removal of uterus, it may occur earlier.

Delay of menopause after 52 years is an indication of certain irregularities in the body.

The ideal age of menopause is 50, Menopause occurs in three major stages. The whole

process of menopause can take 15 years or longer, depending on your age and family

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history. The first stage of menopause is known as perimenopause. The second stage of

menopause occurs when your period no longer arrives. This stage is simply called

menopause and usually occurs around age 50 or 51 and The final stage of menopause is

called postmenopause.1

Menopause causes many changes in a women’s life, both physically and

psychologically. Physical complaints in order of frequency are as follows: hot flashes,

night sweats or chills, disrupted sleep, vaginal dryness, loss of libido, loss of energy,

mood swings, increased irritability, loss of skin tone, and urinary leakage. Psychological

complaints include, loss of confidence, depressed mood, irritability, forgetfulness,

difficulty in concentrating, panic attacks and anxiety.2

The common Psychological problems that affects women’s after menopause are

Depression  and/or anxiety Fatigue

Irritability

Memory loss , and problems with concentration

Mood distruralce

Sleep distruralces , poor quality sleep, light sleep, insomnia and sleepiness.3

Human life is a continuous process of changes and menopause is one of them. Accepting

this fact reduces major fraction of the problems since it induces a psychological strength

to combat the same. Thus a psychological adaptability may be sufficiently helpful for a

woman in facing menopause, one of the major turning points of her life.4

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6.1. NEED FOR STUDY

“All our knowledge brings us nearer to our ignorance”

“Nothing on earth is more international than disease” said Paul Russell. Health

and disease have no barriers across the world. Diseases will last as long as humanity

itself. In the present scenario, more life threatening diseases are emerging in the universe

and will remain as a big threat to mankind. Interestingly, advancement in medical science

and research ensures a better quality in future life and helps the human beings to live up

to their expectations.

Health improves physiological and psychological condition of the

postmenopausal mothers and more significantly it reduces mortality. Moreover research

indicates that health awareness is not only clinically effective, but is cost-effective as

well. Health awareness program compares favorably with other medical interventions

performed commonly in population who are risk of diseases.5

A total of 130 million Indian women are expected to live beyond the menopause

into old age by 2015. The menopause is emerging as an issue owing to rapid

globalization, urbanization, awareness and increased longevity in rural middle-aged

Indian women, who are evolving as a homogeneous group. Improved economic

conditions and education may cause the attitude of rural working women to be more

positive towards the menopause. However, most remain oblivious of the short- and long-

term implications of the morbid conditions associated with middle and old age, simply

because of lack of awareness, and the unavailability or ever-increasing cost of the

medical and social support systems.6

A cross-sectional study was conducted by researcher in Chandigarh, India. With

an objective to assess the knowledge about menopause and postmenopausal bleeding in

women of rural and slum area of Chandigarh. For the current study researcher selected

528 women randomly who were aged above 40 years, The were collected and analyzed

The results of the study shows that, out of total 528 women interviewed, 302 (56.1) were 5

residing in rural area and rest were the residents of slums. 78.8%, rural and 60.2% from

slums have attained menopause. Majority (70.3%) of rural residents have heard about

menopause as compared to 30.9% in slums. The most common menopausal symptom

was vaginal irritation / discharge (42.7%). Less than half of females (38.7%) ever took

treatment for menopausal symptoms. Calcium supplements were taken by majority63%.

7.7% females complained of PMB out of which 13(44.8%) had it after intercourse. The

study highlights that there is lack of awareness regarding menopause and related aspects

especially PMB in both rural and slum population.7

A cross-sectional postal survey was conducted on the psychological status at the

menopausal transition. a sample of menopausal women recruited from the general

registry office in ferrara’s province were selected for the study. four thousands and

seventy-three women were sent a questionnaire designed on the basis of the Women

Health Questionnaire (WHQ). Result identifies three different clusters of psychiatric

symptoms, depressive symptoms, depressed mood with anxiety symptoms, and anxiety.

