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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OFSUBJECT FOR DISSERTATION
MISS. V. KANCHANA
IST YEAR M.SC., NURSING
PSYCHIATRIC NURSING
YEAR 2009-2010
SUSHRUTHA COLLEGE OF NURSING#23, PAPAIAH GARDEN, DIAGONAL
ROAD, BSK 3RD STAGE,
BANGALORE – 560 085.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1. NAME OF THE CANDIDATE AND ADDRESS
Miss. V. KANCHANA,1st Year M.Sc., NursingSUSHRUTHA COLLEGE OF NURSING,#23, PAPAIAH GARDEN, DIAGONALROAD BSK 3RD STAGE,BANGALORE – 560 085.
2 NAME OF THE INSTITUTION
SUSHRUTHA COLLEGE OF NURSING,#23, PAPAIAH GARDEN, DIAGONALROAD BSK 3RD STAGE,CHANAMMANKERE ACHUKATTU,BANGALORE – 560 085.
3. COURSE OF STUDY AND SUBJECT
M.Sc., NURSINGPSYCHIATRIC NURSING
4. DATE OF ADMISSION TO THE COURSE 03-06-2009
5. TITLE OF THE TOPIC A STUDY TO ASSESS THE LEVEL OF STRESS AMONG INFERTILITY WOMEN WHO ARE ALL ATTENDING THE INFERTILITY CLINICS IN SELECTED HOSPITAL AT BANGALORE.
6. BRIEF REUSME OF THE INTENDED WORK:
6.1 INTRODUCTION :
“Stress causes illness causes more stress causes more illness”.
The World Health organization (WHO) ( 1988) had defined infertility as a
failure to conceive after unprotected intercourse for a period of one year.
American Society for reproductive medicine, (2008) had defined stress is
a stimulus which produces mental tension or physiological reaction, so the
experience of infertility is the stimulus. The experience of infertility leads to the
suffering.
According to Dr. Aniruddha Malponi (2009) said that, when diagnosed
with infertility, many couples feel helpless and no longer in control of their bodies
or their life plan. Infertility can be a major crisis because the important life goal of
parenthood is threatened. Most couples are accustomed to planning their lives and
experience his shown then that if they work hard at something they can active it
with infertility, this many not be the case.
Stress among the infertile women is one of the problem in our country. In
the US, an estimated 10.2% of women between the ages of 15 to 44 or about 6.2
million women, have impaired fertility, and the incidence is increasing about 5%
of women experience some period of infertility during their reproductive years.
Between 1982 and 1988 there was a 37% increase of infertile women is expected
ages of 35 to 44. The number of infertile women is expected to reach 6.3 million
on the year 2000, and may be as high as 7.7 million in 2025. So in 2025 similarly
the stress level also increase in infertile women.
According to Sahana Charan in any population the incidence of infertility
is around 15 percent. According to studies conduced, in India the incidence is
between 10 to 20 percent.
According to Padmini Prasad, Gynaecologist and Director of Institute of
Sexual Medicine, told The Hindu, Lifestyle problem. “The reason for infertility
may be various. In Bangalore, a large number of couples who seek advice for
problems in conceiving are professionals with high-stress jobs. Working long
hours, night shifts, frequent travel, stress at the workplace and advancing age
affect a couple’s sexual life. This is addition to certain medical problems may
result in decreased fertility.
According to “young Joo Park” November (1994). The mean of stress of
the infertile women is 2.78 the mean of stress in 4 dimensions 3.81 in cognitive
dimensions, 3.05 in the affective dimension, 2.06 in the marital adjustment
dimension and 2.41 in the social adjustment dimension. The predictors of the
stress of the infertile women are their educational levels and subjective economic
status. They explain 14.08% of total variance.
According to Blenner (1990) describes the predictable progression of
infertility is emotional toll. There are 8 stages, that is Dawning of awareness,
facing a new reality, spiraling down, letting go, quilting and moving out, shifting
focus.
According to Stanton, Duntel, Schetler, (1991) the influence on infertility
related stress is relatively unknown.
According to Comar (1992), He verified that infertility does cause stress
and reported that infertile women experience twice the level of depression when
compared to their fertile counterparts.
According to Daniels (1993) suggested that stress has generally been
considered psychological rather than psychosocial phenomenon, and attention to
social factors that might affect a couple has been neglected help has therefore been
focused on the couple experiencing the fertility problem.
