ASSOCIATION BETWEEN PREMENSTRUAL SYNDROME AND JOB

PERFORMANCE AMONG NURSES WORKING IN TERTIARY CARE

HOSPITALS PESHAWAR

By

Waleed Iqbal

Master of Science in Nursing

Registration Number: 2021/KMU/ INS/MSN/27

Supervised By

Dr. Najma Naz

Associate Professor
Institute of Nursing Sciences-KMU
Khyber Medical University Peshawar

INSTITUTE OF NURSING SCIENCES

KHYBER MEDICAL UNIVERSITY
PESHAWAR-PAKISTAN

1
 SESSION: 2021-2023

DECLARATION

I Waleed Iqbal hereby declare that the thesis titled "Association between Premenstrual

Syndrome and Job Performances among Nurses Working at Tertiary Care Hospital" is the

result of my original research work and has been carried out under the supervision of

Associate Professor Dr Najma Naz. All the information presented in this thesis is true

and based on accurate data to the best of my knowledge. Any contributions or assistance

received from individuals or sources have been duly acknowledged in the thesis.

I further declare that:

The research work presented in this thesis is my own and has not been submitted in part or

in full for any other academic degree or professional qualification. Any external sources of

information, ideas, or data used in this thesis have been properly cited and referenced

according to the prescribed format. The methodology employed in this study, including

data collection, data analysis, and interpretation of results, follows the ethical guidelines

and principles of scientific research.

I understand that any breach of academic integrity, plagiarism, or misrepresentation of

information in this thesis may lead to severe consequences, including the rejection of the

thesis or the revocation of my academic degree.

________________
Waleed Iqbal
MSN-Scholar

2
.

ACKNOWLEDGMENT

I would like to take this opportunity to express my heartfelt gratitude to all those who have

contributed to the successful completion of my thesis titled "Association Between

Premenstrual Syndrome and Job Performances among Nurses Working at Tertiary Care

Hospital." This research work would not have been possible without the support,

guidance, and encouragement of numerous individuals and institutions.

I would like to express my sincere gratitude to my research Supervisor Associate

Professor Dr Najma Naz for her precious guidance, support, and mentorship throughout

this research project. Her expertise and encouragement have been instrumental in shaping

the direction and quality of this work.

Moreover I am deeply obliged to my Co-Supervisor Assistant Professor Mr.

Muhammad Aurangzeb for their invaluable guidance, unwavering support, and constant

motivation throughout the research process.

I extend my sincere appreciation to the management and staff of the LRH, KTH and HMC

who generously permitted me to conduct this study among the nurses at their institution.

Their cooperation and willingness to participate have been essential in gathering the

necessary data for this research. I would also like to thank my friends and family for their

constant support and encouragement. Their belief in me and understanding during the

demanding times of this research journey has been a tremendous source of strength.

Lastly, I am grateful to the Institute of Nursing Sciences (KMU) for providing me with the

opportunity to pursue my academic aspirations and undertake this research project.

3
 DEDICATION

I dedicate this research study to all the nurses working tirelessly in tertiary care hospitals

of Peshawar and beyond. Your commitment to providing critical care and compassion to

patients, even amidst personal challenges, serves as an inspiration to us all.

This study is a tribute to your unwavering dedication, professionalism, and resilience in

the face of diverse challenges, including those posed by premenstrual syndrome (PMS).

Your dedication to the nursing profession and the well-being of your patients is

commendable and deserves recognition.

I also extend my heartfelt appreciation to the participants who took part in this study,

generously sharing their time and insights. Your contribution is invaluable, and I hope that

the findings of this research will ultimately contribute to enhancing the work environment

and support available to nurses.

To my family and friends, thank you for your unwavering support and understanding

throughout this research journey. Your encouragement and belief in my abilities have been

instrumental in reaching this milestone.

Finally, I offer my gratitude to the academic and research community for nurturing an

environment that fosters intellectual growth and exploration. Your guidance and

mentorship have played a pivotal role in shaping this study.