The cluster “depressive symptoms” was more evident in the postmenopausal period with

respect to the premenopausal one. The study concluded that the cluster “depressive

symptoms” is significantly different in the premenopausal group with respect to the

postmenopausal group, with greater levels of symptomatology in the postmenopausal

group.8

Postmenopausal women are less satisfied with their sleep and as many as

61% report insomnia symptoms.4 The National Sleep Foundation has reported that 20%

of menopausal and postmenopausal women sleep less than 6 hours per night during the

workweek, while only 12% of premenopausal women (with the exception of pregnant

women) sleep less than 6 hours.5 Snoring has also been found to be more common and

severe in postmenopausal women. The prevalence of clinically defined sleep apnea—

apnea/hypo apnea index >10 plus the presence of daytime symptoms including daytime

sleepiness, hypertension, or some other cardiovascular symptom—for premenopausal

women was 0.6% compared to 1.9% for postmenopausal women.9

6

A study was conducted on “Menopause, the metabolic syndrome, and mind-body

therapies” .The objective of the study was to assess that, traditional mind-body practices

such as yoga, tai chi, and qigong may offer safe and cost-effective strategies for reducing

insulin resistance syndrome-related risk factors for cardiovascular disease in older

populations, including postmenopausal women. Results show that these practices may

reduce insulin resistance and related physiological risk factors for cardiovascular disease;

improve mood, well-being, and sleep; decrease sympathetic activation; and enhance

cardiovagal function. However, additional rigorous studies are needed to confirm existing

findings and to examine long-term effects on cardiovascular health.10

A postmenopausal woman faces lot of problems, both physically and

psychologically. They have to cope with these changes and accept their new role in the

society and family. So there is a need of promoting and improving the coping strategies

and to reduce the psychological problems.

The need of health awareness has increased dramatically in recent years. Inpatient

and outpatient programs in the hospital and at community sites are being implemented all

over the country. Equally significant, research over the last 10 years has provided

empirical data suggesting that health awareness programs are a safe and effective method

of improving physical, physiological, and psychological wellbeing and greatly enhance

the quality of patients. 11

The researcher therefore has chosen this study, as an opportunity to educate

the patients regarding risk of psychological disorders so that they (clients) can incredibly

maintain the quality of health and safeguard themselves from the risk of psychological

diseases and able to manage it by early detection.

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6.2 REVIEW OF LITERATURE

A research literature review is a written summary of the state of evidence on

research problems. The major steps in preparing a written research review include

formulating a question, devising a search strategy, conducting a researches, retrieving

relevant sources, abstracting and encoding information, critiquing studies, analyzing the

aggregated information and preparing a written synthesis.

Review has been divided under the following headings

1. Studies related to incidence and prevalence of psychological problems in

Postmenopausal women.

2. Studies related psychological problems in postmenopausal women.

Menopause is normal physiological process that every women has to cross

that stage in her life time and she has to adopt to several physiological changes

that will occurs as a result of menopause, several studies shown that as women

crosses the menopausal stage she is prone to get several psychological problems,

that was supported by the following studies.

STUDIES RELATED TO INCIDENCE AND PREVALENCE OF

PSYCHOLOGICAL PROBLEMS IN POST MENOPAUSAL WOMEN.

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A cross sectional study on postmenopausal women with an objective to assess

insomnia prevalence and related risk factors in postmenopausal women. For the study

researcher randomly selected study 204 natural postmenopausal women of rural area

and used Athens insomnia scale (AIS) was used to assess the level of insomnia, the

data were gather and analyzed and the results of the study revealed that there is an

positive correlation with menopause and the insomnia. Hence the researcher

concluded that the menopause induces insomnia in postmenopausal women hence the

medical intervention are recommended to rule it off.12

Another study conducted on employees of Norway with an objective to describe

the incidence and duration of d categories of mental health problems with at least two

weeks of compensated absence from work. For the present study researcher included the