“Seibel, (1997) said one in six couples will experience fertility problems at
some time in their lived and only one half will succeed in becoming pregnant”
According to remerinicle, (2000) infertility is described by the diagnosed
couples as the toughest crisis in their lives. The process of fertility treatments
causes acute stress, which may lead to distress and harm the partness relationship.
A loss of self-esteem may accrue, and fertility failure may negatively affect the
couple’s pride both as a pair and as individual studies show that women more than
men – may experience loss of self esteem, especially after treatment failure.
According to peter S. Finamore, (2007) Asian/Indian women were almost
five times as likely to disclose ( 95% CI 1.35, 16.35).
Disclosure verses non-disclosure in each group and the correlation.
DISCLOSE NON-DISCLOSE P VALUE
Stress about
Infertility(non
responders n = 18)
Not at all 4/13 ( 31%) 9/13 ( 69%)
Mildly 17/44 39%) 27/44 ( 61%)
Moderately 37/86 ( 43%) 49/86 ( 57%)
Very stressed 21/38 ( 55%) 17/38 ( 45%) .3
Comparison of age, satisfaction at work, freedom at work, and global stress
scale for those who disclosure versus those who do not disclosure.
Disclose Nondisclose P=Value
Patient’s age –
mean (SD)
3.5 (4.3) 34.4 (5.6) P=.9
Satisfaction at
work – median
( range )
5 (1-7) 5 (1-7) P=.2
Freedom at work –
median ( range )
5 ( 1-7) 5 ( 1-7) P=.4
Perceived stress
scale score – mean
6.1 6.7 P=.2
According to the Danilute indicates that 97% of couples supported a need
for psychological services in their initial contacts with an infertility clinic. If the
mental health professional ( eg. Psychologist, psychiatrist, social workers ) is
included as paid to delivery of comprehensive fertility services, his or her role can
determined in a variety of ways )
6.2 NEED FOR THE STUDY :
Fertility and parenting are highly important in our society, considered to be a
main value and a developmental task of the adult person.
So when infertility rate is increase in women if may be as high as 7.7 million
in 2025. So the stress level may be increase. Some studies are mention that the
infertile women are having psychiatric disorder and anxiety disorder and other
physical illness it is due to in day to day life the infertile women’s are facing the
stress in their life events.
I seen some of the case of infertile women and they had high level of stress
during the infertility period. During my UG studies this point is motivated me to
do assess the stress level in infertility women. To treat the infertility problem in
infertile women the gynaecologist need is important as well as the psychiatrist
need is important that is to share the feelings of infertile women and to have good
interpersonal relationship with them.
So this concept initiated me to do studies regarding this topics in psychiatrist
Nursing. Very few studies have been conducted till date regarding the stress in
infertile women in the filed of psychiatric nursing. The current study is an initial
effort aiming to improve the mental health of infertile women by assessing the
stress level among those who were attending an infertility clinics. So we planned
to make a study on A STUDY TO ASSESS THE LEVEL OF STRESS
AMONG INFERTILITY WOMEN WHO ARE ALL ATTENDING THE
INFERTILITY CLINICS IN SELECTED HOSPITAL AT BANGALORE.
The institute of Sexual Medicine, Bangalore (2006) , conducted a study
few years ago to identify the incidence and types of sexual and reproductive
problems among IT professional couples in the city who form a major chunk of
those seeking help from the institute for infertility problems. The study came out
with some startling revelations; of the 900 patients examine between April 2005
and May 2006, 180 had not consummated their marriage; 300 had infertility
problems such as low sperm count, problems in the vagina and the hymen, and
defects in the fallopian tube or the uterus;100 suffered from erectile dysfunction or
ejaculatory problems; 100 had by dyspareunia ( pain during intercourse ) while 99
had decreased libido ( sexual anorexia ).
According to Balterman ( 1985 ) Gibson & Myers. ( 2002 ) conducted
study to investigated psychosocial factors thought to be associated with perceived
stress over the course of infertility treatment. The study were to identify the extent
to which psychosocial factors were associated with variation in perceived stress at
regular time intervals during infertility treatment and to identify the extent to
which psychosocial factors were associated with change in perceived stress over
the course of treatment. Identifying factors that may explain stress to provide
potential targets for intervention to reduce stress has significance for those who
provide care for infertile couples.