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 CERTIFICATE OF APPROVAL

This is to certify that the dissertation entitled “Association between Premenstrual

Syndrome and Job Performance among Nurses Working in Tertiary Care Hospitals

Peshawar “has been written by Mr Waleed Iqbal Scholar of Master of Science in Nursing

at Khyber Medical University, Peshawar. This thesis work was the requirement of

awarding the degree of Master of Science in Nursing (MSN) is hereby accepted and

approved by the following supervisors.

Supervisor: _________________________
Dr. Najma Naz
Associate Prof. INS-KMU

Co-supervisor: _________________________
Mr. Muhammad Aurangzeb
Assistant Professor INS-KMU

External Examiner: _________________________

Director: __________________________
Dr. Sabiha Khanum
Director INS-KMU

HOD Post Graduate: __________________________

Dr Dildar Muhammad
Associate Professor INS-KMU

Dated: ----/---/----

5
 ABBREVIATIONS

ASRB Advance studies Review Board

DF Degree of freedom

ERB Ethical Review Board

FIG Figures

HMC Hayatabad Medical Complex

ICU Intensive Care Units

INS Institute Of Nursing Sciences

KTH Khyber teaching hospital

KMU Khyber Medical University

LRH Lady reading Hospital

PCOS Polycystic Ovarian Syndrome

PMS-JP Premenstrual Syndrome-Job Performance

PMSWP Premenstrual Syndrome and Work Performance

PMS Premenstrual Syndrome

PMDD Premenstrual Dysphonic disorder

SD Standard Deviation

SIG Significance

SPSS Statistical Package for Social Sciences

UAE United Arab Emirates

6
 Table of Contents
DECLARATION.....................................................................................................................................ii

DEDICATION........................................................................................................................................iv

CERTIFICATE OF APPROVAL.........................................................................................................v

ABSTRACT............................................................................................................................................ix

BACKGROUND.................................................................................................................................ix

METHODOLOGY..............................................................................................................................x

RESULTS............................................................................................................................................ x

CONCLUSION...................................................................................................................................xi

KEYWORDS:.....................................................................................................................................xi

INTRODUCTION.................................................................................................................................. 1

1.1 OVERVIEW..................................................................................................................................1

1.2 RATIONALE................................................................................................................................4

1.3 OPERATIONAL DEFINITIONS................................................................................................5

1.4 HYPOTHESIS...............................................................................................................................5

1.5 SIGNIFICANCE...........................................................................................................................5

LITRETURE REVIEW.........................................................................................................................7

2.1 INTRODUCTION.........................................................................................................................7

2.2LITRETURE SEARCH STRATEGY..........................................................................................7

2.3 CRITICAL REVIEW ANALYSIS..............................................................................................8

2.3.1 PREMENSTRUAL SYNDROME........................................................................................8

2.3.2 PMS AND JOB PERFORMANCE......................................................................................9

2.3.3 PMS AND PERSONALITY TRAIT (Nursing students and On Job Women)...............10

2.3.4 STRATEGIES FOR RELIEVING THE SYMPTOMS OF PMS....................................12

2.3.5 PMS AND MENSTRUAL CHARACTERISTICS............................................................14

2.3.6 HEALTH EDUCATION AND PMS..................................................................................15

2.3.7 PREVALENCE OF PMS....................................................................................................15

2.3.8 SUMMARY..........................................................................................................................17

CHAPTER 03........................................................................................................................................18

METHODOLOGY...............................................................................................................................18

3.1 INTRODUCTION.......................................................................................................................18

3.2 Study Design................................................................................................................................18

3.3 Study Setting...............................................................................................................................18

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 3.4 Sample Size..................................................................................................................................19

3.5 Sampling Technique...................................................................................................................19

3.6 Sample Selection..........................................................................................................................19

3.6.1 Inclusion Criteria.................................................................................................................19

3.6.2 Exclusion Criteria................................................................................................................19

3.7 Data Collection Tool...................................................................................................................19

3.8 Ethical Considerations................................................................................................................20

3.9 Data Analysis...............................................................................................................................20

3.10 SUMMARY...............................................................................................................................20

CHAPTER 04........................................................................................................................................21

RESULTS..............................................................................................................................................21