90% of employees, a census data were collected by daily attendance register and a total

of 101,512 individuals with one or more were on long-term sick leaves (>2 weeks) due to

psychological problems. The results of the study revealed that, Employees absent for

psychological problems accounted for 16.8% of all incidences and 31.5% of all refunded

sick days. The average one-year incidence was 2.47%, and was significantly higher for

women (3.53%) than for men (1.66%). Hence the researcher concluded that, The

incidence increased with increasing age, and more so for women than for men and There

is an urgent need for more knowledge about the mental health.13

A Recent report of several study were published in an article according to that,

A total of 130 million Indian women are expected to live beyond the menopause into old

age by 2015. The menopause is emerging as an issue owing to rapid globalization,

urbanization, awareness and increased longevity in rural middle-aged Indian women, who

are evolving as a homogeneous group. Improved economic conditions and education may

cause the attitude of rural working women to be more positive towards the menopause.

However, most remain oblivious of the short- and long-term implications of the morbid

conditions associated with middle and old age, simply because of lack of awareness, and

the unavailability or ever-increasing cost of the medical and social support systems.14

9

A cross sectional comparative study on mothers with an objective aims to fill the

current knowledge gap about the prevalence and characteristics of psychological distress.

For the study the researcher selected 152 samples in one group and 33 samples in other A

6-item PD (psychological distress) scale was constructed with a summed score range of

0-12 and a cut-point of 7 indicating serious Psychological distress. Multiple statistical

tests were used to examine the characteristics of Psychological distress. The data were

collected and analyzed and the results of the study revealed that the rate of current

Psychological distress among American Indian women is approximately 2.5 times higher

than that of U.S. women in general.15

A study on women in India with an objective to find the association between

psychiatric morbidity and menopause. For the study the researcher randomly selected the

samples and the data were gathered by using the structured interview schedule, the data

were analysed and association was done with the help of chi-square. The results of the

study shown that, Women in menopause have been found to suffer higher psychological

morbidity as compared to pre menopausal and post menopausal women. The predominant

psycho pathology is from depressive spectrum. Various menopausal symptoms reported

in Indian settings include physical or mental exhaustion, irritability, depressed mood,

decreased sleep and decreased interest in sex.16

Studies related psychological problems of post menopausal women

10

A study on perimenopausal women at china with an objective to “report the

prevalence of symptoms in the Hong Kong Chinese perimenopausal women; to construct

reported symptoms into symptom groupings; and to clarify whether the symptom groups

are associated with menopausal status. For the study the researcher took perimenopausal

women aged 44-55 years, the data were collected from the samples using random

telephonic interview dialing of a random sample of the numbers listed in the residents'

telephone directory and a Standardized questionnaire, including a 22-item symptom

check list, was administered over the telephone. The principal component analysis

method followed by varimax rotation was used to examine the relations among the

symptoms. The Result of the study shows that psychological, non-specific somatic and

vasomotor symptoms were significantly associated with menopausal status, while

musculoskeletal and respiratory were of borderline statistical significance.17

Another study on “Health profile of middle-aged women: The Women's Health

in the Lund Area (WHILA) with an objective to evaluate the impacts of menopause status

and hormone intervention on women's health. For the study researcher randomly selected

4943 women, structured questionnaire was use to collect the data and data were analyzed.

The results reveal that, hot flushes and vaginal dryness were strongly related to

menopausal status. The prevalence of somatic symptoms worsened progressively from

the groups of PM(pre menopausal) to PMO(post menopausal without hormone

replacement therapy) to PMT(postmenopausal with hormone replacement therapy). The

most abundant complaints were headache and muscle-skeletal-joint problems. A total of

85% of women experienced psychological problems. Contrary to our expectation, a

poorer profile of psychological health was found in the PMT group when compared with

the PMO group. Hence the study concluded that high prevalence of symptoms in middle-

aged women could be attributed to age, hormonal influence as well as personality.18

