Aneesha

A TO
A STUDY STUDY TOTHEASSESS

ASSESS THE EFFECTIVENESS
EFFECTIVENESS OF JACOBSON
OF JACOBSON PROGRESSIVE MUSCLE
PROGRESSIVE
RELAXATION MUSCLE
EXERCISE RELAXATION EXERCISE
ON PREMENSTRUAL ON PREMENSTRUAL
SYNDROME AMONG WOMEN
SYNDROME AMONG
ATTENDING WOMEN OPD
GYNAECOLOGY ATTENDING GYNAECOLOGY
IN KG HOSPITAL, OPD
COIMBATORE.
IN KG HOSPITAL, COIMBATORE.
By
ANEESHA.V.B
A Dissertation submitted to the Tamil Nadu Dr. M.G.R. Medical University,

Chennai, in partial fulfillment of requirement for the Degree of
MASTER OF SCIENCE IN NURSING
APRIL 2011
1
A STUDY TO ASSESS THE EFFECTIVENESS OF JACOBSON PROGRESSIVE MUSCLE
RELAXATION EXERCISE ON PREMENSTRUAL SYNDROME AMONG WOMEN
ATTENDING GYNAECOLOGY OPD IN KG HOSPITAL, COIMBATORE.
By
ANEESHA.V.B
A Dissertation submitted to the Tamil Nadu Dr. M.G.R. Medical University,

APRIL 2011
INTERNAL EXAMINER EXTERNAL EXAMINER
2
CERTIFICATE
Certified that this is the bonafide work of ANEESHA.V.B of K.G.

College of Nursing, Coimbatore, submitted in partial fulfillment of the requirement
for the Degree of Master of Science in Nursing to the Tamilnadu Dr. M.G.R.
Medical University under the Registration No: 30096421
Mrs. Vaijayanthi Mohan Das, Prof. (Mrs.) Sonia Das,

Director of Education, Principal,
K.G. College of Health Sciences, K.G. College of Nursing,
Coimbatore. Coimbatore.
3
A STUDY TO ASSESS THE EFFECTIVENESS OF JACOBSON PROGRESSIVE MUSCLE
RELAXATION EXERCISE ON PREMENSTRUAL SYNDROME AMONG WOMEN
ATTENDING GYNAECOLOGY OPD IN KG HOSPITAL, COIMBATORE.
Approved by the Dissertation Committee on: 9.4. 2010
________________
Prof.( Mrs.) SHEEBA.R,
HOD, Obstetrics and Gynaecological Nursing,
K.G. College of Nursing,
Coimbatore-641018
________________
Dr. (Mrs.) CHANDRAKALA MARAN,
Chief Obstetrician and Gynaecologist,
K.G. Hospital,
Coimbatore-641018
_________________
Prof.( Mr.) SUBRAMANIAN.K,
Department of Bio- Statistics and Research,
K.G. College of Nursing,
Coimbatore-641018
A Dissertation submitted to The Tamil Nadu Dr. M.G.R. Medical University,

APRIL 2011
4
ACKNOWLEDGEMENT
“ I Praise and thank God for his abundant blessings,

Constant love and guidance”
With a profound sense of gratitude I praise and thank God

Almighty for his constant help and blessings showered upon me
throughout this study.
The essence of all beautiful art, all great art, is gratitude. Gratitude
can never be expressed in words but this is only deep perception, which
makes the words to flow from ones inner heart.
With a profound sense of gratitude, I praise and thank God Almighty for
his constant help and blessings showered upon me throughout this study.
I am grateful to our honorable Chairman, Padma shri

Dr. G. BAKTHAVATHSALAM, Chairman, K. G. Hospital, who gave me
this opportunity to utilize the facilities in this reputed institution.
I express my sincere, respectful and whole hearted gratitude to

Mrs. VAIJAYANTHI MOHANDAS, Director of Education, K.G.
College of Health Sciences for her efficient guidance, encouragement
and valuable suggestions, which helped me to lay strong foundation of
this study.
It is my pleasure and privilege to express my deep sense of

gratitude to Prof. (Mrs.) SONIA DAS, Principal, K.G. College of
Nursing for her encouragement, inspirations and support as well as for
providing all facilities for successful completion of this study.
5
I express my sincere gratitude to Prof. RAJI.K, Vice Principal and
HOD, Medical Surgical Nursing, K.G. College of Nursing for her
encouragement, inspirations and support for successful completion of this
study.
My sincere and heartfelt thanks to, Prof. (Mrs.)SHEEBA.R,

HOD, Obstetrics and Gynaecological Nursing, K.G. College of Nursing
for her timely support, expert opinion and encouragement which helped
in the successful completion of this study.
I express my sincere thanks and profound gratitude to

Dr.(Mrs.)CHANDRAKALA MARAN, Chief Obstetrician and
Gynaecologist, K.G. Hospital, for her excellent guidance and motivation
in all matters large and small, since the inception of the study.
My special thanks and gratitude to Prof.( Mr.)SUBRAMANIAN.K,

Professor in Biostatistics and Research , who gave me excellent ideas in
statistical analysis and a positive approach to make the whole project in
a good shape.
I submit my sincere thanks to Prof.(Mrs.)SOFIA

CHIRSTOPHER, Class coordinator and HOD,Community Health
Nursing, for her patience, affectionate, moral support and guidance
throughout my study.
I express my sincere gratitude to Prof.(Mrs.)

VIJAYALAKSHMI, HOD, Child Health Nursing, Prof. (Mrs.) TAMIL
SELVI, HOD, Psychiatric Health Nursing.
6
I honestly express my thanks to ,( Mrs.) MUTHUKANNU,
(Mrs.) VIMIJA. M, Associate Professors, (Mrs.)SANGEETHA,
(Mrs.)DHANAPANDI,( Ms.)SANGEETHA Lectures, Department of
Obstetrics and Gynaecological Nursing, K.G. College of Nursing, for
their encouragement and guidance in the completion of this study.
I extend my special heartfelt thanks to all the experts,

Dr. (Mrs.) ESTHER JOHN, Prof. (Mrs.) VIJAYALAKSHMI
MOHANRAJ, Prof.(Mrs.)VIDHYA SESHAN, Prof.(Mrs.)JOHNSY
SUNDARI, Prof( Mrs.) RENUKA, Prof. (Mrs.)SEENA, for validating
the content of the tool and providing valuable suggestions.
My heartfelt thanks to all FACULTY MEMBERS of K.G. College

of Nursing, for their guidance and encouragemet.
I am very grateful to Mrs. JOSEPHINE PRINCEY, English

Lecturer, K.G. College of Nursing, for her valuable editorial support.
My special thanks to Prof. (Mrs.) SUSILA VICTOR, Lecturer, K.

G. College of Arts and Science , for her valuable editorial support.
A word of appreciation to Mr. KATHIR VADIVELU, chief

Librarian of K.G. College of Health Sciences, for rendering his support
and help in procuring the literature related to the study.
I would like to extend my deepest thanks to the PARTICIPANTS for

their co-operation, without them it would have been impossible to
complete the study.
7
Above all with grateful heart I express my love to my beloved
HUSBAND, my MOTHER and my DAUGHTERS for their
unconditional love, immense help, encouragement, care and supporting
prayers.
My special heartfelt thanks to my FAMILY MEMBERS who

skillfully, almost invisibly blended my inabilities in to a melody of
inspiration.
I am extremely thankful to Mr.RANGARAJ, Krishna Xerox,

Saravanampatti, who spent hours to work to prepare the script of this
thesis.
My heartfelt thanks to my CLASSMATES AND JUNIORS who

helped and supported me for the successful completion of this study.
I thank one and all who directly or indirectly helped in successful

completion of this dissertation.
8
INDEX
CHAPTER CONTENT PAGE NO.
I INTRODUCTION 1-10
Need for the study 2-5
Statement of the problem 5
Objectives 5
Operational definitions 5-6
Assumptions 6
Hypothesis 6
Limitations 7
Projected outcome 7
Conceptual Framework 7-10
II REVIEW OF LITERATURE 11- 20
III METHODOLOGY 21-32
Introduction 21
Research approach 21
Research Design 21-22
Setting of the study 24
Variables 25-26
Population 27
Sample size 27
Sampling technique 28
Criteria for sample selection 28
Description of the tool 28-29
Content validity 30
Reliability 30
Pilot study 30
Method of data collection 31
Plan for data analysis 32
IV DATA ANALYSIS AND INTERPRETATION 33-55
V RESULTS AND DISCUSSION 56-60
VI SUMMARY,RECOMMENDATIONSAND
61-64
NURSING IMPLICATIONS OF THE STUDY
BIBLIOGRAPHY
APPENDICES
9
LIST OF TABLES
TABLE PAGE
NO. TITLE NO.
1 Distribution of demographic variables among women with
premenstrual syndrome in experimental and control group. 35-36
2 Distribution of menstrual variables among women with 40-41
premenstrual syndrome in experimental and control group.
3 Distribution of intensity of premenstrual syndrome pre
test and post test scores among women in experimental 44
and control group.
4 Comparison of pre test and post test scores of premenstrual 46
syndrome among women in experimental group.
5 Comparison of intensity of premenstrual syndrome among 47
women in experimental group and control group.
6 Association of intensity of premenstrual syndrome among 48
women with selected demographic variables in
experimental group.
women with selected menstrual variables in experimental
group.
women with selected demographic variables in control
group.
women with selected menstrual variables in control group.
10
LIST OF FIGURES
FIGURE PAGE
NO. TITLE NO.
1. Conceptual framework 10
2. The schematic representation of study design 23
3. Relationship of Variables 26
4. Diagram showing the distribution of

demographic variables according to family birth 39
order of women with premenstrual syndrome in
experimental group and control group.
5. Diagram showing the distribution of menstrual

variables according to the duration of
menstruation of women with premenstrual 43
syndrome in experimental group and control
group.
6. Diagram showing the distribution of intensity of

premenstrual syndrome pre test and post test 45
score among women in experimental group and
control group.
11
LIST OF APPENDICES
APPENDIX TITLE
A. Letter seeking permission for conducting the study