According to Blickstein, Ba or, ( 2004 ). The rate of couples who suffer
from infertility problems in Israel is rising like in other countries. According to
estimation 10% - 12% of the couples in fertility age are suffering infertility
problems.
According to Harefuah (2008) said that in the industrialized world
approximately 12% of couples suffer from infertility.
6.3 REVIEW OF LITERATURE
The review of literature in a research report is a summary of current
knowledge about a particular problem and includes what is known and not known
about the problem. The literature is reviewed to summarize knowledge for use in
practice or to provide a basis of conducting a study. Review of literature section
includes a description of the current knowledge of a particular problem, the gaps in
this knowledge base and the contribution of the study to the development of
knowledge in this area. Review of literature is a key steps in research process.
The typical purpose for analyzing a review existing literature is generate
research question to identify what is known and what is not known about the topic.
The major goals of review of literature are to develop a strong knowledge base to
carry out research and non research scholarly activity.
Review of literature is the study of the prevalent materials to the research.
This help the researcher to get a clear idea about the particular filed. It is important
for the researcher to carryout the research successfully. A critical summary of
research on a topic of interest. Often prepared to put a research problem in
context.
Review of literature for the study has been organized under the following
headings.
Studies related to stress of infertile women
Studies related to information about stress in infertility treatment
Studies related to information about stress coping scale.
1. STUDIES RELATED TO STRESS OF INFERTILE WOMEN
According to young Joo Park (1994) conducted a study on 131 infertile
women were in primary or secondary infertility the were sampled out from the
infertility clinics or K University Medical Center and C Hospital in Second. The
data were collected by using the infertility stress scale which consisted of 35 items
with four dimensions ( Cognitive, affective, marital and social stress ) from adjust
to November 1994. Duncan’s multiple comparison test and multiple regression.
The results are as follows; 1. The mean of the stress of infertile women is 2.78.
The means of the stress in 4 dimentions are 3.81 in the cognitive dimension,
3.05 in the affective dimension, 2.06 in the marital adjustment dimension and 2.41
in the social adjustment dimension. 2. The predictors of the stress of the infertile
women are their educational levels and subjective economic status. They explain
14.08% of total variance.
According to A.R. Bharathi (2002) the study conducted on 60 infertile
women. The findings of the study related that level of depression among 60
infertility women 36 ( 50%) showed mild level of depression 11 ( 18.33%) showed
severe depression 9 ( 15%) showed moderate depression and 4 ( 6.67%) were not
depressed .
According to Tara M. Counsineau (2008) conducted study on 190 female
patients were recruited from three US fertility centers and were randomized into
two experimental and two no treatment control groups. The psychological
outcomes assessed included infertility distress, infertility self-efficacy decisional
conflict, marital cohesion and coping style. Women exposed to the online program
significantly improved in the area of social concerns ( P = 0.038) related to
infertility distress, and felt more informed about a medical decision with which
they were contending ( P = 0.059) distress related to child-free living ( P = 0.063),
increased infertility self-efficacy ( P = 0.067) and decision making clarity ( P =
0.079) A dosage response was observed in the experimental groups for women
who spent > 60 non online for decreased global stress ( P = 0.028) and increased
self efficacy ( P 0.024). This evidence – based Health program for women
experiencing infertility suggests that a web-based patient education intervention
can have beneficial effects in several psychological domain and may be a lost
effective resource for fertility practices.
2. STUDIES RELATED TO INFORMATION ABOUT STRESS IN
INFERTILITY TREATMENT :
According to Venkatesan latha ( 2005) By this study the data was
collected from 100 infertile women who were undergoing treatment for primary
infertility and attended the OPD of Rao Hopsitals, Coimbatore. Path analysis was
used to predict the bio-psycho-socio-behavioral determinants of self-concept. The
results and discussion of this study is a majority of the infertile women ( 65%) had
moderate level of self-concept. It was significantly associated with age ( P. The
self-concept was low in women with age > 30 years, educational status above
higher secondary level and with duration of infertility more then 6 years. The
Following significant predictions were also identified through regression. One unit
increase in family support predicted 44.4% increase in self-concept. One unit
increase in marital adjustment predicted 46.67% increase in self-concept. One unit
increase in depression caused 53.5% decrease in self-concept. One unit increase in
stress reaction to infertility decreased 38.5% of self-concept.
