RAJIV GANDHI UNIVERSYITY OF HEALTH SCIENCE, KARNATAKA,

BANGALORE.

A STUDY TO ASSESS EFFECTIVENESS OF STRUCTURE TEACHING

PROGRAMME ON KNOWLEDGE REGARDING MENSTRUAL

BLOOD BANK AMONG GRADUATE STUDENTS

IN SELECTED COLLEGE

AT KOLAR.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

NAME : Mrs.JANAKI

A E C S PAVAN COLLEGE OF NURSING,

KOLAR-563101

1

RAJIV GANDHI UNIVERSYITY OF HEALTH SCIENCE, KARNATAKA,

BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECTS

FOR DISSERTATION

SL

NO

1. NAME OF THE CANDIDATE

AND ADDRESS

Mrs.JANAKI

PAVAN COLLEGE OF NURSING

2. NAME OF THE INSTITUTION PAVAN COLLEGE OF NURSING,

KOLAR-563101

3. COURSE OF THE STUDY AND

SUBJECT

Ist YEAR, M.Sc (N)

OBSTRETRICS AND

GYNECOLOGICAL NURSING

4. DATE OF ADMISSION

5. TITLE OF THE TOPIC A STUDY TO ASSESS

EFFECTIVENESS OF

STRUCTURE TEACHING

PROGRAMME ON KNOWLEDGE

REGARDING MENSTRUAL BLOOD

BANK AMONG GRADUATE

STUDENTS IN SELECTED

COLLEGE AT KOLAR.

2

6.1. INTRODUCTION

Adolescence is regarded as a unique phase of human development. Among

adolescence girls menarche is an impartment landmark in the process of growth and

maturation. Through menstruation is a natural and normal physiological process for all healthy

adult women as ever it has been surrounded by secrecy and in many societies.1

The word adolescence is derived from a Latin verb adolesence, which means to grow

into maturity. An adolescent belongs to a vital age group not only because they are “enterent

population” to parenthood but also because they are on the threshold between child hood and

adult hood. As they attempt to cross his threshold they face various physiological,

psychological and developmental changes.1

The word "menstruation" is etymologically related to "moon". The terms

"menstruation" and "menses" are derived from the Latin mensis(month), which in turn relates

to the Greek mene (moon) and to the roots of the English words month and moon.2

Girls may start their menstrual period as early as nine years of age and as late as 16

years old. The average age a girl a being menstruating is 12. Since it is too early for the girls

they would not have prepared physically and mentally for the menstruation. When the girls

attain menarche they feel shy to even disclose to their mothers. There will be few chances to

maintain hygiene during menstruation since the matter is not discussed in the nuclear families.

Even though girls of today get information through media it cannot be applied practically

unless it is explained.3

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The menstrual cycle is the scientific term for the physiological changes that occur in

fertile women and other female primates for the purposes of sexual reproduction. This article

focuses on the human menstrual cycle, a "monthly" cycle that takes approximately 28 days to

complete although this does vary from person to person.4

Menstruation is also called menstrual bleeding, menses, catamenia or a period. The

average age of menarche in humans is 12–13 years, but is normal anywhere between ages 8

and 16. Factors such as heredity, diet and overall health can accelerate or delay menarche. The

cessation of menstrual cycles at the end of a woman's reproductive period is

termed menopause. Eumenorrhea denotes normal, regular menstruation that lasts for a few

days (usually 3 to 5 days, but anywhere from 2 to 7 days is considered normal).  The

average blood loss during menstruation is 35 milliliters with 10–80 ml considered normal.5

The endometrial lining of the uterus has an outstanding capacity for

regeneration .Angiogenesis is a critical factor of the proliferative endometrial phase of the

menstrual cycle. It is the process of new blood vessels formation from preexisting vasculature

and is fundamental to the human menstrual cycle. The uterine endometrium is an active tissue

that undergoes regular cycles of growth and breakdown and is recognized as one of the few

adult tissues where significant angiogenesis occurs on a routine, the endometrium lining

expands by 5-7 mm in thickness within each menstrual cycle.7

6.2. NEED FOR THE STUDY

Till date women have been discarding menstrual blood as an unwanted and unsanitary

waste. However, a new research has found that menstrual blood is a rich source of stem cells