A study on women with an objective to examine the relationship between

menopausal transition status and self-reported sleep difficulty. For the study researcher

selected women aged between 48 to 54 years. With the use of data on women

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participating in the medical research council national survey of health and development

who have been followed up from birth in March 1946 (n = 962), relationships between

menopausal transition status and self-reported sleep difficulty were assessed. The results

of the study reveals that, Menopausal transition status was related to severe self-reported

sleep difficulty and sleep difficulty were increased approximately by 2- to 3.5-fold (95%

ci ranges from 1.08-3.27 to 1.99-6.04) for women in most menopausal transition statuses

compared with women who remained premenopausal. Hence the researcher concluded

that Women without prior health problems may experience severe self-reported sleeping

difficulty during the menopausal transition and require tailored care from health

professionals.19

A study on menopausal women with an objective to document the prevalence of

16 symptoms commonly associated with menopause, in women living in Kelantan. For

the study researcher selected 326 naturally menopaused healthy women in Kelantan a

semi-structured questionnaire in was administered to assess the prevalence of 16 common

symptoms, The data obtained were analysed and the results of the study reveals that,

Mean age at menopause was 49.4+/-3.4 (S.D.) years, The prevalence of atypical

symptoms was as follows: tiredness (79.1%), reduced level of concentration (77.5%),

whereas mood swings (51%), sleep problems (45.1%), loneliness (41.1%), anxiety

(39.8%) and crying spells (33.4%) were the main psychological symptoms. Hence the

study concluded that, There was a tendency for the women to admit to having more of the

psychological symptoms, the prevalence of some which increased with increasing

menopausal status.20

A study (health university of negiria) on women’s aged over 45 years with an

objective to identify the numerous health problems in women after 45 years of age. For

the study they took 50 university women workers who are aged above 45 years, A

questionnaire was designed and administered and the data were analyzed using simple

statistical techniques. The findings revealed the different types of health problems that

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women experience after 45 and indicated that many women even at this age do not know

about health implications or coping strategies. Hence they concluded that the women’s

are more prone for health problems after 45 years of age so interventions are very much

needed in order to rule out the potential problems in women.21

A Cross-Sectional Study On Women’s At Brazil With An Objective to identify

The Prevalence Of Physical, Psychological, And Menopause-Related Symptoms And

Their Association With Minor Psychiatric Disorders In Premenopausal, Perimenopausal,

And Postmenopausal Women, For the study the researcher randomly selected 324 women

aged 36 to 62 years (86 premenopausal women, 156 perimenopausal women, and 82

postmenopausal women) and investigated Demographic characteristics, education, and

climacteric symptoms, The 20-item Self-Reporting Questionnaire was used to screen for

minor psychiatric disorders, with a score of 8 or higher indicating positive screening. The

data were gathered and analysed, results of the study revealed that, The variables most

frequently associated with positive findings during the screening for minor psychiatric

disorders were very low education level and memory loss and irritability. Classic

vasomotor complaints were weakly associated with non psychotic disease. In turn,

perimenopausal and postmenopausal women, were at greater risk of minor psychiatric

disorders. Hence the researcher concluded that, Low education level, memory loss,

irritability, and the menopausal transition represent risk factors for positive findings in a

screening for minor psychiatric disorders.22

Another study on elder population with an objective to examine “gender

differences in the associations between affection- and status-related stressors encountered

in the first half of life and physical and mental health problems later on”. Based on the

theory of Social Production Functions (SPF) two hypotheses have been formulated,

which were tested in a representative sample of 446 men and 514 women (aged 40-79).