According to Alice D. Domar (2009) study said women who experience
infertility report increased levels of distress, as this condition has an impact on
virtually every aspect of lives – i.e., partner relationship, sex life, employment
relationship with fertile family members and friends, financial stability (Most
insurance policies do not cover treatment ) and even religious beliefs. In addition
many infertile women are blamed by other for their education. In this study 112
infertile women were interviewed by a psychiatrist prior to treatment, 40.2% met
criteria for a psychiatric disorder. The most common diagnosis was on anxiety
disorder ( 23.2%) followed by major depressive disorder (17%) this compares with
an average prevalence of 3%.
The level of distress in infertility patients tends to increase as treatment
intensifies, so it is possible that the 40% noted in this study would be even higher
in a population of patient undergoing in vitro fertilization (IDF).
According to Alice M. Domer ( 2009 ) conducted Study in the Netherlands,
where assisted reproduction cycles are covered by insurance, showed a cumulative
dropout rate after three cycles of 62%, with only 14% due to active censoring.
Research also suggests that cost is not the determinant for many IVF patients. In a
study of 974 Swedish couples, 65% did not complete the three covered IVF cycles
due to the psychological burden of therapy. Australian couples who were offered
up to six cycles free of charge started a mean number of 3.1 cycles, regardless of
whether a live birth was achieved. The most common reasons for terminating
treatment were emotional ( 66%).
A retrospective study analyzed data on 2,130 German patients who were
covered by insurance for four cycles. The dropout rate for nonpregnant patients
was 40% after the first cycle and 62% after the fourth cycle, and was attributed to
increasing stress and frustration. This study included an analysis of the cumulative
pregnancy rates for patients who did not discontinue treatment. The patients
underwent a mean of only 1.92 IVF cycles, even though the mean number of
cycles to conception was 2.12, and 49% underwent only one cycle. The real
cumulative pregnancy rate was 31.4% after four cycles. However, it was estimated
that if all nonpregnant patients had returned for only one more cycle, the
cumulative pregnancy rate would have increased to 41% - translating to an
ongoing pregnancy rate of 53%, increase to 60% after six cycles.
In a study of 211 couples who had insurance coverage for IVF but
discontinued for reasons other than active censoring, the most commonly cited
factor was psychological burden, followed by the perception of poor prognosis.
Patients who discontinued treatment were as satisfied with therapy as those who
continued. This is consistent with prior research showing that IVF poses more of a
psychological than physical burden.
According to Katerina Lykeridou, (2009), In this studies conducted on
infertility treatment, little is known about the psychological impact of infertility
when it is due to male or female factors and its role in the cause of higher levels of
anxiety and stress. The study involved 404 women undergoing fertility treatment
in a public clinic in Athens. The research instruments were three self-
administrated questionnaires. State and trait anxiety, infertility-related stress
( personal, social and marital domain ) and depression were measured. Women
with male factor infertility had higher levels of state anxiety ( p = 0.007) and social
stress ( p = 0.007) than women with female, mixed and unknown infertility.
Women with idiopathic infertility also had higher levels of trait anxiety (p =
0.001). Thus, the psychological status of women is strongly related to the
aetiology of the infertility problem, and as a result it is necessary for women
undergoing treatment for infertility to have an individualized psychological
support, based on their infertility problem.
According to Latha Venkatesan ( 2009 ) The study conducted on the
impact of positive therapy upon the stress levels in infertile women was studied
through a randomized clinical that the infertile women were randomly assigned in
to the control ( n = 60 ) and experimental group ( n = 60 ) of women pre test stress
was assessed on day 2 of the menstrual cycle of control and experimental group of
infertile women and the positive therapy was implemented from day 2 to 7 of the
menstrual cycle only for the experimental group of women post test stress was
assessed on day 14 of the cycle in both the groups. The results have shown that in
experimental group the post test stress level ( M = 247.51, Standard Deviation –
23.14) was less that the pretest stress level ( M = 164.30 SD = 19.03 ) and the
difference was statistically significant at P < .001 level in control group there was
no statistical difference between the pre test ( = 246 65 5 D = 22.18 ) and post test
( M .247.06 SD = 21.89) stress levels. The result can be attributed to the
effectiveness of positive therapy and has direct implications for nursing practice.
3. STUDIES RELATED TO INFORMATION ABOUT STRESS
COPING SCALE.:
According to T.Y. Lee (2008) A study conducted on total of 138 infertile
couples participated in this study. The Coping Scale for Infertile Couples was
administered with the Infertility Questionnaire, the Perceived Stress Scale, and the
Jalowiec Coping Scale as measures of concurrent validity. Results suggested that
this measure has good reliability and validity, which can contribute toward the
elucidation of coping strategies used by infertile couples and assist in planning
effective interventions.