4

that have the ability to multiply and differentiate into any kind of cells . Earlier, blood from

umbilical cord was regarded as the ultimate reserve for stem cells. Only those who have given

birth at anytime of their life were able to preserve the stem cells as they were obtained from

umbilical cord. But researchers have now discovered and successfully harvested stem cells

from menstrual blood making it possible for all the women including those who have never

given birth to preserve stem cells for themselves. The discovery of stem cells in the menstrual

blood has given a new meaning to menstruation for women who earlier considered

menstruation as nothing but a painful and necessary evil.6 

Approximately 19% (1/5th) of the world’s population is in the group of 10-19 years. As

they are passing through a transition period, from childhood to adulthood, they are under

going a lot of physical as well as psychological stress, due to the changes taking place in their

body.1

The Menstrual stem cells (MeSC’s) have a great importance for clinical translation of

regenerative therapies. The studies demonstrate that these are a unique population of cells that

can be safely isolated and can provide us with an expandable source of stem cells from women

until they reach menopause. Considering their relevance and importance in treatment of rare

diseases including certain neuro disorders, it becomes crucial for women to preserve their

menstrual blood in the Menstrual Blood Bank. Although Menstrual Blood banking is still new

and lot of research is still going on menstrual blood, if its benefits are utilized, it can prove to

be very beneficial for all women who want to give themselves the gift of good health.

Recently, scientists discovered that the stromal cells are present in endometrial tissues

However, obtaining these cells directly is an invasive procedure.6

5

India has a population of more than a billion with about equal division between men

and women. According to the census 2012, it was found that there are about 100 million

women who live in urban areas, with a literacy rate of about 80 %( India Census 2012).

Assuming that there are 60 million women who undergo menstruation, out of which 20 million

women live in Tier 1 and 2 cities (which is the primary target area for a company like

LifeCell). Of these 20 million women, let’s assume that only 1% of these women have the

financial clout to buy this service, the figure is still around 200,000 women that LifeCell can

target. This makes it an attractive proposition for LifeCell to pursue.8

Indian women are considered to be one the most conservative women in the world and

many still have superstitious belief on menstruation. When interviewed with the urban women,

it was found that about 80% of women associated had superstitious belief like not visiting

temples. On the positive side, about 1/3 rd of the women from India’s most 43 cosmopolitan

cities (Mumbai and Delhi) did not follow any traditions associated with menstruation. These

women also considered menstrual blood to be a biological waste, whereas about 3/5 th of the

women from a relatively conservative city like Chennai considered it as impure.8

When the respondents were explained about the menstrual blood stem cells banking, it was

found that close to 3/5 th of the women thought this was believable. Over 4/5 th of younger

women found the concept believable possibly because they were fascinated by the concept

while the older women were skeptical about it. It was also found that about 70% of the women

from Mumbai and Delhi believed in the concept whereas just 34% of the women from

Chennai and Bangalore believed in the concept. At the overall level, 2/5 Th of the women

were willing to collect the blood and those who were no open to collecting the blood, most of

them felt uncomfortable and considered it be to a dirty procedure. Among those who did not

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believe, about ¾ th of them demanded credibility from doctors/ gynecologists. Close to half of

the respondents also mentioned that popularizing the concept through media and people with

prior experience to testify the concept would make them believe. Hygiene of the menstrual cup

was a key concern to more than 4/5 th of the respondents.8

Above studies shows that education is one of main source for increasing the

knowledge and changing the behavior of students regarding menstrual blood banking. So it is

an awful need to study this problem more deeply by many more nurse researchers.

6.3. REVIEW OF LITERATURE

Review of literature involves systematic identification, location, scrutiny and summary

of written materials that contain information on research problem. The literature review is

based on an extensive survey of books, journals and international nursing index. Research and

non-research literature were reviewed to broaden the understanding and gain insight into the

problem under study.

The review has been divided under the following headings.

