الفهرس 
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Abstract
Dysmenorrhea is a disorder characterized by the presence of painful cramps of uterine origin that occur during menstruation. It can reduce the quality of life and hinder social activities in young women, especially when it is accompanied by symptoms such as headache, backache, fatigue, nausea and vomiting, diarrhea, general malaise, weakness, boredom and chills. It is categorized into two types: primary and secondary dysmenorrhea. Primary dysmenorrhea (spasmodic) is defined as colic pain in the suprapubic region and radiate to the lumbar and thighs. The onset of pain is usually a few hours before blood flow starts and will typically last from 8 to 72 hours and is most severe on the 1st and 2nd days of menstruation. Its prevalence varies from 45 to 95 % globally with higher rates reported among adolescent populations.
Treatment approaches for primary dysmenorrhea includes a variety of pharmacological and non-pharmacological methods. Pharmacological treatment includes non-steroidal anti-inflammatory drug (NSAIDs), acetaminophen and oral contraceptives (OCs). Non- pharmacological methods are options of women with primary dysmenorrhea that are so vital and can have significant role in health improvement of women, they include acupressure.
Acupressure is one of all standard Chinese drug approach and is a therapy for the relief of pain symptoms. It is an effective non-invasive nursing intervention for alleviation of primary dysmenorrhea and menstrual distress in high-life stress conditions. It places physical pressure on different points on the surface of the body through greater balance and circulation of energies in the body.
Spleen 6 is one of the most useful and important acupressure-acupuncture points on the body with a multitude of actions and indications. It is a center of energy and intersecting or meeting point of the spleen, liver, and kidney and it is considered as a selective point in treating women’s diseases. Acupressure on this point was used to reduce many disorders, including gynecological like menstrual disorders as dysmenorrhea.
The study aimed to:
Determine the effect of Spleen 6 point acupressure on pain intensity among late adolescents nursing students with primary dysmenorrhea.
Research hypothesis:
Late adolescents nursing students who receive Spleen 6 point acupressure during primary dysmenorrhea exhibit less pain intensity.
Materials and methods
This study was conducted at Faculty of Nursing, Alexandria University (Obstetric &Gynecologic nursing skill’s lab). Subjects: the study was included 80 female students. They were selected from the third academic year in the faculty of nursing according to the following inclusion criteria:
• Willing to participate in the study.
• Single.
• 18-21 years old.
• Suffering from primary dysmenorrhea.
• Having history of regular menstrual cycle with an interval of 21 to 35days and a duration of 3-7days.
• No prior history of any gynecologic problem.Never taking any pharmacological pain relief measures and/or any hormonal therapy.
• With intact leg skin and free from arthritis, phlebitis, burn, wound or any scar, injury, inflammation and eczema.
Tools used in this study:
Three tools were used for data collection. Tool one:Basic data questionnaire:This tool was developed and used by the researcher to collect the following data: socio-demographic data, health profile data, menstrual history, character of primary dysmenorrhea and subjects’ health practices during primary dysmenorrhea. Tool two: The Visual Analogue Scale (VAS): It was adopted and used by the researcher. It is a self-report device consisting of a horizontal line used for subjective estimation of patient’s pain.
Tool three: A modified version of Chamber Price pain rating scale (CPPRS): It was adopted and used by the researcher. It measures pain intensity through observable behaviors.
Tool (I) was tested for content validity by jury of five experts in the field of obstetric and gynecologic nursing and the necessary modification were done.
A pilot study was carried out on 8 students who were excluded from the study sample to test the relevance, validity, and clarity of tool as well as the time needed to complete it.
The main findings of the present study were:
The basic data:
• Three-fifths (60.0%) of female students were equal or more than 21 years old. The mean age of female students was 20.60 ± 0.51 years. Concerning the family size, three-fifths (60.0%) of female students had five members or more.
• The majority of the female students (96.25%) have not any diseases. Most of the female students (87.5%) did not have any surgery.
• Regarding the age of menarche, it was found that more than half (53.75%) of female students reported less than 14 years old.
• More than half (53.75%) of female students reported that they used from 3 to 5 pad per day.
• The majority of female students (95%) reported that their pain start from the beginning of menarche.
• 100% of female students reported that their pain started with the beginning of menstrual flow and continues for a period of 24- 48 hours.
