DR A JAYASUDHA ASSOC PROFESSOR King Khalid University

DR. A. JAYASUDHA ASSOC. PROFESSOR King Khalid University Female College of Applied Medical Sciences, Bisha

� Parenting is viewed by most of the couples as their central role in life, and the thought of not achieving it can be very upsetting. When fertility fails, the couples become psychologically depressed; some may feel frustrated and feel guilty; whereas some get angry to their fate and blame each other for the failure. Instead couples can begin to view themselves constructively rather than viewing their fertility as failure.

� Infertility is not an absolute condition. The ability to conceive varies with each cycle, environmental circumstances and treatment options. Women may find themselves increasingly despairing at the thought of never becoming pregnant. Social events loom as infertile women begin to dread social occasions. They may also get isolated from family members and work colleagues.

�A person with negative perception will also have negative thoughts. Negative thoughts lead to negative beliefs, which are more often irrational. These negative beliefs in the long run affect a person’s mental health as well as physical health. Positive therapy aims at modifying negative thoughts, belief’s, emotions and behavior by using a number of techniques like Relaxation therapy, counseling and exercises.

� In positive therapy the individual is made to understand that worrying about the past or future is unnecessary and unwanted. The individuals are trained to live in the present and enjoy the present. Positive therapy helps to replace debilitating negative thoughts with positive self-enhancing thoughts. It helps in the development of positive personality traits such as courage, confidence, cheerfulness, optimism etc… and making them to face their problems with a smile. The positive therapy was developed by Natesan (2000) a psychologist and is widely used to reduce stress in hospitalized patients with various diagnoses

� It is assumed that when negative thoughts are replaced by positive thoughts, the infertile women can become more realistic and reasonable in their perception. Thus the understanding of stress of infertile women can help nurses to design successful interventions to reduce stress, promote healthy adaptation and prevent them moving towards avoidance and denial.

� An experimental study to determine the impact of positive therapy upon the stress levels in infertile women attending the selected Centre for reproductive medicine at selected hospitals, Coimbatore.

� To determine the levels of stress in infertile women in terms of their stress reactions and general well being. � To determine the impact of positive therapy upon the levels of stress in infertile women.

� Ho 1 There will be no significant difference between the stress reactions of infertile women in the pre and post test among infertile women of experimental and control group. � Ho 2 There will be no significant correlation between stress reactions and general well being of infertile women in the pre test and post test among experimental and control group.

� Both research and non research related research literature were reviewed from published articles and MEDLINE search to broaden the understanding and gain insight into the selected problem under study. The review of literature related to topic of study is grouped under the following headings: � Incidence of infertility � Biological dimensions of infertility � Stress in Infertile women � Impact of stress reduction strategies in infertile women � Positive therapy and stress reduction

� The experimental research approach was selected for the present study as the study involved a new intervention for infertile women � The controlled experiment is considered to be the gold standard for yielding reliable evidence about the cause and effect. Hence the randomized clinical trial (RCT) a full experimental design to test a new treatment involving random assignment to treatment group and control group was selected for the present study as the study has to determine the impact of positive therapy upon stress levels.

� The data were collected from 120 infertile women who were randomly assigned into control and experimental group. The pretest stress was assessed on day 2 of the menstrual cycle and the post test stress was assessed on day 14 of the menstrual cycle of all the infertile women. The positive therapy was implemented only for the experimental group of women for 5 times from day 3 to Day 7 and they were asked to continue to practice by listening to the audio cassette given to them on positive therapy.

� It is therapy which facilitates sound mental health, leading to better adjustments through relaxation therapy, counseling and exercises. � Relaxation therapy: It involves deep breathing practice, relaxation training. � Counseling: It involves the techniques of rational emotive therapy, thought stopping, and cognitive restructuring. � Exercises: Positive therapy involves tension releasing exercises, smile therapy and laughing therapy to help clients to get rid of their tension and develop a happy state of mind. �

� The instruments used for data collection were demographic variable proforma, biological variable proforma, and stress reactions to infertility inventory and WHO’s general well being index. Validity and reliability were established for the tools developed by the researcher and the standardized tools were translated into Tamil and their reliability was established. Pilot study was conducted on 10 infertile women. The analysis of data was done through an integrated system of computer program known as statistical package for social sciences (SPSS)

� The control group infertile women reported a stress score of 246. 13± 21. 82 in the pretest and in post test 247. 06 ± 21. 89 Whereas the experimental group women had their stress mean score of 247. 51± 23. 14 in the pre test and after undergoing positive therapy it was found to be 164. 30± 19. 03 in the post test which was statistically significant at p< 0. 0001 level.