1. Review related to menstruation

2. Review related to menstrual blood banking

3. Review related to structured teaching programme.

Menstruation is a normal physiological cycle common to all females of the reproductive

age group. Menstruation may be defined as “a periodic vaginal bleeding which the women

herself must diagnose as menstruation based on her previous experience and on accompanying

signs and symptoms.”9

7

A cross-sectional descriptive study carried out on 1100 school adolescent girls in district

Wardha, Central India. Data were collected using a self-administered structured questionnaire

on menstruation. Mean ages of menarche were 13.51 + 1.04 years and 13.67 + 0.8 years for

urban and rural areas respectively. Abnormal cycle length was common and affected 30.48%.

The majority 56.15 experienced dysmenorrheal and 56.16 percent had premenstrual syndrome.

Self medication was practiced by 7.13% of the adolescent girls. The most common

premenstrual symptom was headache 26.74%. Absenteeism from the school 13.9% was the

effect of menstruation related problems on their daily routine. Majority of the girls 75.58%

had discussed menstrual problems with someone, most commonly with their mothers 38.15%.

There was a general lack of information about menstrual issues especially with regards

to cycle length, duration of menses and age at menarche. The mean age of menarche was

significantly higher in girls involved in vigorous sporting activity in urban area compared to

their non-sporting counterparts.10

A Cross-sectional descriptive study using self-administered questionnaire. Four hundred

and fifty six girls whose ages ranged from 14-19 years with mean and median ages of 16 ±

0.93 years and 16 years respectively were surveyed. Their ages at menarche ranged from 9

years to 16 years and the mean age at menarche was 12.5 ±1.28 years. Their

menstrual cycle lengths ranged from 21-35 days with mean menstrual cycle length of 27.9±

0.9 days; the mode and median were both 28 days. The mean duration of menstrual flow was

4.9 days with mode and median of 5 days. Seventy one percent had menses lasting 3-5 days

while 27.2% had menses lasting over 5 days. Some 24% had irregular menses six months after

their menarche and 59.6% were experiencing menses with clots. The prevalence of

8

dysmenorrhoea was 74.4%.Some 80.2% of the girls got counseling and education on care for

their menses from their parents.11

A study conducted on menstrual bleeding patterns are considered relevant indicators of

reproductive health The authors evaluated self-reported bleeding patterns, incidence of

spotting, and associations with reproductive hormones among 201 women in the BioCycle

Study with 2 consecutive cycles. Women bled for a median of 5 days (standard deviation: 1.5)

during menstruation, with heavier bleeding during the first 3 days. Only 4.8% of women

experienced midcycle bleeding. Increased levels of follicle-stimulating hormone (β = 0.20,

95% confidence interval: 0.13, 0.27) and progesterone (β = 0.06, 95% confidence interval:

0.03, 0.09) throughout the cycle were associated with heavier menstrual bleeding, and higher

follicle-stimulating hormone levels were associated with longer menses. Bleeding duration and

volume were reduced after anovulatory compared with ovulatory cycles (geometric mean

blood loss: 29.6 vs. 47.2 mL; P = 0.07). 12

A cross-sectional study in 2 Asian countries. A standard questionnaire was designed

inclusive of socio- demographic characteristics of subjects as well as menstrual history.

Quantitative variables were analyzed using Falconars' formula as well as maximum likelihood

analysis. Structural modeling was then applied to twin correlations to provide estimates of the

relative genetic and/or environmental factors contribution in determining the measured trait.

Menstrual characteristics were found to be under environmental influence where the best

fitting model for menstrual interval and duration was common environment. Proband-wise

concordance analysis for amount of menstruation, amenorrhea, and irregular menstruation

revealed no genetic influence. The best fitting model for menstrual irregularity was CE

(C73%, E27%). The same model was defined for amenorrhea (C48%, E52%).Environmental

9

factors are most likely responsible to determine the menstrual flow, its integrity, and

regularity. 13

A study conducted on menstrual status data were collected from 596 secondary-school

students from the Amman area via a self-administered questionnaire. The students' mean age

was 15.7 ± 1.5 years. Mean age at menarche was 13.1 ± 1.1 years for those who recalled it and

12.8 ± 1.4 years per the probit analysis. Menstruation duration was 4 to 7 days for 73.6% of

the students, and it was more than 7 days for 2.2%. Mid-cycle pain was reported by 30.9% and

dysmenorrhea by 37.6% of the students, 8% of who needed to miss school 1 day per cycle.