4.1 INTRODUCTION.......................................................................................................................21

4.2 SOCIO-DEMOGRAPHIC.........................................................................................................21

4.5 ASSOCIATION BETWEEN PMS AND JOB PERFORMANCE..........................................24

4.5.1 Correlation between PMS and PMS...................................................................................24

4.5.2 Correlation between PMS and Job Performance..............................................................24

4.5.3 Significance (Sig.) of the Correlations................................................................................24

4.5.4 Sample Size (N)....................................................................................................................25

4.6 SUMMARY.................................................................................................................................26

CHAPTER 5..........................................................................................................................................27

DISCUSSION, CONCLUSION AND RECOMMENDATIONS......................................................27

5.1 INTRODUCTION.......................................................................................................................27

5.2 DISCUSSION..............................................................................................................................27

5.4 LIMITATIONS AND IMPLICATIONS..................................................................................32

5.5 CONCLUSION...........................................................................................................................32

5.6 RECOMMENDATIONS............................................................................................................33

5.7 SUMMARY.................................................................................................................................34

REFRENCES........................................................................................................................................35

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 LIST OF APPENDICES

APPENDIX 01 ASRB Approval Letter) 40

APPENDIX 02 Permission Letter for Data Collection from INS) 50

APPENDIX 03 ERB Approval 51

APPENDIX 04 Permission Letter from HMC 52

APPENDIIX 5 Permission Letter from LRH 53

APPENDIX 6 Permission letter from KTH 54

APPENDIX 07 Informed Consent 55

APPENDIX 08 Study Tool- Questionnaire 56-58

APPENDIX 09 Plagiarism Report 59-62

9
 ABSTRACT

BACKGROUND

The relationship between premenstrual syndrome (PMS) and job performance is a subject

of growing interest, particularly in high-stress environments like critical care nursing. This

study aims to find the association between PMS and the job performance of critical care

nurses at tertiary care hospitals in Peshawar. Premenstrual syndrome (PMS) can

significantly affect the well-being of individuals, with potential implications for their daily

functioning. Critical care nurses, tasked with demanding responsibilities, operate in a

high-pressure environment where job performance is of utmost importance. Understanding

the potential association between PMS and the job performance of these nurses at a

tertiary care hospital in Peshawar is essential to enhance both the nurses' working

conditions and the quality of care, they provide to the patients.

OBJECTIVE

Objective of the study is to find out association between premenstrual syndrome and job

performance among Nurses working in tertiary care hospitals of Peshawar.

METHODOLOGY

A correlational study was conducted to achieve the objective of the study. Moreover a well

adopted questioner tool and purposive sampling technique was used. The total population

for this study was 346.Out of these 240 participants from LRH, 58 were from KTH and 48

were from HMC Peshawar. The sample size was calculated via Rao soft software. The

calculated sample size was 183, so the sample size from LRH was 127, KTH =31 and

from HMC the sample size was 25 participants.

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RESULTS

The majority of the participants were in the age range of 26 to 30 years old, with varying

levels of job experience and education. The study found a statistically significant

correlation (r=0.298**) between PMS and job performance among the participants.

Correlation is significant at the 0.01 level (2-tailed)" suggests that there was a strong

correlation between PMS and job performance, and this correlation was statistically

significant at a p-value of 0.01 (which implies a very low probability that the observed

correlation occurred by chance). This finding underscores the potential impact of

premenstrual syndrome on the job performance of individuals.

CONCLUSION

This study delved into the unexplored territory of the association between Premenstrual

Syndrome (PMS) and job performance among critical care nurses. With a dearth of prior

research on this specific topic, our investigation has shed light on a significant relationship

between PMS and job performance. The findings underscore the importance of

recognizing the potential impact of PMS on the professional lives of critical care nurses,

highlighting the need for further attention and support in this regard. As healthcare

institutions strive to optimize the well-being and productivity of their nursing staff, the

current study adds a crucial dimension to the understanding of factors influencing job

performance. Moving forward, interventions and strategies can be tailored to address the

challenges posed by PMS, ultimately fostering a more conducive work environment and

enhancing the overall quality of patient’s care.