B. Letter granting permission for conducting the study
C. Letter seeking experts opinion for content validity of the
tool
D. Format for content validity
E. List of experts for content validity
F. Certificate For Jacobson Progressive Muscle Relaxation
Exercise.
G. Certificate For English Editing
H. Certificate For Tamil editing.
I. Tool I -Section- A: Demographic variable.
Section- B: Menstrual variable.
Tool II – Modified COPE (Calendar of premenstrual
experiences) four point Likert scale.
(English and Tamil)
J. Procedure of Jacobson progressive muscle relaxation
exercise
12
CHAPTER -1
INTRODUCTION
“One day she is in all smiles and happiness then, the another day there
will be no living with her, she flies into a rage.”
- Greek
Poet
Menstruation is the visible manifestation of cyclic physiologic

uterine bleeding due to shedding of the endometrium. In majority, apart
from bleeding per vagina, there may be premonitory symptoms such as
pelvic discomfort, backache, fullness of breast, mastalgia, headache or
depression just prior to menstruation. If these premonitory symptoms are
predominant, these are grouped into a syndrome called premenstrual
syndrome (D.C. Dutta, 2007).
Premenstrual syndrome is a collection of physical,

psychological, and emotional symptoms related to one’s menstrual cycle.
30-40% women suffer some impairment of daily activities , 75% has mild
symptom and 3-8% has severe premenstrual syndrome. An estimated
3 of every 4 menstruating women experience mild form of premenstrual
syndrome. These problems tend to peak in the late 20s and early 30s
(Mayo clinic, 2009).
Pre menstrual syndrome is reported in women of all culture all

over the world. In a survey of women,88% reported moderate to severe
premenstrual symptoms. Premenstrual signs and symptoms usually occur
about one week before a woman’s period starts and disappear soon as
her period begins. The signs and symptoms disable a woman in some
13
ways and disrupt her day to day activities (American Psychiatric
Association, 2003).
More than 80% treatment have been proposed for alleviating

the symptoms of Premenstrual syndrome but no treatment has been found
to be consistently effective. Treatments include diuretics, prostaglandin
inhibitors, progesterone inhibitors, ovulation inhibitors, vitamins, lithium
and antidepressants. It also includes life style measures like charting of
symptoms daily diet restriction(salt, carbohydrate, caffeine, chocolate,
alcohol) exercise, stress management, yoga, progressive muscle
relaxation, relationship skills, self groups and education.
Pharmacotherapy may be initiated only when these measures have failed
(Women’s Health, 2002).
Jacobson Progressive Muscle Relaxation exercise is one of the

relaxation techniques. It is a systematic tensing and relaxing of each
muscle groups starting from head to toe. The advantages of this relaxation
exercise includes, it reduces anxiety and pain, promotes sleep, decrease
fatigue and skeletal muscle tension, increases confidence and ability to
handle pain (Stout. A.L, 2008).
NEED FOR THE STUDY
Premenstrual syndrome is an entity that causes considerable

morbidity, in about 3% of the women, it may disrupt the woman's life
when severe symptoms recur. Many women have premenstrual cyclic
symptoms of psychological or physical nature and sometimes these limit
their functional capacity. The symptoms due to neurohormonal imbalance
or ageing may start as early as 35 years of age. The prevalence of
14
premenstrual syndrome in general is about 2-10% for disabling
symptoms, while minor symptoms present up to 80% of women. In the
present series, a high prevalence of premenstrual syndrome was observed
in premenopausal women. A recent survey of 3,913 women of 15-54
years of age have premenstrual syndrome (J.V Joshi, S. N Pandey,
2010).
A cross sectional community survey was conducted among the

women in 25-40yrs age group. Among the subjects surveyed 75.8%was
recorded to be having problem related to menstruation. Physical problem
were present in 32(35.2%) and psychological problem in 5(55%) where
as 32 (35.2%) had both physical and psychological problems. Most
common physical problem was abdominal pain (49.5% ) and
backache(41.8%) and the most common psychological problem was the
desire to be alone (18.7%) and depression(17.6%).Intolerable abdominal
pain and backache were reported by 15(16.5%) and 10(11%) subject
respectively (M. Arunkumar, Walia, 2003) .
Pre menstrual syndrome is a combination of physical and

psychological symptoms seen among women in reproductive age, in their
30 years or older. Symptom occur in luteal phase with resolution within
one or two days of onset of menses. The management of premenstrual
syndrome include simple measures like Jacobson progressive muscle
exercise, dietary changes and vitamin supplementation. Pharmacological
agents may be useful in selected clients, support and counseling is of
paramount importance in management of premenstrual syndrome. Nurses
can manage woman who have minor physiological and emotional
changes associated with a mild degree of pre menstrual syndrome.
15
Women with severe and moderate symptoms should be referred for
evaluation and follow up (Hsia and Hong, 2008).
A study was conducted on relaxation intervention used for the

treatment of pain in adults. Based on the type of relaxation interventions
(Progressive muscle relaxation exercise, autogenic training, jaw
relaxation, rhythmic breathing and other relaxation exercises) and
summarized with respect to various study characteristics and results, the
most frequently used support technique was Jacobson progressive muscle
relaxation exercise particularly for premenstrual pain ( Kristine. L.
K 2006).
Jacobson progressive muscle relaxation can be used

effectively in alleviating premenstrual syndrome physical symptoms such
as fatigue, sleeplessness, dizziness, headaches, breast tenderness and
swelling, back pain, abdominal pain and bloating, muscle cramps and
behavioral symptoms such as food cravings, irritability, anger, depressed
mood, crying and tearfulness, anxiety, tension, mood swings, lack of
concentration, confusion, forgetfulness, loneliness, tension (Krishna
Seshadri,2006).
Studies showed that yoga, exercise and relaxation therapy are

effective to reduce premenstrual syndrome. It will be highly beneficial to
implement this approach to those who are having premenstrual syndrome.
So the researcher had the interest in Jacobson progressive muscle
relaxation exercise in reduction of premenstrual syndrome and selected as
research topic. If practiced properly it will be highly beneficial for the
women suffering from premenstrual syndrome.
16
STATEMENT OF THE PROBLEM
A Study To Assess The Effectiveness Of Jacobson Progressive
Muscle Relaxation Exercise On Premenstrual Syndrome Among
Women Attending Gynaecology OPD in K.G. Hospital,
Coimbatore.
OBJECTIVES
1. To assess the intensity of premenstrual syndrome of the women in
experimental and control group.
2. To provide Jacobson progressive muscle relaxation exercise to
women in experimental group.
3. To assess the effectiveness of Jacobson progressive muscle
relaxation exercise on premenstrual syndrome among women in
the experimental group.
4. To compare the intensity of premenstrual syndrome among women
in both experimental and control group.
5. To associate the findings with selected demographic variables and
menstrual variables.
OPERATIONAL DEFINITIONS
Effectiveness
Effectiveness refers to the reduction in the intensity of
premenstrual syndrome experienced by women after providing Jacobson
progressive muscle relaxation exercise.
Premenstrual syndrome
17
Premenstrual syndrome is a physical, psychological and
behavioural symptoms that occur two weeks prior to menstruation.
Jacobson progressive muscle relaxation exercise

Jacobson Progressive muscle relaxation is a relaxation technique
in which the patient first tenses and then relaxes major muscle groups of
the body in a pre-fixed and systematic order, usually beginning at the top
of the body and progressing downwards up to feet.
Women
Women in reproductive age group of 20-45 years.
ASSUMPTIONS.
1. Women experience pre menstrual syndrome two weeks prior to
menstruation.
2. Jacobson progressive muscle relaxation exercise is a means of
relaxation and decreases pre menstrual syndrome.
3. Most of the women are unaware of regarding Jacobson progressive
muscle relaxation exercise.
HYPOTHESIS
There is a significant difference in premenstrual syndrome among
women following Jacobson progressive muscle relaxation exercise and
in women not following the exercise
LIMITATIONS
The study is limited to
• Women attending Gynaecology OPD in K.G . Hospital,
Coimbatore.
18
• Women in reproductive age group of 20-45 years.
• Women who are able to understand Tamil and English.
• Women who have regular menstrual period
• Women not having medical and surgical problems.
PROJECTED OUTCOMES
• The findings of the study will identify the need and effectiveness of
simple non pharmacological measures of reducing pre menstrual
syndrome such as Jacobson progressive muscle relaxation
exercise.
• The findings of the study will help in relaxation, comfort, reduction
of premenstrual syndrome in women without any complications.
CONCEPTUAL FRAMEWORK
This study was aimed at determining the effectiveness of
Jacobson Progressive Muscle Relaxation Exercise in reduction of
premenstrual syndrome.
The investigator adopted “J.W. Kenny’s open system model ” as a basis

for conceptual framework. According to J.W. Kenny’s, all living system
are open and they are in continuous exchange of matter, energy and
information, which results in varying degree of interaction with the
environment from which the system receives input and gives back output
in the form of matter energy and information. System model consists of
three phases input, through put and output.
Input
19
Based on J.W .Kenny’s open system model input can be a matter,
energy and information that enter into the system from the environment
through its boundaries.
In this study input refers to the information needed by the system

and collecting history from the experimental and control group.
Throughput process
The process that allows the input to be changed so that it is useful to

the system. Through put is the operation phase or manipulation and
activity phase.
In this study, the throughput is the process of evaluating the

effectiveness of Jacobson Progressive Muscle Relaxation Exercise by
COPE(Calendar of premenstrual experiences) four point Likert scale. For
experimental group Jacobson Progressive Muscle Relaxation Exercise is
provided and for control group routine care is given.
Output
Output is any information that leaves the system and enters the
environment through system boundaries. It refers to the ultimate results,
which are expected following program implementation.
In this study output is the difference in the intensity of premenstrual

syndrome between experimental and control group.
Feed back
Feedback is the result of through put, it allows the system to be

rectified as part of the input of the same system.
20
According to the theorist, feedback is the information of environment
responses to the system. Output is utilized by the system in adjustment,
correction and accommodation to the interaction with the environment.
The effectiveness of Jacobson progressive muscle relaxation exercise in
reducing the intensity of premenstrual syndrome is considered as the
difference observed and expected. For the present study feedback is not
included.
21
FIGURE – 1
CONCEPTUAL FRAMEWORK BASED ON MODIFIED J.W. KENNY’S OPE
CLINICAL SET UP
INPUT THROUGH PUT

O
(PROCESS)
Collection of
To evaluate the
demographic data and effectiveness of Jacobson Effectivenes
menstrual data from progressive muscle Jacobson progr
both relaxation exercise by muscle relax
experimental&control checking pre menstrual exercise in red
group of women syndrome score. of intensity o
having pre menstrual menstrual syn
syndrome by Modified C
Assessment of intensity of four point liker
Experimental group
pre menstrual syndrome in
experimental and control Providing Jacobson progressive
group using modified COPE muscle relaxation exercise
four point likert scale Control group
Routine care given