Body mass index was correlated with age at menarche.14

A study conducted on technology to reprogram human somatic cells back to pluripotency

allows the production of patient-specific induced pluripotent stem cells (iPSCs) and holds a

great promise for regenerative medicine. Thus, in an effort to develop a suitable source for

iPSC studies to avoid the limitations mentioned above, we have here identified

stromal cells derived from menstrual blood (MenSCs) as suitable candidates. In the present

study, we found that MenSCs can be reprogrammed to pluripotent status by doxycycline-

inducible lentiviral transduction of OCT4, SOX2, and KLF4. The resulting MenSC-iPSCs

showed the same characteristics as human embryonic stem cells with regard to morphology,

pluripotent markers, gene expression, and the epigenetic status of pluripotent-cell-specific

genes. These cells were able to differentiate into various cell types of all 3 germ layers both in

vitro and in vivo.15

A study revealed that Induced pluripotent stem cells (iPSCs) were originally generated by

forced ectopic expression of four transcription factors genes-OCT4, KLF4, SOX2, and c-

MYC-in fibroblasts. Menstrual blood-derived mesenchymal cells (MBMCs) are

10

multipotent cells that show detectable levels of some of the core ES cells regulators. The aim

of this study was to determine whether reprogramming efficiency could be increased by using

MBMCs as a cell source to generate iPSCs. Cells with high nucleus/cytoplasm ratio can be

detected about 5 days of posttransduction, and colonies of typical ES-like cells begun to

appear after 7 days. At day 15, colonies were picked up and expanded for characterization.

Our results show that the reprogramming was faster and with efficiency around 2-5%, even in

the absence of ectopic expression of c-MYC.16

A study revealed that menstrual blood is easily accessible, renewable, and inexpensive

source of stem cells. In this study, we investigated the chondrogenic differentiation potential

of menstrual blood-derived stem cells (MenSCs) compared with that of bone marrow-

derived stem cells (BMSCs) in two-dimensional culture. MenSCs were strongly positive for

mesenchymal stem cell markers in a manner similar to that of BMSCs. Differentiated MenSCs

showed strong immunoreactivity to a monoclonal antibody against Collagen type 2, in a

pattern similar to BMSCs. Accumulation of proteoglycans in differentiated MenSCs was also

comparable with that in differentiated BMSCs. However, the mRNA expression patterns as

judged by RT-PCR of chondrogenic markers such as Collagen 2A1, Collagen 9A1 and SOX9

in MenSCs were different from those in BMSCs. Given these findings, MenSCs appear to be a

unique stem cell population with higher proliferation than and comparable chondrogenic

differentiation ability to BMSCs in two-dimensional culture.17

A study conducted on menstrual blood stromal stem cells (MBSCs) have been

demonstrated to exhibit stem cell properties such as the capability for self-renewal and

multipotency, allowing for multilineage differentiation. In this study, we examined the

potential effect of MBSCs on proliferation of peripheral blood mononuclear cells (PBMCs) in

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allogeneic mixed lymphocyte reaction (MLR).Menstrual blood was collected from healthy

donors after menstrual blood flow initiated and its mononuclear cell fraction was

separated. Cells were subsequently cultured and adherent cells were allowed to propagate and

used as stem cells. For functional analysis, PBMCs were co-cultured with MBSCs, collected

after 4 days and added to allogeneic PBMCs. MBSCs showed surface and intracellular

markers of mesenchymal stem cells with the exception of the high expression of Oct-4A.