KEYWORDS: Premenstrual Syndrome, PMS, Job Performance, Nurses, Tertiary Care

Hospitals, Peshawar, Pakistan.

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 CHAPTER 1

INTRODUCTION

1.1 OVERVIEW

Premenstrual syndrome (PMS) is a common gynecological condition characterized

by physical and behavioral symptoms that occur a few days before or after menstruation.

A cross-sectional research study was conducted at Bisha University Saudi Arabia

involving 388 female students enrolled in the Faculty of Medical Applied Sciences and the

Faculty of Medicine. Participants completed a self-administered questionnaire, and the

assessment of Premenstrual Syndrome (PMS) was done using the Premenstrual Syndrome

Scale (PSS) in accordance with diagnostic criteria. The participants' average age was 19.5

years with a standard deviation of 4.9 years, and the prevalence of PMS was found to be

64.9%. The majority of female students demonstrated an extroverted personality type

(35%), while 13.4% were overweight or obese. Within the group of participants with

PMS, 19.5% engaged in regular exercise (p < 0.05). Menstruation was shown to

significantly impact various aspects of quality of life (p < 0.05), including daily activities

and homework. Additionally, nearly half of the female students experienced the influence

of menstruation on their learning environment. This emphasizes the importance of

addressing risk factors as a crucial intervention strategy among female students. Another

research study was conducted in Debremarkos, Northwest Ethiopia, involving female

secondary school students from Grades 9 to 12. The purpose was to assess the prevalence

of premenstrual syndrome (PMS) and identify its associated factors. Students with at least

one somatic or affective symptom occurring from 13 days before to 4 days after

menstruation onset were classified as having PMS. The findings revealed that 81.3% of

participants reported experiencing PMS(1).

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 According to SB Larson, the majority of women, 90% report experiencing some

degree of PMS, such as bloating, headaches, and mood fluctuations. Research indicate that

around 12% of women endure moderate PMS symptoms, with the condition being more

prevalent between the late 20s and 40s, and the most pronounced symptoms often

appearing in the late 30s and early 40s. It is estimated that nearly 75% of women will

encounter PMS-like symptoms at some point in their lives(2).These symptoms

significantly affect women's daily lives and overall quality of life, particularly among

female students. Unfortunately, many students tend to overlook the indicators of PMS,

leading to adverse effects on their academic performance (3, 4).PMS can manifest as

irritability, nervousness, fatigue, and menstrual cramps, negatively impacting a woman's

well-being during her menstrual cycle. Premenstrual depression is also reported as a

significant morbidity among female university students, affecting around 37.2% of them.

The cyclical occurrence of both mental and physical signs in PMS disrupts cognitive-

emotional processes, making it more likely to affect female students' academic

performance(5).Various techniques have been used to alleviate PMS symptoms, including

supportive counseling, education, increased physical activity, and a balanced diet for

milder cases. Medications like oral contraceptives, gonadotropin-releasing hormone

agonists, and non-steroidal anti-inflammatory drugs are recommended for severe PMS

symptoms. Despite the prevalence of PMS among women, there is no official national

survey on the subject in Japan. Online polls suggest that a significant majority of women

find their premenstrual disorders highly unpleasant. Moreover, there is a lack of research

on how female students experience PMS symptoms while pursuing their studies(6).

Personality characteristics play a crucial role in one's self-esteem and overall well-

being. Low self-esteem has been associated with various health issues in teenagers,

impacting their outlook on life and their response to stressors. The connection between

13
premenstrual symptoms and certain personality traits is difficult to compare due to varying

study results. Around 5% to 8% of women experience significant PMS symptoms, while

the underlying causes remain speculative. Hormonal issues and neurotransmitter

imbalances have been suggested, but scientific evidence supporting these theories is

limited. PMS affects a substantial number of women, including students, and it can have

far-reaching consequences on their physical, emotional, and academic well-being.