10
CLINICAL SET UP
------not included in this study 10
22
CHAPTER II
REVIEW OF LITERATURE
Review of literature is a written summary of the state of an art of a

research problem. It helps the researcher to familiarize themselves with the
knowledge base. It includes the activities involved in identifying and searching
comprehensive picture of a state of knowledge on that topic ( Polit and Hungler
2009).
Woman with pre menstrual syndrome can suffer from all of the most
common signs and symptoms. Breast pain and tenderness, bloating, backache,
painful thighs, mood swings, irritability, loss of control, headache, nausea,
vomiting, diarrhea, tearfulness, outbursts, depression, anxiety, fatigue, weakness,
dizziness. Some women can become isolated and withdrawn because of these
symptoms ( Dorrisnoel, Klinger,2002).
SECTION A:Studies related to prevalence and perception of premenstrual

syndrome.
SECTION B:Studies related to management of premenstrual syndrome.
SECTIONC:Studies related to relaxation techniques on premenstrual
syndrome.
SECTION D :Studies related to Jacobson progressive muscle relaxation
exercise in premenstrual syndrome.
23
SECTION A: STUDIES RELATED TO PREVALENCE AND
PERCEPTION OF PREMENSTRUAL SYNDROME.
A qualitative research was conducted to study the prevalence of

premenstrual syndrome among 300 female BSc nursing students between 17-25
years of age from selected nursing colleges in Mangalore. The findings revealed
that majority(55%) were in age group of 20-22 years. The prevalence of
premenstrual syndrome based on ICD-10 diagnostic criteria was found to be
13.33%. Based on premenstrual syndrome scale the majority (76%) of samples had
premenstrual syndrome as mild,15% as moderate, 7% as severe and 2 % of
subjects reported to have no impairment. There was significant association
between the prevalence of premenstrual syndrome and variables like age and
performing relaxation technique (Mathias. J, 2007).
A study was conducted on prevalence and impact of premenstrual

syndrome in 700 college women aged 20-25 years in Al-An city. Subjects were
interviewed about cyclic and recurrent behavioral and premenstrual symptoms
using a structured and validated questionnaire. The prevalence of premenstrual
syndrome was 16.4%.Only 52 affected subjects(45.2%)were currently taking
treatment for premenstrual syndrome and majority (60%) used pharmacological
therapy. Premenstrual syndrome had a moderate but significant impact (p=0.001)
on quality of life, social interaction, lifestyle and emotional wellbeing. Difficulty in
performing daily functions and decrease in stigma were the two most adversely
affected parameters ( Ritz. D. E. et al., 2006).
24
A study was conducted on the prevalence and frequency of symptoms
of premenstrual syndrome in female undergraduate students of university of
Calabar. A survey of 200 nulliparous subjects aged between 16 and 31 years
revealed that 83.5% of them regularly experienced symptoms suggestive of
premenstrual syndrome .The commonest symptom were lower abdominal pain,
pimples, puffy face, tender or painfully engorged breast and depression or tension.
The least frequent symptom were backache and common cold.42% of subjects
complained of severe abdominal pain. There was an association between severity
of abdominal discomfort and symptoms experienced by subjects (Diana. C. Dell,
2004).
A study was conducted on prevalence and prediction of premenstrual

syndrome among college aged women in Saudi Arabia , using a self report
questionnaire (n=464). At least one premenstrual symptom was experienced by
448 women(96.61%)and 176 (37.5%) had a high symptom severity score.
Premenstrual symptom frequency was significantly associated with menstrual
history, self perception of mental stress, physical activity, consumption of sweet
tasting foods and coffee (Rasheed. R, et al., 2003).
The comparative study was conducted to measure the effect of

menstrual cycle phase on personality variables in women with and without
premenstrual syndrome. The personality diagnostic questionnaire revised was
administered in both the follicular and luteal phases to women with premenstrual
syndrome(n=40). An appropriate control group(n=20) also completed the
questionnaire in both phases. Only women with premenstrual syndrome
25
demonstrated a significant increase in total personality diagnostic questionnaire
revised score from the follicular to the luteal phase. Women with premenstrual
syndrome had significantly higher total personality diagnostic questionnaire
revised scores than the asymptomatic controls during the follicular and luteal
phases (Berlin, R. et al., 2001).
SECTION B: STUDIES RELATED TO MANAGEMENT OF

PREMENSTRUAL SYNDROME
A study was conducted to compare the efficiency of Vitrex agnus castor

fruit with placebo for women with the premenstrual syndrome in China. Eligible
patients were randomly assigned into vitrex agnus castor fruit or placebo group.
Symptoms were documented with a daily rating scale with four symptom factors
(negative affect, water retention, food cravings and pain). Sixty-seven patients
were enrolled and randomly assigned to receive one tablet of vitrex agnus castor
fruit or placebo once a day. All the four symptom factor scores were significantly
reduced by the 3rd treatment cycle. Premenstrual syndrome sum scores decreased
60% ,the efficacy rate in treatment group was significantly higher than that in
placebo group at the 3rd treatment cycle. Vitex agnus castor extract shows
effective in treating moderate to severe premenstrual syndrome in especially in
symptoms of negative affect and water retention ( Lin. S, et al., 2010).
A qualitative study was conducted in Institute of Psychological

Sciences, UK among women aged 18-45 years with regular menstrual cycles who
were prospectively diagnosed with mild premenstrual syndrome. Women who
were eligible after three screening cycles (n = 36) underwent a two-cycle
placebo run-in phase. They were randomly assigned to receive Hypericum
26
perforatum (St John’s wort) tablets 900 mg/day or identical placebo tablets for two
menstrual cycles. After a placebo-treated cycle, the women crossed over to receive
placebo or Hypericum perforatum for two additional cycles. Symptoms were rated
throughout the trial using the Daily Symptom Report. There was a significant
reduction in premenstrual syndrome among women receiving Hypericum
perforatum than placebo ( Orsi. N, et al., 2007).
A case control study was conducted on calcium and vitamin D intake

and risk of incident premenstrual syndrome in Amherst among women aged 27-44
years. Intake of calcium and vitamin D was measured by a food questionnaire.
After adjustment for age, parity, and other risk factors, women in highest quintile
of total vitamin D intake had a relative risk of 6.59 compared with those in the
lowest quintile. The intake of calcium from food sources was also inversely related
to premenstrual syndrome; compared with women with a low intake. The intake of
low fat milk was also associated with a lower risk (p<0.001). A high intake of
calcium and vitamin D reduce the risk of premenstrual syndrome (Johnson. E. R,
Berton. et al., 2005).
A study was conducted to assess the efficiency of homeopathic

treatment in reducing symptom associated with premenstrual syndrome in
Hadassah hospital, Jerusalem. A sample of 20 women aged 20-48 years with
premenstrual syndrome were treated randomly with one oral dose of a
homeopathic medication or placebo. The subjects completed menstrual distress
questionnaire before and after the treatment. The results revealed that improvement
of more than 30% was observed in 90% patients receiving active treatment and
37.5% receiving placebo (p=0.048). Homeopathic treatment was found to be
27
effective in alleviating the symptoms of premenstrual syndrome on comparison to
placebo (Yakir. et al., 2003).
A qualitative study was conducted in The clinical research centre,

Cambridge, USA regarding the consumption of carbohydrate-rich beverage to
alleviate negative mood symptoms and food cravings in women with severe
premenstrual syndrome. Subjects (n =53) completed daily symptom ratings of
mood and food cravings for two baseline menstrual cycles. Subjects were
randomized to isocaloric active or placebo beverage groups after baseline. Active
powder contained complex and simple carbohydrates and the placebo was sucrose,
gelatin, vitamins flavorings and citric acid. The powder was mixed with fluid and
taken twice daily for the 5 days preceding anticipated menstruation. Mean age of
the sample was 36 years(22-46years). Outcome was measured with daily symptom
ratings and The Profile of Mood States. Premenstrual consumption of the
carbohydrate-rich beverage reduced mood symptoms for approximately one third
of women, in comparison to those consuming placebo (E.W. Freeman, A. L.
Stout, et al., 2002).
A comparative clinical trial was conducted to evaluate the efficiency of

bromocriptine over placebo in management of premenstrual syndrome in GSVM
Medical College, Kanpur. A sample of 15 women with severe premenstrual
syndrome participated in a 6 month study which included 2 months of control
cycle followed by bromocriptine 2.5 mg/day or placebo for next 4 months.
Symptoms were evaluated using the calendar of premenstrual experiences. The
results showed that bromocriptine was effective in managing premenstrual
28
syndrome symptoms specially mastidynia and fluid and electrolyte symptoms like
water retention and edema than placebo (Singh, V.K. 2002).
A study was conducted on using acupuncture to treat premenstrual

syndrome in Croatia. More than 60% of the women in both groups suffered from
premenstrual symptoms such as anxiety, mastalgia, insomnia, nausea,
gastrointestinal disorders, where as smaller number of women suffered from
phobic disorders, premenstrual headache and migrains. There were 3 women from
the first group and 7 women from the second group who continued the medication
treatment with fluoxetine. In the first group 9 women having premenstrual
syndrome symptoms stopped taking acupuncture, after 2 treatments, 8 women
stopped taking acupuncture after 3 treatments and one women stopped taking
acupuncture after 4 treatments. The success rate of acupuncture in treating
premenstrual symptoms was 77.8%,where as it was 5.9% in the placebo group
(Habek. D, et al., 2002).
SECTION C: STUDIES RELATED TO RELAXATION TECHNIQUES ON

PREMENSTRUAL SYNDROME.
A qualitative study was conducted on 50 clinically healthy women

volunteers who were in their premenstrual period. Thirty women having
premenstrual syndrome were compared with twenty control women to evaluate 1
week training of 61-points relaxation yogic exercise. In both the groups cold
pressor test was performed, systolic blood pressure , diastolic blood pressure and
heart rate were measured. Basal systolic blood pressure, diastolic blood pressure
29
& heart rate of women with premenstrual syndrome was significantly higher than
the control subjects suggesting the presence of stress in women with premenstrual
syndrome. Following 1 week of 61-points relaxation training, the control group
showed a significant decline in systolic blood pressure, diastolic blood pressure
and heart rate respectively, the premenstrual syndrome group showed a significant
reduction in systolic blood pressure, diastolic blood pressure and heart rate,
immediately after cold pressor test. These results suggest a reduction in
sympathetic activity by 61-points relaxation training and it can be used as an
effective relaxation tool during premenstrual stress (Dvivedi J, Kaur H, 2009).
A comparative study was conducted to find out whether premenstrual
symptoms were relieved by massage therapy in Touch research institute, USA. 24
women were randomly assigned to a massage therapy or a relaxation therapy
group. The massage therapy group showed decrease in anxiety, depressed mood
and pain immediately after the first and last massage sessions. The longer term (5
week) effects of massage therapy included a reduction in pain and water retention
and overall menstrual distress. The study findings suggest that massage therapy is
an effective adjuvant therapy for treating severe premenstrual symptoms ( Reif.
M. H, et al., 2007).
SECTION D: STUDIES RELATED TO JACOBSON PROGRESSIVE