Main outcome measures were number of chronic somatic diseases and level of

psychological distress. As expected, regression analyses showed no gender differences in

the associations between affection-related stressors and physical and mental health 13

problems later on. In contrast, but as also expected, status-related stressors encountered in

the first half of life were associated with later physical and mental health for men only. It

is concluded that the gender differences in the associations between earlier social

stressors and later health problems may be more complex than the common assumption

that men are only affected by status stress and women only by affection stress.23

A study on middle aged women in taiwanese with an objective to investigate the

role of menopausal transition and menopausal symptoms in relation to quality of life in a

cohort of middle-aged women. For the study researcher selected a total of 734

premenopausal women participated in the baseline study, and 579 women (78.9%)

completed a follow-up 2 years later. Quality of life was assessed by the medical

outcomes study short form-36. Participating women were asked for demographic data,

about vasomotor symptoms, and to complete the medical outcomes study short form-36

and the hospital anxiety and depression scale. In multivariate analysis, only vasomotor

symptoms had an adverse influence on role limitation of emotion after adjusting for age,

education, menopausal status, baseline cognitive score, and Hospital Anxiety and

Depression Scale score. Hence the researcher concluded that no significant effect of

menopausal transition on quality of life among Taiwanese women.24

A study on patients at south Africa and the result were published according

that report, Psychological co-morbidity is high in patients with obesity and is associated

with a variety of medical and dietary problems as well as demographic, social and

cognitive risk factors. Young overweight and obese women are at particular risk for

developing sustained depressive mood, which is an important gateway symptom for

major depressive disorder. Increased knowledge of behavioral risk factors has enabled

patients with obesity to be classified on a psychological basis and this needs to be

considered as part of a patient's clinical assessment and treatment strategy. Increased

awareness of abnormal eating behaviour, together with profiling of personality traits,

could improve treatment selection for obese women and improve the outcome of weight-

14

loss programmes. Individualized anti-obesity drug therapy/interventions may be required

depending on the patient's psychological characteristics25

STATEMENT OF THE PROBLEM

“A STUDY TO ASSESS THE KNOWLEDGE REGARDING COMMON

PSYCHOLOGICAL PROBLEMS AFTER MENOPAUSE, AMONG

PREMENOPAUSAL WOMEN RESIDING IN SELECTED RURAL AREAS AT

TUMKUR WITH A VIEW TO DEVELOP AN INFORMATION BOOKLET”

6.3 OBJECTIVES OF THE STUDY:

To assess the level of knowledge regarding the risk of common psychological

problems after menopause among pre menopausal women.

To determine the association between knowledge scores of samples with the

selected demographic variables.

To develop and distribute the information booklet on common psychological

problems after menopause.

6.4 RESEARCH HYPOTHESIS:

H1: There will be significant association between the knowledge score of Pre menopausal mothers with the selected demographic variables.

6.5 VARIABLES: Variables are an attribute of a person or objects that varies, that takes different values.

Research variable in this study the knowledge of Pre menopausal mothers regarding common psychological problems after menopause.

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Extraneous variables in this study are age, educational qualification, religion, occupation, family income, source of health information.

6.6 OPERATIONAL DEFINITIONS :

Assessment: In this study assessment refers to an organized systemic process of collecting information about knowledge of premenopausal mothers regarding risk of common psychological problems after menopause.

Knowledge : In this study knowledge refers to the cognitive ability to interpret the information regarding the risk of common psychological problems after menopause.

Psychological problems : In these study psychological problems refers to the

problems occurring in the mind of postmenopausal women such as depression,

anxiety, irritation, insomnia, lack of concentration and is measured by Greene

climacteric scale.

Pre menopausal mothers: in the present study the premenopausal mothers refers to the women aged between 40 to 50 years of age and reached the menopause.

Information booklet : It is the information source prepared by the researcher on risk of common psychological problems after menopause and it will be distributed to the premenopausal mothers in order to create awareness among them.

6.7 ASSUMPTIONS:

The premenopausal mothers in selected rural areas may not have adequate knowledge regarding common psychological problems after menopause.

The premenopausal mothers will get an opportunity to gain knowledge regarding common psychological problems after menopause.

The premenopausal mothers utilize the information booklet in a positive way to safeguard themselves from potential complications.

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The response given by the samples to the questionnaire will represent their true measures of knowledge regarding common psychological problems after menopause among them.

The knowledge of premenopausal mothers may be influenced by demographic factors like education, age etc.