Understanding and addressing PMS symptoms are essential for supporting the overall

health and performance of women, particularly in academic settings(7).A cross-sectional

study was conducted in six nursing schools of Quetta, a self-structured questionnaire from

March to September 2017. The prevalence of PMS was determined among the

participants. Individuals with irregular periods showed a slightly higher likelihood of PMS

diagnosis (8). A questionnaire-based research study was carried out with 300 female

students aged between 16 to 23 years, who were enrolled in various educational

institutions in Peshawar. The questionnaire, comprising 54 closed-ended questions, was

designed to gather information on demographic details, maternal education, and menstrual

knowledge, the impact of menstruation on education, menstrual practices, PMS, and

approaches for managing such irregularities. The collected data underwent analysis using

SPSS version 16.0.The findings indicated that a significant portion of the participants fell

within the 20-21 years age group, and the average age of menarche was around 13-14

years. A majority of the respondents demonstrated a normal Body Mass Index (BMI) and

experienced moderate bleeding during their menstrual periods. The menstrual cycles for

most participants were either less than or equal to 28 days. A large percentage (74.3%) of

respondents experienced menstrual periods lasting 4 to 7 days on average. Among

menstrual irregularities, dysmenorrhea emerged as the most prevalent issue among the

girls. During menstruation, approximately 51.7% of respondents reported severe

14
abdominal pain, 39.3% reported intense leg pain, and 52.7% reported severe back pain.

Furthermore, the study revealed that 28.7% of the respondents sought treatment for their

menstrual irregularities. In conclusion, the study emphasized the significance of

addressing menstrual patterns and related problems adequately to ensure the overall well-

being of adolescent girls(9).

1.2 RATIONALE

PMS symptoms might affect a nurse's ability to concentrate, make decisions, and

perform tasks efficiently. In a critical care setting, where split-second decisions and

focused attention are crucial, any decrement in job performance due to PMS symptoms

could have significant implications for patient care and overall hospital operations. Nurses

play a vital role in patient care, especially in critical care units. Any drop in their

performance due to PMS-related symptoms could potentially compromise patient safety

and quality of care. Furthermore the impact of various factors on nurses' job performance

has been studied, the specific association between PMS and job performance in critical

care settings might not have received much attention. Filling this research gap can

contribute valuable insights to nursing communities.

1.2 OBJECTIVE

The Objective of this study is, to identify the association between premenstrual

syndrome and job performance among Nurses working in tertiary care hospitals of

Peshawar.

1.3 OPERATIONAL DEFINITIONS

Premenstrual syndrome: PMS is physical and psychosocial condition which was

evaluated via PMS scale containing 11 items of symptoms, in which above 05 symptoms

was consider PMS positive while less than 05 symptoms were consider PMS Negative (1).

15
Job performance: job performance will be evaluated via Job performance scale, where

average score from 0 to 2 for job performance will be consider poor, while 3 to 5 will be

consider good (19).

1.4 HYPOTHESIS

Ho: There is no significant correlation between premenstrual syndrome and job

performance among nurse.

Ha: There is a significant correlation between premenstrual syndrome and job

performance among nurse.

1.5 SIGNIFICANCE

Understanding the Impact of Premenstrual Syndrome (PMS) on Nurses:

Premenstrual syndrome is a common yet often overlooked health issue among women,

including nurses. Exploring the impact of PMS on job performance provides valuable

insights into how this condition affects nurses' ability to carry out their professional duties

effectively. The current study will helps identify the specific challenges that nurses with

PMS face during their menstrual cycle. By understanding these challenges, healthcare

organizations can implement support mechanisms and accommodations to assist nurses in

managing their symptoms and maintaining optimal job performance. By examining the

impact of PMS on job performance, this study emphasizes the importance of promoting

female employee health and well-being in the workplace. It will highlights the need for

healthcare organizations to consider the unique health needs of their female workforce.

Overall, the study's significance lies in its potential to improve understanding,

support, and management of PMS among nurses in tertiary care hospitals. It has broader

implications for enhancing workplace environments, promoting employee well-being, and

ultimately, positively influencing patient care outcomes.