MUSCLE RELAXATION EXERCISE IN PREMENSTRUAL SYNDROME
A quantitative study was conducted in the Oozhiasthanam Teacher
Training Institute, Tirunelveli district among women aged 20-25 years and were
screened for premenstrual syndrome using a rating scale. 30 eligible women were
recruited in the experimental group. Jacobson progressive muscle relaxation
30
exercise was taught to the experimental group with the help of video CD and each
participant was advised to do, twice daily for 4 weeks. The investigator checked
the performance every day. Post test was conducted after 28 days after the
administration of Jacobson progressive muscle relaxation exercise . There was a
significant reduction in premenstrual syndrome (p< 0.05). Jacobson progressive
muscle relaxation exercise was effective in reducing premenstrual syndrome
among college women. (Lindsie Mary. l, Tamilmani. R, 2009).
A qualitative study was conducted among six female subjects who

were between 31-44 years of age attended a pre menstrual syndrome clinic and
participated in a group therapy program designed to alleviate their pre menstrual
symptoms. Rational-emotive therapy and Jacobson progressive muscle relaxation
exercise were offered in an effort to alleviate severe psychological symptoms. Pre
treatment assessments were carried out using Moods Menstrual distress
Questionnaire. Significant differences were found in a number of psychological
and physical symptoms of menstrual distress, in cognitive functioning and
neuroticism, following the combined group therapy (Micheal .E, Bernard. L,
2009).
A study was conducted on relaxation in women with premenstrual

syndrome in 107 women compared with three interventions: progressive muscle
relaxation exercise, reading leisure material, and charting. Participants in the
relaxation response group received tape instructions on relaxation of all muscles
to elicit the relaxation response. The first trial found evidence that relaxation
response (15–20 minutes twice daily for 3 cycles) significantly improved physical
symptoms at 5 months compared with reading leisure material or charting
31
symptoms. In women with severe premenstrual symptoms, relaxation response
also improved emotional symptoms and social withdrawal symptoms compared
with reading leisure material or charting symptoms (Irene Kwan, Joseph Loze
Onwude 2009).
Women with mild premenstrual syndrome may not need any

medication, if the symptoms are severe and causing discomfort some drugs, like
antidepressants are used to reduce premenstrual syndrome. For mild premenstrual
syndrome, some dietary changes like avoiding salty foods, caffeine and alcohol,
eating fresh fruits and vegetables, having small but frequent meals, increasing
calcium intakes, and taking multivitamin supplements can help in curbing the
premenstrual syndrome. Incorporating exercise in the daily routine like walking,
cycling, swimming, etc. getting plenty of sleep, and practicing Jacobson
progressive muscle relaxation to reduce stress and help to control the premenstrual
syndrome and lead a regular life (Kanika Khara, 2009).
A study was conducted among thirty healthy college women with

regular menstrual cycles for 3 months in Duke University, North Carolina. The
subjects completed the Menstrual Distress Questionnaire (MDQ) at the beginning
and end of the study, recorded their menstrual cycles for 3 months on an
investigator-developed calendar recording sheet. Subjects were then given an
audiotape with a Jacobson progressive muscle relaxation exercise. The total
premenstrual distress scores declined significantly, as did the subscales measuring
behavior and negative affect (Groer. M, et al., 2008).
32
CHAPTER III
RESEARCH METHODOLOGY
INTRODUCTION
Research methodology is the techniques used to structure a study

and to gather and analyze information in a systematic fashion (Polit and
Beck, 2007).
In this section, following topics are discussed in relation to
methodology adopted by the investigator. It includes the description of
research design, setting of the study, variables, population, sample size,
sampling technique and sample selection criteria, description of the tool,
content validity, reliability, pilot study, method of data collection and plan
for data analysis.
RESEARCH APPROACH
In this present study the researcher had adopted quantitative approach.
RESEARCH DESIGN
Quasi experimental research design was adopted in this study. The

investigator assigned the participants in two groups namely experimental
and control groups and introduced the experimental subjects to Jacobson
progressive muscle relaxation exercise and routine care given to control
group to reduce pre menstrual syndrome. Effectiveness was measured
through Modified COPE (calendar of premenstrual experiences) by four
point Likert scale.
21
Experimental group: O1 X O2
Control group : O3 - O4
O1 - Pre test score of intensity of premenstrual syndrome in experimental

group
X – Jacobson progressive muscle relaxation exercise
O2 - Post test score of intensity of premenstrual syndrome in experimental
group
O3- Pre test score of intensity of premenstrual syndrome in control group
O4- Post test score of intensity of premenstrual syndrome in control group
22
FIGURE-2
SCHEMATIC REPRESENTATION OF RESEARCH DESIGN
Quantitative approach
Quasi- Experimental study research design
Study Setting: Gynaecology OPD, K.G.Hospital, Coimbatore
Target Population: Women attending Gynaecology OPD in,

K.G.Hospital, Ciombatore.
Accessible Population: Women attending Gynaecology OPD having

premenstrual syndrome as per inclusion criteria in K.G.Hospital, Coimbatore
Sampling Technique: Convenience Sampling technique
Sample Size- 40(experimental group 20 and control group 20)
Experimental group Control group
Assessment of intensity of premenstrual syndrome

Modified COPE by four point Likert scale.
Jacobson progressive muscle relaxation exercise Routine care
Assessment of effectiveness of Jacobson progressive muscle relaxation exercise,

Modified COPE(calendar of premenstrual experiences) by Four point Likert scale.
Data Analysis and interpretation: Descriptive and inferential statistics
Study findings and conclusions
23
SETTING OF THE STUDY
Setting are the more specific places where data collection occurs (Polit
and Beck, 2004).
The study was conducted in K.G.Hospital, Coimbatore, which is a
550 bedded multispeciality, NABH certified hospital. It is situated in the
heart of Coimbatore City. The hospital is renowned for its excellent
medical expertise, nursing care and quality of diagnostic services. The
Obstetrics and Gynaecology department of K.G hospital is well staffed
with two chief Gynaecologist,6 duty doctors and 12 staff nurses with
twenty four hours services and emergency care. It offers advanced and
affordable health care to the people. All the facilities are provided for
conducting normal and instrumental delivery. The facilities include
maternity wards, 4 outpatient departments, well equipped 3 labour rooms
and one neonatal ICU and operation department for emergency
management. There are about 1000 cases attending the out patient
department per month and nearly 150 deliveries are conducting per month.
Out of these 150 deliveries, there are 50 cesarean deliveries.
The investigator selected this setting for the following reasons

• .Availability of study sample.
• Economic feasibility of conducting the study
24
VARIABLES
Variables are the measurable characteristics of a concept and consist of
logical group of attributes (Polit and Beck, 2007).
Independent variable
Jacobson progressive muscle relaxation exercise.
Dependent variable
Premenstrual syndrome.
Influencing variables
Age, education, occupation, dietary pattern.
Extraneous variables
Support system, knowledge regarding alternative therapies.
25
FIGURE-3
RELATIONSHIP BETWEEN VARIABLES
Influencing variables Dependent variable Independent

Variable
Age, education,
occupation, dietary Premenstrual Jacobson progressive
pattern. syndrome muscle relaxation
exercise
Extraneous
variables
Support system,
knowledge regarding
alternative therapies
26
POPULATION
Population represents the entire aggregation of cases that meet a
designed set of criteria that are accessible to the researcher for a study and
for which researcher is able to make generalizations (Polit and Beck,
2004).
Total population of the present study is 100. Target population is 50
SAMPLESIZE
Sample size was determined by using Mahajan formula and it follows

allowable error method
Sample size (n) = 4pq/L2
4=Constant number
P=Percentage of population
Q=100-p
L=Allowable errors
P=Target population/Total populationx100
P =50/I50x100=33
q =100-P=100-33=67
L= 15
n=4x33x67/15x15=39.3~40
According to this the researcher decided to have the sample size as 40 for
study.
27
SAMPLING TECHNIQUE
Sampling technique is the process of selecting a subset of
population in order to obtain information regarding a phenomenon in a way
that represents the entire population. (Polit and beck, 2007).
Convenience sampling technique was used for the study. The investigator
selected the persons who fulfilled the inclusion criteria formed for the study.
CRITERIA FOR SAMPLE SELECTION

Inclusion criteria
• Women having regular menstruation.
• Women who are willing to participate in the study.
• Women who are able to understand Tamil and English.
• Women attending Gynaecology OPD, K.G. Hospital, Coimbatore.
Exclusion criteria
• Women having medical and surgical problems
DESCRIPTION OF THE TOOL

The researcher developed the tool on the basis of objectives,
hypothesis and extensive review of literature of the study. The following
steps were adopted prior to the development of the tool. Review of literature
provided adequate content for the tool presentation, personal experience of
the investigator in clinical field and expert opinion from teachers of
Obstetrics and Gynaecological department, were of extreme help in devising
a tool. The tool was developed in English.
28
TOOL I
SECTION A- DEMOGRAPHIC VARIABLES
A self designed questionnaire developed by researcher herself which
comprises of 10 items for obtaining demographic data of the mother through
personal interview.
SECTION B- MENSTRUAL VARIABLES

It comprises of 10 items for obtaining menstrual data of the mother through
personal interview.
TOOL II
SECTION C- MODIFIED COPE (calendar of premenstrual experiences)
• To assess the intensity of pre menstrual syndrome among women
attending Gynaecology OPD.
• In order to assess the intensity of premenstrual syndrome, Modified
COPE by four point Likert scale was used by the investigator. It
consist of 22 items to rate the intensity of pre menstrual syndrome.
The items are scored as none, mild, moderate and severe on the scale.
Each subject is assessed according to the scorings.
The scoring system is divided into the following categories

0 = NONE
1-22 = MILD
23-44 = MODERATE
45-66 = SEVERE
29
CONTENT VALIDITY
Content validity is the degree to which the items in an instrument
adequately represent the universe of content for concept being measured
(Polit and Beck, 2004).
The tool was submitted to experts of the departments of Obstetrics and
Gynaecological nursing .A criterion rating scale for validation of tool was
developed. Experts were asked to give their opinions and suggestions about
content of the tool.
RELIABILITY
Reliability of the tool was established by using split half technique.
It showed rhh = 0.9 and hence the tool was found to be reliable.
PILOT STUDY
Pilot study is the scale version, or trial done in preparation for main
suitability, practicability, appropriateness and flexibility of the study and
tool (Denise F. Polit, 2004).
The investigator conducted the pilot study in K.G. hospital,