STATEMENT OF THE PROBLEM:
“A STUDY TO ASSESS THE LEVEL OF STRESS AMONG INFERTILITY
WOMEN WHO ARE ALL ATTENDING THE INFERTILITY CLINICS IN
SELECTED HOSPITAL AT BANGALORE”.
6.4 OBJECTIVE OF THE STUDY:
1) To asses the level of stress among infertile women who are all
attending the infertility clinics.
2) To correlate demographic data with the level of stress among infertile
women who are all attending the infertility clinics.
6.5 OPERATIONAL DEFINITION :
1. STRESS :
Stress is the body’s reaction to a change that requires a physical mental or
emotional adjustment or response.
2. WOMEN :
Women who had failed to conceive after unprotected inter course for a
period of one year.
3. INFERTILITY :
Refers to a condition in which the married women is unable to conceive after
at least one year of unprotected regular intercourse and diagnosed as infertile by an
obstetrician.
6.7 ASSUMPTION :
1. All infertile woman experience stress
2. The level of stress experienced for infertility differs from women to women.
3. Education will enhance the knowledge about stress and stress management of
infertility.
6.8 DELIMINATION :
The study is limited to the infertile women in selected infertility clinics.
The study is limited to who can read and write kannada or English.
The study was limited to women who were willing to participate in the
study.
The sample size is limited to 60.
7. MATERIAL AND METHODS :
DEFINITION :
Methodology refers to the means of gathering data that are common to all
sciences including nursing. It is different from the word technique which refer to
specific tools that are used in a given method. We may classify all methods of data
collection methods as follows.
7.1 SOURCE OF DATA :
The data will be collected from infertile women in infertility clinics at
selected hospital at Bangalore.
7.2 METHODS OF COLLECTION OF DATA :
Data will be collected through questionnaire by interview method.
VARIABLES :
INDEPENDENT VARIBALE
selected demographic variable Name, age, sex, education occupation,
Income, religion.
DEPENDEDT VARIABLE :
Knowledge regarding the level of stress of infertility.
7.2.1 RESEARCH APPROACH :
Research approach will be conducted by survey method.
7.2.2 RESEARCH DESIGN :
A Descriptive study was chosen to assess the level of stress among infertile
women who are all attending the infertility clinics in a selected hospital at
Bangalore.
7.2.3 RESEARCH SETTNG :
The present study will be conducted at who are all attending the infertility
clinics in selected hospital at Bangalore.
7.2.4 POPULATION :
The population for the present study is done on infertile women who are all
attending infertility clinics in selected hospital at Bangalore.
7.2.5 SAMPLE SIZE :
The sample consists of 60 No’s infertile women who are all attending the
infertile clinic in selected hospitals at Bangalore.
Women who are willing to participate in the study.
Infertile women who are all attending the infertility clinics.
7.2.6 SAMPLING TECHNIQUE :
Samples were selected by the investigator using convenient sampling
technique.
7.2.7 SAMPLING CRITERIA :
INCLUSION CRITERIA :
1. Infertile women were at the age group of above 20-45 yrs.
2. Infertile women who are all willing to participate in the study
3. Infertile women who are all available during the period of data collection in
OPD.
4. Infertile women’s who can understand Kannada and English.
EXCLUSION CRITRIA :
Infertile women were at the age group of <20 and >45 yrs.
Infertile women who are all not willing to participate in the study.
Infertile women who are not available during the period of data collection.
Infertile women who cannot understand Kannada and English.
Infertile women who had severe physical & mental illness.
7.2.8. TOOLS FOR DATA COLLECTION :
Instruments used for this study consist of 2 parts they are described below
Part – I – Demographic data
Part – II – Standardised stress scale-cohen’s scale
Part – I
The demographic data is relation to age,sex, educational status, occupation
monthly income, religion, type of family and duration of married life.
Part – II
It consist of 14 items.
7.2.9 METHODS OF DATA ANALYSIS AND PRESENTATION :
Data analysis will be through descriptive and inferential statistics.
Descriptive Statistics
Frequency, percentage, mean, median and standard deviation will be used.
Inferential Statistics :
Chi-square test will be used.