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 CHAPTER 2

LITRETURE REVIEW
2.1 INTRODUCTION

A literature review is an essential component of academic research and scholarly

writing. It refers to a critical and comprehensive assessment of published academic

sources and works (such as books, journal articles, conference papers, thesis, and

dissertations) that are relevant to a particular research topic or field of study. The main

purpose of a literature review is to provide context, Identify gaps, Support the research

rationale and develop a theoretical framework, moreover, researchers can learn from

previous studies about suitable methodologies and approaches that have been used to

address similar research questions and compare and contrast of the finding.

2.2LITRETURE SEARCH STRATEGY

Various search engines may be used to search the literature. For the current study,

Google Scholar, Medline, PubMed, and CINAHL have been utilized to conduct a

literature search. In addition, Pak Medi Net has been utilized to find national research

publications. The topic-related search phrases ["association" OR "effectiveness" OR

"impact"] AND ["PMS OR" "PMS prevalence" OR "PMS disorders"] AND ["job

performance" OR "academia OR "exercise"] were used to get relevant search results.

Following that, each article's abstract was examined in order to conduct study-related

relevant articles. A literature review's primary objective stays to look for papers that

compare to the present study's goals and objectives. While looking through the literature,

some restrictions were taken into account. Research article included full-text, free-text,

and original research papers.

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 Inclusion and Exclusion Criteria for Literature Search

S/No Inclusion Criteria Exclusion Criteria

1 Original research articles Unpublished articles

2 Full-text article PMS Not in full-text article

3 Written in English Other than English

4 Articles within last 08 years Published before 2015

2.3 CRITICAL REVIEW ANALYSIS

This session's goal primarily is to give a brief discussion of the literature review on

the impact of PMS, the relationship between PMS and work performance, the relationship

between PMS and personality traits, etc. The research was divided into distinct stages for a

better comprehension so that each session could be explored in depth.

The below mentioned sessions have been covered in this chapter.

1. PMS

2. PMS and Job performance

3. PMS and Personality Trait

4. Strategies for Relieving the symptoms of PMS

5. PMS and Menstrual Characteristics

2.3.1 PREMENSTRUAL SYNDROME

PMS is a cyclical phenomenon of emotional and physical symptoms that

significantly disrupt daily routine activities and interfere with personal happiness. 1 MS

affects approximately 42.8 percent of women, but despite widespread awareness, it

remains the most significant knowledge gap and the primary reason women seek treatment

for the symptoms(3).PMS affects mostly 20 to 25% of women of reproductive age, and the

18
other related term used is premenstrual dysphoria, which affects 3 to 7% of reproductive-

age women. In Japan, very little research was done regarding coping methods among

women regarding PMS. Still, women are using non-pharmacological therapy for such

disorders. About 35.8% of medical students reported that PMS affects the quality of their

lives. Furthermore, PMS was found to be more prevalent among female students than

among Japanese women.1/3 of the students felt that PMS impacted their routine job. (6)

2.3.2 PMS AND JOB PERFORMANCE

PMS had a significant impact on the daily work of the nurses (p<0.0001). More

than half of the nurses experienced PMS symptoms, even among those with regular

menstrual cycles. Approximately half of the nurses reported moderate cramps and back

pain. Common methods of pain relief included taking pills, resting, and using hot

applications. Cold weather and family problems were identified as factors that increased

pain during PMS. The prevalence of PMS and its impact on job performance among

nurses working at Madinah Maternity and Child Hospital and affiliated Primary Health

Care Centers in Al-Madinah, Saudi Arabia Data were collected from 310 nurses using the

Premenstrual Syndrome Scale (PMS Scale and with the help of SPSS 22.The study

revealed that 52.0% of the nurses experienced PMS, with an average PMS score of

114±32. Younger nurses with fewer children, those who had pain before and during their

periods, and those using regulated medication reported significantly higher PMS scores

(p<0.05). Nurses experiencing dysmenorrhea, cramps, and back pain also showed higher

PMS scores. (1).