Coimbatore. For the pilot study, the investigator selected a total of 10
samples who were assigned to specific group (experimental group 5,control
group 5). The study purpose was explained to the sample subjects. After the
pilot study the researcher found the need for minor modification in
demographic data, menstrual data, making required modifications in the
tool. When analyzed, the results gave evidence that the tool was feasible.
After the pilot study, the investigator proceeded for the main study.
30
METHOD OF DATA COLLECTION
Data collection was done by using structured interview schedule. The

researcher introduced herself and obtained an oral consent from the subjects
to participate in the study. The data was collected by using a self designed
questionnaire.
DESCRIPTION OF INTERVENTION
A written permission was obtained to conduct the study from the

human ethical committee of K.G. hospital, Coimbatore. Data collection was
done within the given period of 4 weeks. The investigator personally
explained the purpose of the study and established good rapport with the
women attending Gynaecology OPD and were screened for premenstrual
syndrome using Modified COPE (calendar of premenstrual experiences)
before giving the intervention and assured confidentiality.
The data was collected from the samples as follows,
The intensity of premenstrual syndrome was assessed in both

experimental and control group by Modified COPE (Calendar of
premenstrual experiences) four point Likert scale. After the pre test Jacobson
progressive muscle relaxation exercise was given to the samples in
experimental group, it was done twice daily for 20 minutes for one month.
Then the intensity of premenstrual syndrome was again assessed using the
same scale in experimental group and control group after one month.
31
PLAN FOR DATA ANALYSIS
Data were planned to analyze on the basis of objectives and testing of

hypothesis by using descriptive and inferential statistics.
Descriptive statistics were used to analyze the frequency, percentage, mean

and standard deviation of the following.
• Demographic and menstrual variables of women.
• Intensity of pre menstrual syndrome
Inferential statistics was used to determine the relationship association and

comparison to identify the differences.
• To compute the significance of difference between the pre test and

post test scores of women in experimental group was by paired ‘t’
test
• To compare the effectiveness in experimental and control group was
by ‘z’ test.
• To associate the selected demographic and menstrual variables with
premenstrual syndrome level in both the groups by chi-square test.
32
CHAPTER IV
DATA ANALYSIS AND INTERPRETATION
Analysis is categorizing, ordering, manipulating and summarizing of

data to obtain answers to research hypothesis and questions. This section
deals with the analysis and interpretation of data collected from 40 women
with premenstrual syndrome in K.G. Hospital, Coimbatore.
The findings based on descriptive and inferential statistical analysis

are tabulated as following heading,
Table-1 Distribution of demographic variables among women with

Table-2 Distribution of menstrual variables among women with

Table-3 Distribution of intensity of premenstrual syndrome pre test and

post test scores among women in experimental and control group.
Table-4 Comparison of intensity of premenstrual syndrome among women

in experimental group and control group.
Table-5 Comparison of pre test and post test scores of premenstrual

syndrome among women in experimental group.
33
Table-6 Association of intensity of premenstrual syndrome among women
with selected demographic variables in experimental group.

with selected menstrual variables in experimental group.

with selected demographic variables in control group.

with selected menstrual variables in control group.
34
TABLE- 1
DISTRIBUTION OF DEMOGRAPHIC VARIABLES AMONG
WOMEN WITH PREMENSTRUAL SYNDROME IN
EXPERIMENTAL AND CONTROL GROUPS
S
Experimental group Control group
No Demographic Number Percentage Number Percentage
variables (n1=20) % (n2=20) %
1 Age in years
a)20-25 years 3 15 2 10
b)26-30 years 4 20 4 20
c)31-35 years 3 15 4 20
d)36-40 years 7 35 6 30
e)41-45 years 3 15 4 20
2 Education
a)Primary 3 15 2 10
b)Secondary 7 35 9 45
c)Graduate 10 50 9 45
3 Occupation
a)House wife 7 35 6 30
b)Coolie 1 5 2 10
c)Professional 10 50 9 15
d)Business 2 10 3 45
4 Marital status
a)Married 12 60 11 55
b)Unmarried 8 40 9 45
35
5 Habitation
a)Rural 2 10 1 5
b)urban 9 45 10 10
c)Semi urban 9 45 9 45
6 Dietary pattern
a)Vegetarian 6 30 5 15
b)Non- 14 70 15 75
vegetarian
7 Type of family
a)Nuclear family 12 60 10 50
b)Joint family 8 40 % 10 50
8 Family birth
order
a)First 11 55 10 50
b)Second 6 30 5 25
c)Third and 3 15 5 15
above
9 Social support
a)Family 11 55 10 50
b)Neighbors 4 20 3 15
c)Friends 4 20 5 25
d)Others 1 5 2 10
10 Sources of
health
information
a)Newspaper 11 55 9 45
b)Radio 1 5 2 10
c)TV 6 30 5 25
d)Internet 2 10 4 20
The above table showed that the distribution of demographic variables
of women in both group.
36
According to age of the women in experimental group,3(15%) were
between 20-25 years,4(20%) were between 26-30 years,3(15%) were
between 31-35 years,7(35%) were between 36-40 years and 3(15%) were
between 41-45 years. Considering the education 3(15%) had primary
education, 7(35%) had secondary education and 10(50%) were graduates.
Considering the occupation of the woman, 7(35%) were house wife,
1(5%) was coolie, 10(50%) were professional and 2(10%) were business
people in experimental group. In control group 6(30%) were housewife,
2(20%) were coolie, 9(45%) were professional and 3(15%) were business
people.
With regard to marital status in experimental group 12(60%) were

married and 8(40%) were unmarried. In control group 11(55%) were
married and 9(45%) were unmarried.
Considering the habitation in experimental group 2(10%) were from

rural, 9(45%) were from urban and 9(45%) were from semi urban. In control
group 1(5%) was from rural, 10(50%) were from urban and 9(45%) were
from semi urban.
Regarding the dietary pattern 6(30%) were vegetarian, 14(70%) were

non vegetarian in experimental group. In control group 5(25%) were
vegetarian, 15(75%) were non vegetarian.
Considering the type of family in experimental group 12(60%) were

from nuclear family,8(40%) were from joint family. In control group
10(50%) were from nuclear family and 10(50%) were from joint family.
37
Considering the family birth order 11(55%) were first
born,6(30%)were second born and 3(15%) were born third and above in
experimental group. In control group 10(50%) were first born,5(25%) were
second born and 5(25%) were born third and above.
Considering the social support 11(55%) got support from family,

4(20%) got support from neighbors, 4(20%) got support from friends and
1(5%) got support from others in experimental group. In control group
10(50%) got support from family, 3(15%) got support from neighbors,
5(25%) got support from friends and 2(10%) got support from others.
With regard to sources of health information in experimental group

11(55%)got information from newspaper,1(5%) got information from radio,
6(30%) got information from TV and 2(10%) got information from internet.
In control group 9(45%) got information from newspaper, 2(10%) got
information from radio, 5(25%) got information from TV and 4(20%) got
information from internet.
38
FIGURE – 4
DIAGRAM SHOWING THE DISTRIBUTION OF DEMOGRAPHIC VARIABLES AMONG WOMEN
WITH PREMENSTRUAL SYNDROME IN EXPERIMENTAL AND CONTROL GROUPS
PERCENTAGE (%)
39
TABLE- 2
DISTRIBUTION OF MENSTRUAL VARIABLES AMONG
WOMEN WITH PREMENSTRUAL SYNDROME IN
EXPERIMENTAL AND CONTROL GROUPS
Experimental Control group
Group
S
No
Menstrual
variables
Number Percentage Number Percentage
(n1=20) % (n2=20) %
1 Parity
a)One 11 55 10 50
b)Two 8 40 7 35
c)Three & above 1 5 3 15
2 Pain during
menstruation
a)Yes 17 85 15 75
b)No 3 15 5 25
3 Duration of
menstruation
a)2-3 days 6 30 5 25
b)3-4 days 10 50 8 40
c)5-6 days 4 20 7 35
4 Family history
of premenstrual
syndrome
a)Yes 13 65 11 55
b)No 7 35 9 45
40
Food preference
during
5 menstruation
a) Vegetarian 13 65 11 55
b) Non- 7 35 9 45
vegetarian
6 Awareness on
JPMRE
a)Yes 3 15 1 5
b)No 17 85 19 95
7 Any experience
of JPMRE
a)Yes 0 --- 0 ---

b)No 20 100 20 100
The above table showed that the distribution of menstrual variables of

women in experimental and control groups.
With regard to parity 11(55%) had one child,8(40%) had two children
and 1(5%) had three children in experimental group. In control group
10(50%) had one child,7(35%) had two children and 3(15%) had three
children.
Considering pain during menstruation in experimental group 17 (85%)
had pain during menstruation,3(15%) had no pain during menstruation. In
41
control group 15 (75%) had pain during menstruation and 5(25%) had no
pain during menstruation.
Considering duration of menstruation 6(30%) had 2-3 days of
menstruation,10 (50%) had 3-4 days of menstruation and 4 (20%) had 5-6
days menstruation in experimental group. In control group 5 (25%) had 2-3
days menstruation,8 (40%) had 4-5 days menstruation and 7 (35%) had 5-6
days menstruation.
Considering the family history of premenstrual syndrome 13(65%) had

family history of premenstrual syndrome,7(35%) had no family history of
premenstrual syndrome in experimental group. In control group 6(30%) had
family history of premenstrual syndrome and 14(70%) had no family history
of premenstrual syndrome.
With regard to food preference during menstruation in experimental

group 13(65%) were vegetarian and 7(35%) were non vegetarian. In control
group 11(55%) were vegetarian and 9(45%) were non vegetarian.
Considering the awareness on Jacobson progressive muscle relaxation

exercise 3(15%) had awareness and 17(85%) had no awareness in
experimental group. In control group 1(5%) had awareness 19 (95%) had no
awareness on Jacobson progressive muscle relaxation exercise.
Considering the experience of Jacobson progressive muscle