PROJECTED OUTCOMES
Much scope is there for mental health nurse to play a pivotal role in
imparting knowledge to the infertility women and their family members to reduce
the level of stress.
The psychiatric nurse can play important role in the management of Stress
by planning and co-ordinating the multi-modality treatment programme.
This study will help nursing students to conduct health education
programme regarding special emotional needs of infertility.
In research, this study is helpful for nurses, to find out various effective
interventions for stress among women who were attending infertility clinic.
India is a developing country. Productive citizens determine the future of
the nation also. By assessing the level of stress among women who were attending
the infertility clinic, nurses can play major role in maintaining mental health of
infertility women by early investigation which is turn, contribute to the national
development.
7.3 DOES THE STUDY REQUIRE ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER
HUMANS OR ANIMALS ? IF SO, PLEASE DESCRIBE BRIEFLY.
No.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION ?
Permission will be obtained from the research committee of the Sushrutha
College of Nursing.
Informed consent will be taken from the hospital where the data will be
collected.
8. LIST OF REFERENCES :
BOOKS REFERENCES:
1. Evelyn Corsini, Trau C. Green, Tara M. Causinean et al. ‘Human
Reproduction’ 2008 volume 23, published by oxford university press
page No. 55-566.
2. Emuni research souk 2009 ( Emuni Res 2009 ) the Euro –
Mediterranean student research Multi-conference a Juma 2009
“Fertility problems and Psycho – Social Aspects.
3. Peter S. Finamore, “ Fertility – Sterility” 2007-Vol. 88, Published by
Elsevier inc. Page No. 817-821.
4. KEYE – CHANG “infertility evaluation – treatment” 1995 – chapter – 4
published by W. B.Saunders company , Page No– 259-39.
5. Dr. Aniruddha Malpani et al “How to have a Baby”-2009, overcoming
infertility chapter – 32.
INTERNET REFERENCE
Pubmed index for midline.
www.google.com
JOURNALS
Latha Venkatesan “The impact of positive therapy upon the stress level in
infertile women”The journal of Nightingale Nursing times 2009.
Journal of Reproductive and Infant Psychology, Volume 27, Issue 3 August
2009.
THESIS REFERENCES :
(i) Young Joo-Park (1995). “The stress of the Infertile women.”
(ii) Evelyn corsirin : Trak C.Green, Tara M. Cousinean et al.2008).
“Online psychoeducational support for infertile women”:
(iii) Blickstein, And Baor, L. ( 2004 ) “Trends in Multiple Births in
Israel”. Hare Fuah, 143(11) 79-832.
(iv) Remernick, L.( 2000) “Childless in land of imperative motherhood;
stigma and coping among Infertile Israeli women” Sex Roles.
(v) Myra G. Schneides et al (2000) “Association of Psychosocial Factors
with the stress of infertility Treatment”.
(vi) Alice M. Doman (2009) “Infertility and the mind/body connection”.
(vii) Katerina Lykeridou (2009). “The impact of infertility diagnosis on
psychological status of women undergoing fertility treatment”.
(viii) Harefuah, (2008) “Stress and distress in infertility among women.”
(ix) Boivin J, Schmidt L 2005.. “Infertility – related stress in men and
women predicts treatment outcomes 1 year later”
(x) Gallinelli A. Roncaglia R. Matteo ML, Ciaccio I. Volpe A.
Facchinetti F.(2001) “Immunological changes and stress associated
with different implantation rates in patients undergoing in vitro
fertilization-embryo transfer”.
(xi) A.R.Bharathi,(2002) “Level of depression among infertile women”
9. SIGNATURE OF THE
CANDIDATE
10. REMARKS OF THE GUIDE The topic is relevant and it will reduce the strees
level among infertile women through
information booklet.
11. NAME AND DESIGNATION
11.1 GUIDE Ms. A. R. BHARATHI,
PROFESSOR CUM PRINCIPAL
DEPT. OF PSYCHIATRIC NURSING
SUSHRUTHA COLLEGE OF NURSING
BANGALORE.
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF THE
DEPARTMENT
Ms. A. R. BHARATHI,
PROFESSOR CUM PRINCIPAL
DEPT. OF PSYCHIATRIC NURSING
SUSHRUTHA COLLEGE OF NURSING
BANGALORE.
11.6 SIGNATURE
12.
12.1
REMARKS OF THE
CHAIRMAN AND
PRINCIPAL
12.2 SIGNATURE