MBSCs affected the proliferative response of PBMC in a dose-dependent manner.18

A study revealed that we are in the beginning of the era of regenerative medicine and

many researchers are testing adult stem cells to be used for tissue repair and regeneration in

the human body. Many adult stem cells have been discovered since the late 1990's with more

recently a novel adult stem cell described in menstrual blood. The menstrual blood is derived

from shedding of the endometrial lining, specifically the functionalis layer, which contains

highly proliferative cells used to prepare the female body for implementation of a fertilized

egg. Cell characterization experiments of stromal stem cells discovered in

menstrual blood have demonstrated cells to be multipotent which can successfully differentiate

in vitro into cell lineages derived from the mesoderm and the ectoderm. The study

demonstrates menstrual stem cells are a novel cell population that may be routinely and safely

isolated to provide a renewable source of stem cells from child-bearing women.19

A study revealed cerebrovascular diseases are the third leading cause of death and the

primary cause of long-term disability in the United States. The only approved therapy for

stroke is tPA, strongly limited by the short therapeutic window and hemorrhagic

complications, therefore excluding most patients from its benefits. Parkinson's and

12

Huntington's disease are the other two most studied basal ganglia diseases and, as stroke, have

very limited treatment options. Stem cells can be opportunely used to modulate inflammation,

abrogate cell death and, therefore, preserve neural function. We here discuss the role of stem

cells as restorative treatments for basal ganglia disorders, including Parkinson's disease,

Huntington's disease and stroke, with special emphasis to the recently investigated

menstrual blood stem cells. We highlight the availability, proliferative capacity,

pluripotentiality and angiogenic features of these cells and explore their present and future

experimental and clinical applications.20

A study conducted on Effectiveness of structured teaching programme on nursing

management of first stage of labor among staff nurses. A study was conducted on 35 nurses.

By using convince sampling method samples were selected and data was collected by

structured knowledge questionnaire. The findings showed that post test knowledge scores of

nurses after administering structured teaching programme on management of first stage of

labor was higher than pre test knowledge score. Hence study concluded that structured

teaching programme was effective method for improving knowledge among staff nurses.21

A quasi-experimental study conducted on effectiveness of structured teaching programme

on improving knowledge and skill of mothers caring for children with tubercular meningitis. A

study was conducted with 32 mothers to assess the effectiveness of structured teaching

programme on knowledge and skills. Two skills were taken for teaching care of back and

pressure points and tube feeding. The knowledge scores of mothers nearly doubled after

intervention with PTP from 29.34 to 56.71. Thus the study concluded that structured teaching

programme on specific topic should become a regular feature of health care providers

functions.22

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6.4. OBJECTIVES OF THE STUDY

To assess the existing knowledge of graduate students regarding menstrual blood bank.

To develop and conduct a structure teaching programm(STP) regarding menstrual blood

bank.

To evaluate the effectiveness of structure teaching programm regarding menstrual blood

bank.

To find the association between pre-test knowledge scores and selected demographic

variable.

6.5. OPERATIONAL DEFINATION OF THE TERMS:-

a) Effectiveness: It refers to the difference in percentage of correct response and mean

knowledge score of Teachers in pre-test and post-test.

b) STP: It refers to systematically organized teaching plan regarding menstrual blood bank

among graduate student.

c) Menstrual blood Bank: a where from menstrual blood are collected and preserved. Its

highly proliferative and possess the unique ability to develop

into various other types of healthy cells.

d) Graduate students: A students who are studying degree or equivalent course.

6.6. HYPOTHESES

H1: There will be a significant difference between the mean pre-test and post-test

knowledge scores of graduate students regarding menstrual blood bank.

H2: There will be a significant association between the mean pre test knowledge scores

and selected demographic variables.

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6.7. Research variables:

Dependent variables: knowledge of graduate students regarding menstrual blood bank.

Independent variables: Structured teaching program for knowledge of graduate students

regarding menstrual blood bank.

INCLUSIVE CRITERIA

Who are available during the period of data collection

Who are willing to participate in the study

EXCLUSIVE CRITERIA

Students who are not willing to participate in the study.

Students who don’t have time to attained the study

7. MATERIAL AND METHODS:-

7.1. Sources of data:- From the graduate students in selected college at kolar.

7.2. Method of data collection:-

i) Research design: Pre experimental study. One group Pre-test and Post-test design

ii) Setting: selected college at kolar.

iii) Sample Size: 60

iv) Sample techniques: simple random sampling

v) Tools for date collection: 1) Socio demographic data sheet

2) Self administered questionnaire

vi ) Duration of study: 4 – 6 wks

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vii) Method of analysis and interpretation:

The researcher will use appropriate statistical technique for data analysis and present in

the form of table, graphs and diagrams.