relaxation exercise in experimental group 20(100%) had no experience and
in control group also 20(100%) had no experience of Jacobson progressive
muscle relaxation exercise.
42
FIGURE-5
DIAGRAM SHOWING THE DISTRIBUTION OF MENSTRUAL VARIABLES AMONG WOMEN
WITH PREMENSTRUAL SYNDROME IN EXPERIMENTAL AND CONTROL GROUPS
PERCENTAGE (%)
43
TABLE-3
DISTRIBUTION OF INTENSITY OF PREMENSTRUAL SYNDROME PRE
TEST AND POST TEST SCORES AMONG WOMEN IN EXPERIMENTAL AND
CONTROL GROUP n=40
S No Experimental group control group
PMS Pre test Post test Pre test Post test
scores score score score score
NO % NO % NO % NO %
1 Mild --- ---- 15 75 ----- ----- ----- -----
2 Moderate 15 75 5 25 17 85 14 70
3 Severe 5 25 --- ----- 3 15 6 30
From the table In experimental group, during the pretest, 15(75%)

had moderate premenstrual syndrome, 5(25%) had severe premenstrual
syndrome and no one had mild premenstrual syndrome. During the posttest
15(75%) had mild premenstrual syndrome, 5(25%) had moderate
In control group, during the pretest, 17(85%) had moderate premenstrual

syndrome, 3(15%) had severe premenstrual syndrome and no one had mild
premenstrual syndrome. During the posttest 14(70%) had moderate
premenstrual syndrome, 6(30%) had severe premenstrual syndrome and no
one had mild premenstrual syndrome.
44
FIGURE-6
DIAGRAM SHOWING THE DISTRIBUTION OF INTENSITY OF PREMENSTRUAL SYNDROME
AMONG WOMEN IN EXPERIMENTAL AND CONTROL GROUP
PERCENTAGE (%)
45
TABLE- 4
COMPARISON OF PRE TEST AND POST TEST SCORES OF
PREMENSTRUAL SYNDROME AMONG WOMEN IN
EXPERIMENTAL GROUP
n=20
Tabulated
Premenstrual value of ‘t’
S Mean SD
syndrome Calculated at 5% level
No
scores value of ‘ t’ of
significance
1 Pre test score 40.95 4.5

4.403 2.093
2 Post test score 20.65 3.47
From the above table
The calculated value of‘t’ (4.403) is greater than the tabulated value of‘t’
(2.093) at 5 % level of significance. The null hypothesis is rejected. It is
concluded that there is a significant difference between the pre test and
post test scores among women in experimental group.
TABLE- 5
46
COMPARISON OF INTENSITY OF PREMENSTRUAL
SYNDROME AMONG WOMEN IN EXPERIMENTAL AND
CONTROL GROUP
n=20
Tabulated
Premenstrual Calculated value of ‘z’
Mean SD
S No
syndrome value of ‘ z’ at 5% level
scores of
significance
1 Experimental
20.65 3.47
group 13.27 1.96
2 Control group 40.55 5.45
From the above table
The calculated value of ‘z’(13.27) is greater than the tabulated value of

‘z’(1.96) at 5 % level of significance. The null hypothesis is rejected. It is
concluded that there is a significant difference between the intensity of
premenstrual syndrome among experimental group and control group. So
the Jacobson progressive muscle relaxation exercise is effective in
reducing premenstrual syndrome.
TABLE- 6
47
ASSOCIATION OF INTENSITY OF PREMENSTRUAL
SYNDROME AMONG WOMEN WITH SELECTED
DEMOGRAPHIC VARIABLES IN EXPERIMENTAL GROUP.
n=20
Calculated Tabulated
Demographic Above Below value of χ2 value of χ2
S variables median median at 5% level
No of
significance
1 Type of family
a)Nuclear 5 7
<1 NS 3.84
b)Joint 4 4
2 Dietary pattern
a)Vegetarian 4 2
<1 NS 3.84
b)Non-vegetarian 5 9
3 Habitation
a)Rural/Semi urban 5 7
<1 NS 3.84
b)Urban 4 4
4 Family birth
order
<1 NS 3.84
a)First/second 3 1
b)Third& above 10 6
48
The calculated value of χ2 is less than the tabulated value of χ2 at 5%
level of significance.
There is no association between the type of family and intensity of

There is no association between the dietary pattern and intensity of

There is no association between the habitation and intensity of

There is no association between the family birth order and intensity of

TABLE- 7
ASSOCIATION OF INTENSITY ON PREMENSTRUAL
MENSTRUAL VARIABLES IN EXPERIMENTAL GROUP
49
n=20
Tabulated
S Menstrual Above Below Calculated value of χ2
No variables median median value of χ2 at 5% level
of
significance
1 Pain during
menstruation
a)Yes 7 8 <1 NS 3.84
b)No 2 3
2 Duration of
menstruation
a)2-3/3-4 days 7 9 <1 NS 3.84
b)5-6 days 2 2
3 Parity
a)One/Two 6 11 <1 NS 3.84
b)Three & more 2 1

4 Family history of
PMS
a)Yes 8 6 <1 NS 3.84
b)No 3 3

50
There is no association between the pain during menstruation and
intensity of premenstrual syndrome.
There is no association between the duration of menstruation and

There is no association between the parity and intensity of premenstrual

syndrome.
There is no association between the family history of premenstrual

syndrome and intensity of premenstrual syndrome.
TABLE- 8
DEMOGRAPHIC VARIABLES IN CONTROL GROUP
n=20
Tabulated
51
S Demographic Above Below Calculated value of χ2
No variables median median value of χ2 at 5 % level
significance
1 Type of family
a)Nuclear 8 6
b)Joint 3 3
<1 NS 3.84
2 Dietary pattern
a)Vegetarian 7 4
<1 NS 3.84
b)Non-vegetarian 5 4
3 Habitation
a)Rural/Semi urban 9 4
b)Urban <1 NS 3.84
4 3
4 Family birth
order
a)First/second 5 8
<1 NS 3.84
b)Third& above 2 5

There is no association between the type of family and intensity of

52
There is no association between the dietary pattern and intensity of
There is no association between the habitation and intensity of

There is no association between the family birth order and intensity of

TABLE - 9
MENSTRUAL VARIABLES IN CONTROL GROUP
n=20
Tabulated
S
Menstrual Above Below Calculated value of χ2
No
variables median median value of χ2 at 5% level
of
53
significance
1 Pain during
menstruation
a)Yes 9 4
<1 NS 3.84
b)No 4 3
2 Duration of
menstruation
a)2-3/3-4 days 4 7
<1 NS 3.84
b)5-6 days 5 4
3 Parity
a)One/Two 5 10 3.84
b)Three & more <1 NS

3 2
4 Family history of
PMS
<1 NS 3.84
a)Yes 7 4
b)No 5 4

There is no association between the pain during menstruation and

There is no association between the duration of menstruation and

54
There is no association between the parity and intensity of premenstrual
syndrome.
There is no association between the family history of premenstrual

syndrome. and intensity of premenstrual syndrome
CHAPTER V
RESULTS AND DISCUSSION
The purpose of the study is to assess the effectiveness of

Jacobson progressive muscle relaxation exercise on premenstrual
syndrome among women. The discussion of the present study is based on
the findings obtained from statistical analysis of the collected data
.Paired ‘t’ test was used to test the difference between pre test and post
test result. ‘z’ test was used to compare the effectiveness of Jacobson
progressive muscle relaxation exercise on premenstrual syndrome among
both groups. Chi square was used to find out the association between
premenstrual syndrome scores with selected demographic and menstrual
variables.
55
1. To assess the intensity of premenstrual syndrome of the women in
experimental and control group
The intensity of premenstrual syndrome was assessed by Modified

COPE (Calendar of premenstrual experiences) four point Likert scale.
Table 3 showed the distribution of intensity of premenstrual

syndrome among women in experimental and control group.
The present study data revealed that,
In experimental group, during the pretest, 15(75%) had moderate
premenstrual syndrome, 5(25%) had severe premenstrual syndrome and
no one had mild premenstrual syndrome
In control group, during the pretest,17(85%) had moderate premenstrual
syndrome, 3(15%) had severe premenstrual syndrome and no one had
mild premenstrual syndrome.
A study was conducted on the prevalence and frequency of
symptoms of premenstrual syndrome in female undergraduate students. A
survey of 200 nulliparous subjects aged between 16 and 31 years revealed
that 83.5% of them regularly experienced symptoms suggestive of
premenstrual syndrome .The commonest symptom were lower abdominal
pain, pimples, puffy face, tender or painfully engorged breast and
depression or tension. The least frequent symptom were backache and
common cold. 42% of subjects complained of severe abdominal pain.
There was an association between severity of abdominal discomfort and
symptoms experienced by subjects (Diana, C. Dell, 2004).
2. To provide Jacobson progressive muscle relaxation exercise to

experimental group.
56
With the supporting literature, Jacobson progressive muscle relaxation
exercise was provided to the experimental group, it was done twice daily
for one month.
3. To assess the effectiveness of Jacobson progressive muscle

relaxation exercise on premenstrual syndrome among women in the
experimental group.
Table 4 showed the comparison of pre test and post test scores of
premenstrual syndrome among women in experimental group. It revealed
that, the calculated value of ‘t’ (4.403) is greater than the tabulated value
of ‘t’ (2.093) at 5 % level of significance. So the hypothesis is accepted.
It is concluded that there is a significant difference in the intensity of
premenstrual syndrome among women in the experimental group.
A qualitative study was conducted among six female subjects
who were between 31-44 years of age attended a pre menstrual syndrome
clinic and participated in a group therapy program designed to alleviate
their pre menstrual symptoms. Rational-emotive therapy and Jacobson
progressive muscle relaxation exercise were offered in an effort to
alleviate severe psychological symptoms.. Pre treatment assessments
were carried out using Moods Menstrual distress Questionnaire.
Significant differences were found in a number of psychological and
physical symptoms of menstrual distress, in cognitive functioning and
neuroticism, following the combined group therapy (Micheal, E.
Bernard, L. 2009).
4. To compare the intensity of premenstrual syndrome among women