Control Group (N=60) Stress level Experimental Group (N=60) N % Low stress (< 220) 7 11. 7 10 16. 7 Average stress (221 – 8 13. 3 9 15. 0 23 38. 3 21 35. 0 22 36. 7 19 31. 7 237) Moderate high stress (238 – 249) High stress (> 250)

Control Group (N=60) Exp. Group (N=60) Stress N % 6 10. 0 60 100. 0% Average stress (221 – 237) 16 26. 7 - - Moderate high stress (238 – 249) 19 31. 7 - - High stress (> 250) 19 31. 7 - - Low stress (< 220)

Group N Pre test Post test ‘t’ Value Mean SD Control 60 246. 65 22. 18 247. 06 21. 89 0. 937 Experimental 60 247. 51 23. 14 164. 30 19. 03 33. 93*** P<. 0001

Dimensions of stress Pre test Post test ‘t’ Value Mean SD Physical 24. 15 2. 99 25. 91 4. 10 - 7. 692 xxx Emotional 27. 76 2. 93 27. 95 2. 88 -. 773 Social 39. 08 6. 36 38. 00 6. 36 2. 226 x Sexual 25. 83 4. 98 25. 18 4. 07 4. 163 xxx Relationship concern 40. 01 5. 46 39. 53 5. 46 2. 682 xx Rejection of child free life style 38. 25 3. 63 37. 88 3. 63 1. 831 Need for parenthood 51. 55 4. 62 52. 60 4. 06 - 4. 751 xxx

Dimensions of stress Pre test Post test ‘t’ Value Mean SD Physical 25. 46 4. 10 13. 83 2. 63 27. 534*** Emotional 28. 18 2. 93 14. 80 3. 29 28. 124*** Social 37. 81 6. 36 23. 23 4. 79 23. 827*** Sexual 25. 41 4. 98 17. 00 5. 94 10. 844*** Relationship concern 39. 95 5. 46 25. 86 3. 96 22. 834*** Rejection of child 37. 60 3. 63 27. 46 4. 26 20. 087*** 52. 16 4. 62 42. 10 3. 72 16. 848*** free life style Need for parenthood *** P <. 0001

� The control group infertile women reported a general well being score of 14. 65± 2. 11 in the pretest and in post test 15. 56± 1. 38 (‘t’ 3. 013). Whereas the experimental group women had their general wellbeing mean score of 14. 81± 2. 31 in the pre test and after undergoing positive therapy it was found to be 20. 93± 2. 17 in the post test (‘t’ 38. 32)which was statistically significant at p< 0. 001 level. �

Group N Pre test Post test ‘t’ Value Mean SD Control 60 14. 65 2. 11 15. 11 1. 38 3. 013 Experimental 60 14. 81 2. 31 20. 93 2. 17 38. 32*** P <. 0001

Treatment outcome Control group (n=60) N % Experimental group (n=60) N 2 value % Pregnant 2. 000 Non pregnant (df =1) 25 41. 67 40 66. 67 35 58. 33 20 33. 33 The data presented in the above table shows that 40 (66. 67%) women in the experimental group got conceived as against 25 (41. 67%) women from the control group. The results can be attributed to the significance of positive therapy, though it was not statistically significant.

�A majority of the women in control and experimental group were experiencing moderate to high level of stress and decreased level of general wellbeing in the pretest. Whereas after undergoing positive therapy the experimental group of women had low stress and increased level of general well being in the post test. The control group infertile women did not have any significant reduction in the stress or improvement in their general wellbeing. There was a significant negative correlation between stress and general wellbeing in the pre and post test of both control and experimental groups.

� Nursing practice : The infertile women need to be motivated to seek treatment at the early age, as the fertility potential declines with advancement of age. The women living in nuclear families can be explained the need to have supportive people at home in helping them to avoid strenuous domestic work during the luteal phase of implantation of the conceptus. The nurses will be able to render culturally sensitive care if they develop an understanding about how infertility is viewed in the context of various religions and cultural groups

� The family counselling can be conducted in which even the husbands and other significant family members can be taught to learn and use positive therapy. � The positive therapy can be taught to community health nurses to implement for the infertile women at home as well as follow them up and encourage them to practice it regularly.

� Nursing education : As the infertile women face much of the psycho social problems and they are very sensitive, the students must be taught to show a compassionate and empathetic attitude while caring for infertile women. The counselling skills education and stress reduction strategies is also required to be incorporated in the curriculum to enable the students to implement it effectively for their patients in distress.

� Nursing research with regard to care of infertile women is not yet well developed. Further research in the area of bio-psychosocial dimension of infertile women are required to identify specific interventions that would be useful in helping the infertile couples to achieve their ultimate goal of becoming a parent. The interventions which would increase marital adjustment, family support and decrease stress of infertile women are to be developed, tested through research and recommended for practice.

� The same study can be done on a larger population for a more valid generalization. � The study can be replicated in different settings. � A comparative study can be conducted to evaluate the effectiveness of different strategies available to reduce stress in infertile women. � The knowledge, attitude and practice of reproductive health nurses in stress reduction strategies of infertile women can be studied. � The effectiveness of positive therapy in reducing stress in patients suffering from any other illness can be studied

� Abbey, A. Halman, L. J. , Andrews, F. M (1992). Psychosocial, treatment, and demographic predictors of the stress associated with infertility. Fertility and sterility. 57(1), 122 -128. � Brucker, P. S. , Mckenry, P. C. (2004). Support from health care providers and the psychological adjustment of individuals experiencing infertility. J obstet gynec neonatal nursing. 33(5). 597 -603. � Burns, N. , Grove, S. (1999). Understanding Nursing Research. Philadelphia: W. B. saunders.

� De klerk, C. et al. (2005). Effectiveness of a psycho social counselling intervention for first time IVF couples. Human Reproduction. 20(5), 1333 – 8. � Latha and Rohini, N. S. (2006). Management of stress in wives of alcoholics through Positive Therapy. Unpublished manuscript. Department of Psychology, Avinashilingam University for Women. Coimbatore. � Polit, D. F. , & Hungler, B. P. (1998). Nursing research: principles and methods. Philadelphia. J. B. Lippincott &co.

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