Pilot study: - 10% of population structured for the study during the year of 2013.

Main study: - Data will be collected by the Self administered questionnaire method using the

above tools.

Statistical analysis and inertretation:

Data will be analysed on the basis of objectives and hypothesis by using descriptive and

inferential statistics. Descriptive statistics analysis by the frequency man, and standard

deviation will be used for the descriptive statistics. In inferential statistics chi-square test will

be used to find out the association between the post test knowledge scores with their selected

demographic variable and paired “t” test will be used to evaluate the effectiveness of

structured teaching programme on menstrual blood bank. The result will be presented in the

form of tables,graphs and diagrams.

Ethical issues : All the subjects will be explained about the purpose, the objectives and

the procedure of the study.

viii) Project outcome: - This study helps to know about effectiveness of structured teaching

program for knowledge of graduate students regarding menstrual

blood bank.

7.3 Does the study require any investigation or intervention to be conducted on students

or other human or animals?

No. As educational intervention is used only teaching is required regarding all the

aspects of partograph and teaching will cause no harm to staff nurses.

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7.4 Has ethical clearance been obtained from institution?

YES. prior to the study , permission will be obtained from the concerned authorities

to conduct the study in the selected hospitals at kolar and also from the Ethical/Research

committee of Pavan college of nursing .The purpose of the study will be explained to the

staff nurses.

8. REFERENCES:-

1. Grinder.R.E. Adolesence second edition, New york, John Wiley & Sons, 2005, 9-25

Pp.

2. Allen, Kevin, The Reluctant Hypothesis: A History of Discourse Surrounding the

Lunar Phase Method of Regulating Conception. Lacuna Press.2007,

p. 239. ISBN 978-0-9510974-2-7.

3. Hedge K. Desai P and Hazra M.” Adolescents menstrual pattern”. The journal of

Obstetrics and gynecology of India; 2005: 40(2):259-261.

4. Greenberg, Jerrold S.; Clint E. Bruess, Sarah C. Conklin exploring the dimensions of

human sexuality (3rd Ed.). Jones & Bartlett. (2007). pp. 136–137.

5. David L Healy "Menorrhagia Heavy Periods - Current Issues". Monash University.

(2004): ABN 12 377 614 012.

6. Neha Verma, “Menstrual Blood Banking: Scope and Future”, PM Health In Focus

January 03, 2012.

7. Girling, JE, and PA Rogers. "Recent Advances in endometrial angiogenesis research."

Angiogenesis, 2005: 89-99.

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8. Pavan P Sethia, Development and Commercialization Of Menstrual Blood Stem Cells

Banking, Case Western Reserve University, January 21, 2011.

9. Vollman. F. Rudolf. Textbook of Obstetrics and Gynecology.Philadelphia; W.B.

Saunders Company, 2007, 19 Pp.

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17. Khanmohammadi M, Khanjani S, Bakhtyari MS.Proliferation and chondrogenic

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two-dimensional culture. Department of Embryology and Stem Cells. Tehran, Iran. Int

J Hematol. 2012 May;95(5):484-93.

18. Nikoo S, Ebtekar M, Jeddi-Tehrani M. Effect of menstrual blood-derived stromal stem

cells. Department of Immunology, Faculty of Medical Sciences, Tarbiat Modares

University, Tehran, Iran. J Obstet Gynaecol Res. 2012 May;38(5):804-9.

19. Allickson JG, Sanchez A, Yefimenko N, Assessing the Proliferative Capability of a

Novel Adult Stem Cell Identified inMenstrual Blood. Cryo-Cell International, Inc.,

Oldsmar, FL, USA. Open Stem Cell J. 2011;3(2011):4-10

20. Rodrigues MC, Voltarelli J, Sanberg PR. Recent progress in cell therapy for basal

ganglia disorders with emphasis on menstrualblood transplantation in stroke.

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Medicine. USA. Neurosci Biobehav Rev. 2012 Jan;36(1):177-90.

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first stage of labour among nurses at KLE’s Dr. Prabhakar Kore Hospital and MRC,

Belgaum [unpublished dissertation] Bangalore: Rajiv Gandhi University of Health

Science. 2007 April.

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