in both experimental and control group.
57
Table 5 showed the comparison of intensity premenstrual
syndrome among women in experimental and control group. It reveals
that, the calculated value of ‘z’ (13.27) is greater than the tabulated
value of ‘z’ (1.96) at 5% level of significance. The hypothesis is
accepted. It is concluded that there is a significant difference between the
pretest and post test scores of premenstrual syndrome of women between
experimental and control group.
5. To associate the findings with selected demographic variables and
menstrual variables.
The study was conducted on factors associated with age,
education, occupation, marital status, habitation, dietary pattern, type of
family, family birth order, social support, sources of health information in
assessment of premenstrual syndrome.
Table 6 showed the association of selected demographic variables
like type of family, dietary pattern, habitation, family birth order in
assessment of premenstrual syndrome in experimental group .Association
was found by using chi square test. The result showed that the calculated
value of chi square is less than tabulated value of chi square at 5% level
of significance. There was no association found between the premenstrual
syndrome and other demographic variables like type of family, dietary
pattern, habitation, family birth order and premenstrual syndrome.
Table 7 showed the association of selected menstrual variables
like pain during menstruation, duration of menstruation, parity, family
history of premenstrual syndrome in assessment of premenstrual
syndrome in experimental group .Association was found by using chi
square test. The result showed that the calculated value of chi square is
less than tabulated value of chi square at 5% level of significance. There
was no association found between the premenstrual syndrome and other
menstrual variables like pain during menstruation, duration of
58
menstruation, parity, family history of premenstrual syndrome and
Table 8 showed the association of selected demographic

variables like type of family, dietary pattern, habitation, family birth
order in assessment of premenstrual syndrome in control group
.Association was found by using chi square test. The result showed that
the calculated value of chi square is less than tabulated value of chi
square at 5% level of significance. There was no association found
between the premenstrual syndrome and other demographic variables like
type of family, dietary pattern, habitation, family birth order and
Table 9 showed the association of selected menstrual variables
like pain during menstruation, duration of menstruation, parity, family
history of premenstrual syndrome in assessment of premenstrual
syndrome in control group .Association was found by using chi square
test. The result showed that the calculated value of chi square is less than
tabulated value of chi square at 5% level of significance. There was no
association found between the premenstrual syndrome and other
menstrual variables like pain during menstruation, duration of
menstruation, parity, family history of premenstrual syndrome and
A study was conducted on prevalence and prediction of
premenstrual syndrome among college aged women, using a self report
questionnaire (n=464). At least one premenstrual symptom was
experienced by 448 women(96.61%)and 176 (37.5%) had a high
symptom severity score. Premenstrual symptom frequency was
significantly associated with menstrual history, self perception of mental
59
stress, physical activity, consumption of sweet tasting foods and coffee
(Rasheed. R. et al., 2003).
CONCLUSION
The present study was supported by a series of other studies which
confirmed that Jacobson progressive muscle relaxation exercise was
effective in reducing premenstrual syndrome. The respondent revealed
that Jacobson progressive muscle relaxation exercise was effective during
premenstrual syndrome to provide comfort, relaxation and sense of well
being. From the analysis and result the researcher concluded that
Jacobson progressive muscle relaxation exercise provided during
premenstrual syndrome is effective.
CHAPTER VI
SUMMARY, RECOMMENDATIONS AND

NURSING IMPLICATIONS.
SUMMARY
Premenstrual syndrome is seen in women in luteal phase of

menstrual cycle, can be managed through pharmacological and non
pharmacological measures. There are many simple, effective and less
expensive measures to relieve premenstrual syndrome that can be initiated
by the nurse, with the potential benefits of reduction in the use of
medications and an increase is patient satisfaction.
The investigator in this study assessed the effectiveness of Jacobson

progressive muscle relaxation exercise in reducing premenstrual
syndrome. Quasi experimental (Pretest Post test control group) research
60
design was adopted in this study. Women were selected by convenience
sampling technique. The sample size was 40.
Extensive review of literature, professional experience and expert
guidance from the field of obstetrics and gynaecology led the investigator
to design the methodology.
The conceptual framework developed for this study was based on
Modified Kenny’s open system model.
The tools used for the study are Modified COPE, four point Likert
scale to assess the intensity of premenstrual syndrome.
After obtaining the content validity from the expert, the pilot study
was conducted and along with that reliability of the tool was tested. The
ethical aspect of the research was maintained throughout the period,
formal permission was obtained from the authority. The information
collected was kept confidential.
Data collection was done for a period of 4 weeks after obtaining
oral consent from women with premenstrual syndrome attending
gynaecology OPD.
Descriptive statistics was used to analyze the frequency, mean and
standard deviation. Inferential statistics was used to determine
comparison and association, there was a significant difference between
premenstrual syndrome scores among experimental and control group.
The overall experience of conducting this study was satisfying as
there was good co-operation from women, nurses, and doctors. The study
was a new experience for the investigator.
The present study showed that Jacobson progressive muscle
relaxation exercise was effective in reducing premenstrual syndrome
among women.
RECOMMENDATIONS
61
The following recommendations were made by the investigator after
the study.
• The similar study can be undertaken on a large sample.
• A similar study can be conducted separately for adolescent girls
and women.
• A comparative study can be performed to evaluate the
effectiveness of different relaxation techniques.
NURSING IMPLICATIONS
Many women would like to avoid pharmacological measures of

premenstrual syndrome and this may contribute towards the popularity of
alternative methods of premenstrual syndrome. The investigator has
drawn the following implications from the study. This is of vital concern
for nursing practice, nursing education, nursing administration and
nursing research.
NURSING PRACTICE
• Nurses can provide holistic care with alternative and
complimentary therapies.
• Nurses can prepare the women from the luteal phase of menstrual
cycle to get better outcome during the premenstrual syndrome
period.
• Nurses can prepare the women in managing premenstrual
syndrome as an integral nursing intervention to achieve relaxation,
fitness and healthy lifestyle for better outcome.
NURSING EDUCATION
62
• The nursing curriculum should be updated with the inclusion of
topics on various relaxation techniques in premenstrual syndrome.
• The nursing curriculum could be strengthened with current concept
of premenstrual syndrome management to enable the nursing
students to provide appropriate information to the women with
• Periodic conference, seminars, workshop and symposiums can be
arranged regarding various relaxation techniques in managing
premenstrual syndrome to make nursing professionals competent
enough to meet the ever changing needs of the society.
NURSING ADMINISTRATION
• The nurse administrator should take more responsibility to

inculcate notions of health care in the clients.
• The nurse administrator should motivate the staff nurses to
encourage them regarding the use of various relaxation techniques
in caring women with premenstrual syndrome.
• The nurse administrator should organize in service education
programme for nurses about various relaxation techniques in
managing premenstrual syndrome.
NURSING RESEARCH
• Nursing researchers should be aware about the new trends and

existing health care system. Emphasis should be laid on research in
the area of non pharmacological measures of premenstrual
syndrome.
63
• The study can be issued for further reference. It may form a base
for further study in the field. Research should be done in different
aspects of alternative relaxation techniques to reduce premenstrual
syndrome symptoms to the women during their menstrual cycle.
64
APPENDIX – D
FORMAT FOR CONTENT VALIDITY
Name of the expert :

Address :
Total content of the tool : Adequate / Not Adequate
Kindly validate each tool and tock where ever applicable
S.No No of Strongly Agree Need Remarks

Tool/Section Agree modification
Signature of the expert with date
65
APPENDIX – E
LIST OF EXPERTS FOR CONTENT VALIDITY
1. Dr. (Mrs.) Chandrakala Maran,

Chief Obstetrician and Gynaecologist,
K.G. Hospital,
Coimbatore.
2. Dr. (Mrs.) Esther John, Ph.D.,

Principal,
Ganga College of Nursing,
Coimbatore.
3. Prof. (Mrs.)Vijayalakshmi Mohanraj,M.Sc(N),

Nursing Superintendent,
Sri Ramakrishna Hospital,
Coimbatore.
4. Prof. (Mrs.) Vidhya Seshan, M.Sc(N),

HOD,Obstetrics and Gynaecological Nursing Department,
PSG College of Nursing,
Coimbatore.
5. Prof. (Mrs. )Johnsy Sundari, F.K. M.Sc(N),

Obstetrics and Gynaecological Nursing Department,
PSG College of Nursing,
Coimbatore.
6. Prof. (Mrs.)Renuka, M.Sc (N),

Sri Ramakrishna College of Nursing,
Coimbatore.
7. Prof. (Mrs.)Seena, M.Sc(N),

Crescent College of Nursing,
Kerala.
66
APPENDIX - F
CERTIFICATE FOR JACOBSON PROGRESSIVE

MUSCLE RELAXATION EXERCISE
TO WHOM SO EVER IT MAY CONCERN
This is to certify that the Jacobson progressive muscle relaxation

exercise selected by Mrs. ANEESHA.V.B, II year M.Sc Nursing student,
K.G. College of nursing, Coimbatore for her dissertation “A STUDY TO
ASSESS THE EFFECTIVENESS OF JACOBSON PROGRESSIVE
MUSCLE RELAXATION EXERCISE ON PREMENSTRUAL
SYNDROME AMONG WOMEN ATTENDING GYNAECOLOGY OPD
IN KG HOSPITAL, COIMBATORE”, is validated for its appropriateness
by S. RAJESH KANNAN, B.A, M.P.Ed, M.Phil, C.F.C, PGDY.,
Qualified Fitness Consultant.
Signature
67
APPENDIX - G
CERTIFICATE FOR ENGLISH EDITING
This is to certify that the tool developed by Mrs. ANEESHA.V.B,

II year M.Sc. Nursing student of K.G. College of Nursing, for her
dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF
JACOBSON PROGRESSIVE MUSCLE RELAXATION EXERCISE ON
PREMENSTRUAL SYNDROME AMONG WOMEN ATTENDING
GYNAECOLOGY OPD IN KG HOSPITAL, COIMBATORE”, is edited
for English language appropriateness by, Mrs. JOSEPHINE PRINCEY,
M.A., M.Phil.,
Signature
68
APPENDIX - H
CERTIFICATE FOR TAMIL EDITING
This is to certify that the tool developed by Mrs. ANEESHA.V.B,

II year M.Sc. Nursing student of K.G. College of Nursing, for her
dissertation “A STUDY TO ASSESS THE EFFECTIVENESS OF
JACOBSON PROGRESSIVE MUSCLE RELAXATION EXERCISE ON
PREMENSTRUAL SYNDROME AMONG WOMEN ATTENDING
GYNAECOLOGY OPD IN KG HOSPITAL, COIMBATORE”, is edited
for Tamil language appropriateness by, Mrs. SUSILA VICTOR, M.A.,
M.Phil., M.A., M.Ed.,
Signature