• More than three quarters (82.5%) of female students experienced the pain at lower abdomen and radiated to back and thighs.
• More than three-quarters (81.25%) of female students experienced colicky pain.
• Most of female students (82.5%) reported that the pain recurred every month.
• Regarding the aggravated factors of menstrual pain, two-thirds (66.25%) of female students reported anxiety and stress while less than half (45.0% & 43.75%) of them reported study burden and cold weather respectively.
• Concerning measures of girls to relieve menstrual pain, less than two-thirds (63.75%, 63.75%) respectively of female students reported warm fluids intake and rest and sleep. In addition, more than half (52.5%) of them reported analgesics or antispasmodics.
• As regard to the physical symptoms associated with primary dysmenorrhea, less than three-quarters (71.3%) of female students had weakness and malaise. Meanwhile, nearly half of them (52.5% & 47.5%) had anorexia and dizziness respectively.
• The majority of female students (93.8%) suffered from mood changes as nervousness as a psychological symptom associated with primary dysmenorrhea.
• According to the behavioral symptoms associated with primary dysmenorrhea, more than three-fifths (63.8%) of female students suffered from sleep disturbance, slightly less than half (47.5%) of them suffered from repeated quarrels and excitement.
Pain intensity as measured by visual analogue scale (VAS) before and after intervention:
• Before intervention, it was obvious that the majority of female students (97.5%) had severe pain.
• After the first intervention session (immediately), it was found that more than three-quarters (76.25%) of female students had moderate pain.
• After the second intervention session (after 2 hours), it was noticed that about two-third (65%) of female students had mild pain.
• A highly statistically significant difference was observed among female students before and after intervention.
Behavioral responses to pain as measured by modified version of chamber price pain rating scale (CPPRS) before and after intervention:
• Before intervention, in relation to posture, Tense body posture was obvious among most of female students (83.75%). After the first intervention session, more than three-quarters (78.75%) of female students had guarded body posture. After the second intervention session, it was found that 100% of female students were very relaxed.
• Regarding gross motor activity: Before intervention, more than three-quarters (76.25%) of female students were very restless. After the first intervention session, less than three-fifths (58.75%) of female students were slightly restless. After the second intervention session, it was observed that 100% of female students had quiet gross motor activity.
• Concerning facial expression: Before intervention, more than two-thirds (68.75%) of female students had constant frowning or grimacing. After the first intervention session, less than three-quarters (70%) of female students had no frowning. After the second intervention session, it was noticed that 100% of female students had no frowning.
• Regarding verbalization: Before intervention, more than three-fifths (61.25%) of female students were groans, moans. After the first intervention session, the majorities of female students (97.5%) were normal or had no sound. After the second intervention session, it was found that 100% of female students were normal or had no sound.
• A highly statistically significant difference was obvious among female students before and after intervention.
• Before intervention, it was observed that more than three-fifths (61.3%) of female students had unbearable pain.
• After the first intervention session, it was found that more than half (53.8%) of female students had mild pain.
• After the second intervention session, it was noticed that 100% of female students had mild pain.
Relation between pain intensity (before intervention) with aggravated factors of menstrual pain and measures done by girls to relieve menstrual pain: There were not statistically significant differences between them.
Recommendations:
Based on the findings of the present study, the following recommendations are suggested:
• Periodic participation of medical and nursing staff in training programs about of non-pharmacological methods of pain management specifically acupressure to improve their knowledge and skills.
• Sp6 acupressure should be advocated as a non-pharmacological approach for management of menstrual pain.
• Females, medical and nursing staff should be encouraged and educated about the application of sp6 acupressure as non-invasive treatment for primary dysmenorrhea.
• Useful potential effects of non-pharmacological modalities on pain management should be included in the obstetrics and gynecology curricula at different educational setting. Especially, the management of primary dysmenorrhea with such modalities specifically Sp6 acupressure.
• Maternity health care settings need to contemplate the possibility of integrating the use of acupressure in their policies, and hence the clinical practice.
• Nurses at maternity and child health centers could provide their clients with information about the natural management of primary dysmenorrhea (with complementary and alternative therapies).
• Mass media and professional journals can be used successfully to spot light on benefits of non-pharmacological methods of pain management specifically acupressure.