6.8 DELIMITATIONS OF THE STUDY:

- The study will be limited to only 100 premenopausal mothers.- The study is delimited to pre menopausal mothers who are residing in selected

rural areas of Tumkur.- The knowledge score will be measured by structured interview schedule

6.9 PILOT STUDY:

The pilot study will be conducted among 10 samples. The purpose of pilot study is to find out the feasibility of conducting study and design on plan of statistical analysis. This also will help to assess the practicability of carrying out the main study. The findings of the pilot study samples will not be included in main study.

7. MATERIALS AND METHODS:

7.1 SOURCE OF DATA: The data will be collected from premenopausal mothers residing in selected rural area at Tumkur.

7.2 METHODS OF DATA COLLECTION: The study will be initiated only after obtaining permission from concerned authorities. The data collection procedure will be carried out for a period of three months. At first a good rapport will be established with the samples and the purpose of the study will be explained to them, so as to get the co-operation from them. For procedure of data collection, a questionnaire interview schedule will be used for collection of data.PART I: questionnaire related to demographic data.

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PART II: Consist of questionnaire assessing knowledge regarding risk of common psychological disorders after menopause.

7.2 (1) RESEARCH APPROACH: A descriptive research approach will be used.

7.2 (2) RESEARCH DESIGN: Non experimental descriptive survey research design is used for this study.

7.2 (3) RESEARCH SETTINGS: The study will be conducted in selected rural areas at Tumkur.

7.2 (4) POPULLATION: Population of the study will be premenopausal mothers.

TARGET POPULATION: Premenopausal mothers residing in selected rural areas.

ACCESSIBLE POPULATION: pre menopausal mothers of rural area who will be available during study.

7.2 (5) SAMPLE SIZE: The total study sample consists of 100 premenopausal mothers residing in selected rural areas at Tumkur.

7.2 (6) SAMPLE TECHNIQUES: Purposive sampling technique will be used for the current study.

7.2 (7) SAMPLING CRITERIA:

INCLUSIVE CRITERIA: Premenopausal mothers residing in selected rural area. Premenopausal mothers who are available during the study. Premenopausal mothers who are aged between 40years to 50 years.

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EXCLUSIVE CRITERIA: Premenopausal mothers who suffering with illness. Those who are not willing to participate in the study. Premenopausal mothers who cannot understand either kannada nor English.

7.2 (8) DATA COLLECTION METHODS: Demographic Proforma. Structured interview schedule to assess knowledge.

7.2 (9) DATA ANALYSIS METHODS: The data collected will be organized tabulated and analyzed by using descriptive and inferential statistics. The data will be planned to present in the form of tables and figures.

DESCRIPTIVE STATISTICS: Mean, mean percentage, standard deviation and average will be used for assessing the level of knowledge.

INFERENTIAL STATISTICS: chi-square test will be used to find out the association between demographic variables with knowledge scores.

TIME AND DURATION OF THE STUDY: The time and duration of the study will be limited to three months or as per the guidelines of university.

7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO PLEASE, DESCRIBE BRIEFLY. Since the study is descriptive interventions are not required.

7.4 HAS ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR INSTITUTION? Yes, the pilot study and the main study will be conducted after the approval from the research committee. Permission will be obtained from the concerned head of the institution. The purpose and details of the study will be explained to the study subjects and an informed consent will be obtained from them. Assurance will be given to the

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study subjects regarding the confidentiality and anonymity of the data collected from them.

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22

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9 SIGNATURE OF THE CANDIDATE

10 REMARKS OF THE GUIDE

11 NAME AND DESIGNATION OF

11.1 GUIDE

11.2 SIGNATURE

PROF. NAGANANDINIHOD PSYCHIATRIC NURSING

11.3 CO-GUIDE(IF ANY)

11.4 SIGNATURE

23

11.5 HEAD OF THE DEPARTMENT

11.6 SIGNATURE

12 12.1 REMARKS OF PRINCIPAL

12.2 SIGNATURE

24