69
APPENDIX – I
TOOL I
SECTION A
DEMOGRAPHIC VARIABLES
The investigator records according to the responses of the subjects
INSTRUCTION
1. Age in years
a) 20-25
b) 26-30
c) 31-35
d) 36-40
e) 41-45
2. Education
a) Illiterate
b) Primary
c) Secondary
d) Graduate
3. Occupation
a) House wife
b) Coolie
c) Professional
d) Business
4. Marital status
a) Married
b) Unmarried
5. Habitation
a) Rural
b) Urban
c) Semi urban
6. Dietary Pattern
a) Vegetarian
70
b) Non-vegetarian
7. Type of family
a) Nuclear family
b) Joint family
8. Family birth order

a) First
b) Second
c) Third and above
9. Social support
a) Family
b) Neighbours
c) Friends
d) Others
10. Sources of health information

a) News paper
b) Radio
c) Television
d) Internet
71
SECTION B
MENSTRUAL VARIABLES
INSTRUCTION
The investigator records according to the responses of the subjects
1. Age at menarche
2. Last Menstrual period
3. Menstrual pattern
a.Regular
b.Irregular
4. Parity
a. one
b. two
c. Three or above
5. Pain during Menstruation

d. Yes
e. No
6. Duration of menstruation
a. 2-3 days
b. 3-4 days
c. 5-6 day
7. Family history of pre menstrual syndrome

a. Yes
b. No
8. Awareness on Jacobson Progressive

Muscle relaxation Exercise
a. Yes
b. No
9. Previous experience of Jacobson Progressive

Muscle Relaxation Exercise
a. Yes
b. No
72
TOOL-II
MODIFIED COPE (CALENDAR OF PREMENSTRUAL
EXPERIENCES) FOUR POINT LIKERT SCALE
SL CONTENTS NONE MILD MODERATE SEVERE

NO 0 1 2 3
I PHYSICAL SYMPTOMS
1 Fatigue
2 Abdominal bloating
3 Breast tenderness
4 Back ache
5 Muscle cramps
6 Headache
7 Gastrointestinal symptoms
8 Dizziness
9 Heart palpitation
10 Hot flushes
11 Swelling
II BEHAVIOURAL
SYMPTOMS
12 Irritability
13 Anxiety/Tension
14 Mood Liability
15 Food cravings
16 Depression
17 Over sensitivity
18 Expressed anger
19 Crying easily
20 Isolation
21 Forgetfulness
22 Poor concentration
Scorings
0 – None
1-22 – Mild
23-44 –Moderate
45-66 – severe
73
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74
APPENDIX: J
PROCEDURE FOR JACOBSON PROGRESSIVE MUSCLE

RELAXATION EXERCISE
Progressive muscle relaxation is a systematic technique for

achieving a deep state of relaxation. It was developed by Dr. Edmund
Jacobson more than fifty years ago. Dr. Jacobson discovered that a
muscle could be relaxed by first tensing it for a few seconds and then
releasing it. Tensing and releasing various muscle groups throughout the
body produces a deep state of relaxation, which Dr. Jacobson found
capable of relieving a variety of conditions, from premenstrual syndrome,
high blood pressure, to ulcerative colitis.
PREPARATION OF THE WOMEN AND UNIT:
• Explain the sequence of the procedure.

• Obtain oral consent from the women.
• Provide privacy.
• Ask the women to lie in supine position or in sitting position
according to convenience.
PROCEDURE
• To begin with close your eyes and take three deep breaths,
exhaling slowly each time. As you exhale, imagine that tension
through out your body begins to flow away.
• Make a tight fist with your right hand, squeeze it tightly. Note how
it feels (p) now relax. Hold for 7-10 seconds and then release for
75
15-20 seconds. Use these same time intervals for all other muscle
groups.
• Once again squeeze your hand tightly and study the tension that
you feel (p) and just relax and think of the tension disappearing
from your fingers. (p)
• Make a tight fist with your left hand, squeeze it as tightly as you
can and note the tension in your fingers and your hand and
forearm. (p) now relax (p).
• Once again, squeeze your fist tightly. And again just relax. (p).
• Now make a tight fist with your right hand and raise your hand.
Hold it tightly(p). now relax totally. Feel the warmth escaping
down through your upper arm, forearm and out of your finger. (p).
• Now make a tight fist with your left hand and raise your hand.
Hold it tightly and feel the tension (p) now relax. Concentrate on
the feelings flowing through your arm. (p).
• Now squeeze both fists at once and bend both arms to make them
totally tense through out. Hold it and think about the tension you
feel.(p). now relax, and feel the total warmth flowing through your
muscles. All the tension is flowing out of your fingertip. (p).
• Now wrinkle your forehead and squint your eyes very tight and
hard. Squeeze them tight and hold. Feel the tension across your
forehead and through your eyes. Now relax. Note the sensations
running through your eyes. Just relax. (p).
• Squeeze your jaws tight together and raise your chin to make your
neck muscles tight. Hold it bite down hard, tense your neck and
squeeze your lips really tight (p) now relax (p).
• Now all together wrinkle up your forehead and squeeze your eyes
tight, bite down hard with your jaws, raise your chin and tighten up
76
you neck and make your lips tight. Hold them all and feel the
tension throughout your forehead and eyes and jaw and neck and
lips. Hold. Now relax. Just totally relax and enjoy the tingling
sensation. (p).
• Now squeeze both shoulders forward as hard as you can until you
feel your muscles pulling tightly across your back, especially in the
area between your shoulder blades. Squeeze them tight. Now
relax(p).
• Now squeeze your shoulders forward again and at the same time
tighten your stomach muscles. Feel the tension through out your
stomach. Hold it (p) now relax (p).
• Once again squeeze your shoulders blades forward again, tighten
your stomach muscles and feel the tension through out your upper
body. Now relax (p).
• Now review all the muscle systems that we have covered so far.
First take three deep breaths (p). Tighten both fists and bend both
your arms to squeeze your biceps tight. Wrinkle your forehead and
squeeze. Keep your eyes tight. Bite down hard with your jaws,
raise your chin and hold your lips tight. Squeeze shoulders forward
and tighten your stomach muscles. Hold them all feel the tension
through out. Now relax. Take a deep breath. Just feel the tension
disappearing. Think about the total relaxation through out all your
muscles. Just relax (p)
• Now with the legs. Make right heel tight push it down hard, raise
your toes so that your calf muscles and thigh are extremely tense.
Squeeze your toes up and push your heel down hard. Now relax
(p).
77
• Once again make your left heel tight. Push it down hard, raise your
toes so that your calf and thigh muscles are extremely tense. Push
down on the heel and raise your toes. Now relax (p).
• Now make your heels tight and push them down and raise your
toes so that your calf and thighs are extremely tense. Push heel
down, squeeze your toes up and squeeze your leg in tight. Now
relax (p).
• Now do both legs together. Squeeze your heels in tight. Push down
on your heels and raise your toes as high and as tight as you can.
Hold it (p) now relax (p).
• Now take three deep breaths (p). now tense all the muscles exactly
as you have practiced, fists and biceps, forehead, eyes, jaws, neck,
lips, shoulders, stomach, legs. Hold it (p). now relax. (p).
• Breath in deeply three times. Notice how relaxed all your muscles
feel. Now once again tense every muscles and hold it (p) and relax.
Let all the tension disappear. Breath normally and enjoy the
complete tension, free state of your body and muscles. (p).
TERMINATION
Now slowly open your eyes. Slowly get up and sit for a while. Now you
are completely relaxed, fresh and comfortable.
Each pause is for 10 seconds.
78
ASSESSMENT OF INTENSITY OF PREMENSTRUAL
SYNDROME OF WOMEN IN EXPERIMENTAL GROUP
PROVIDING JACOBSON PROGRESSIVE MUSCLE RELAXATION

EXERCISE TO WOMAN IN EXPERIMENTAL GROUP
BIBLIOGRAPHY
79
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A TO

A STUDY STUDY TOTHEASSESS

A Dissertation submitted to the Tamil Nadu Dr. M.G.R. Medical University,

MASTER OF SCIENCE IN NURSING

A Dissertation submitted to the Tamil Nadu Dr. M.G.R. Medical University,

MASTER OF SCIENCE IN NURSING

INTERNAL EXAMINER EXTERNAL EXAMINER

Certified that this is the bonafide work of ANEESHA.V.B of K.G.

Mrs. Vaijayanthi Mohan Das, Prof. (Mrs.) Sonia Das,

Approved by the Dissertation Committee on: 9.4. 2010

A Dissertation submitted to The Tamil Nadu Dr. M.G.R. Medical University,

MASTER OF SCIENCE IN NURSING

“ I Praise and thank God for his abundant blessings,

With a profound sense of gratitude I praise and thank God

I am grateful to our honorable Chairman, Padma shri

I express my sincere, respectful and whole hearted gratitude to

It is my pleasure and privilege to express my deep sense of

My sincere and heartfelt thanks to, Prof. (Mrs.)SHEEBA.R,

I express my sincere thanks and profound gratitude to

My special thanks and gratitude to Prof.( Mr.)SUBRAMANIAN.K,

I submit my sincere thanks to Prof.(Mrs.)SOFIA

I express my sincere gratitude to Prof.(Mrs.)

I extend my special heartfelt thanks to all the experts,

My heartfelt thanks to all FACULTY MEMBERS of K.G. College

I am very grateful to Mrs. JOSEPHINE PRINCEY, English

My special thanks to Prof. (Mrs.) SUSILA VICTOR, Lecturer, K.

A word of appreciation to Mr. KATHIR VADIVELU, chief

I would like to extend my deepest thanks to the PARTICIPANTS for

My special heartfelt thanks to my FAMILY MEMBERS who

I am extremely thankful to Mr.RANGARAJ, Krishna Xerox,

My heartfelt thanks to my CLASSMATES AND JUNIORS who

I thank one and all who directly or indirectly helped in successful

CHAPTER CONTENT PAGE NO.

2. The schematic representation of study design 23

4. Diagram showing the distribution of

5. Diagram showing the distribution of menstrual

6. Diagram showing the distribution of intensity of

A. Letter seeking permission for conducting the study

Menstruation is the visible manifestation of cyclic physiologic

Premenstrual syndrome is a collection of physical,

Pre menstrual syndrome is reported in women of all culture all

More than 80% treatment have been proposed for alleviating

Jacobson Progressive Muscle Relaxation exercise is one of the

NEED FOR THE STUDY

Premenstrual syndrome is an entity that causes considerable

A cross sectional community survey was conducted among the

Pre menstrual syndrome is a combination of physical and

A study was conducted on relaxation intervention used for the

Jacobson progressive muscle relaxation can be used

Studies showed that yoga, exercise and relaxation therapy are

Jacobson progressive muscle relaxation exercise

The investigator adopted “J.W. Kenny’s open system model ” as a basis

In this study input refers to the information needed by the system

The process that allows the input to be changed so that it is useful to

In this study, the throughput is the process of evaluating the

In this study output is the difference in the intensity of premenstrual

Feedback is the result of through put, it allows the system to be