Despite its limitations, this research contributes significantly to the existing

literature on performance management within Turkey's IT sector. By addressing the

connection between job satisfaction and organizational performance, the study provides

19
valuable insights that can aid in enhancing the overall performance of IT companies in

Turkey. Given the current importance of the information technology sector and the

relevance of human resources in small and medium-sized enterprises (SMEs), it becomes

essential to assess the various aspects of employee management and satisfaction. The

study has certain limitations, such as restricted access to companies' HR data and the

reliance on a comparative analysis of only two companies. Furthermore, the findings are

based solely on secondary data. To improve accuracy and generalizability, future research

should incorporate a larger sample size and include more companies in the study. There is

a relationship between job satisfaction among employees and the organizational

performance process within Turkey's information and technology sector. Existing

literature reveals a lack of quantitative and empirical research that addresses the need for

change in the IT sector of Turkey. This research seeks to bridge that gap by providing data

that sheds light on the critical drivers of success in this industry. Additionally, the study

aims to offer valuable insights to help managers efficiently manage employee

performance.

2.3.3 PMS AND PERSONALITY TRAIT (Nursing students and On Job Women)

There is a strong relationship between PMS and basic personality traits. PMS

prevalence of less extrovert types of personality in women is much higher than

neuroticism. It is clear now that PMs have a great impact on different personality traits.

Furthermore, approximately 57% of females on the job or in school are affected by PMS,

which most likely has an impact on their social life and family relationships. So it is

important to create awareness among adolescents through social media and print media

and give them information regarding coping with PMS(6).

20
 Some psychological factors such as neuroticism, stress, and strategies used for

coping have a strong connection with premenstrual syndrome. To avoid and reduce the

risk of PMS in women, stress reduction programs are essential because psychological

stressors worsen PMS and lead to other complications(7). Good coping strategies, stress-

reducing exercise, or any program are associated with the reduction of PMS, and lastly,

very severe exertions would be made by health care experts to persuade culture and

overwhelmed gender-biased unfavorable conclusions in the control and diagnosis of

PMS.11

Menstruation-related problems are prevalent in nursing students as well. They are

mostly affected by amenorrhea, dysmenorrhea, and well as PMS.PMS affected 63% of

nurses, who reported depressive symptoms, anxiety, pain, irritability, and a change in

appetite. PMS was found mostly in 2 nd and 4th-year nursing students. These young females

are very curious about their conditions as a result of PMS's negative impact on young

girls’ social, psychological, and physical health. Therefore, it is strongly encouraged that a

woman with PMS go through pharmacological and non-pharmacological treatment

methods such as exercise, diet, acupuncture, diuretics, vitamins, and minerals related to

PMS(10). According to Heydari et al, half of nursing students, or nearly one-third of the

sample, harmed their quality of life, as a result of PMS.PMS affects approximately one in

every five women of any age after menarche. Studies show that PMS is mostly prevalent

among educated women (about 80.6%), while ordinary women are less affected(11, 12).

2.3.4 STRATEGIES FOR RELIEVING THE SYMPTOMS OF PMS

According to Naval Heydari et al about 30 to 80 percent of reproductive-age

women experience a series of mental and physical symptoms as well as social dysfunction

during the premenstrual period, and aromatherapy has a significant effect on physical,

21
mental, and social symptoms among females with PMS. Mostly, a combination of Rosa

damascene and citrus aurantium blossoms is used for physical and psychological

symptoms and social functions among women with PMS. Both of these are effective in

improving and reducing the signs and symptoms of PMS, but Rosa damascene has a

greater effect compared to Citrus aurantium in all three categories.(13) However, both of

these oils are essential for relieving the signs and symptoms of PMS. Rosa damasica with

a concentration of 4% and citrus aurantum with a concentration of 0.5% are used. When a

woman's luteal phase of menstruation arrived, they placed 10 drops of essential oil in her

eye from 30 cm away and covered it with an eye pad for 5 minutes, as well as smelled

their blossom for 5 minutes and inhaled it with a normal breathing pattern. The vital oils
14
used in the study Rupari et al are usually obtained from Barij Essence and Adonis Gol

Darou Pharmacological Companies, which prepare all these materials in the desired

concentration. It is commonly available in a 5 mL bottle and has a beneficial effect on

women suffering from PMS(14, 15).

Gnana Sambanthan S et al. conducted a study and discovered that Pilates exercise,

which includes chest lifting with rotation, chest lifting, spine twisting supine, leg

stretching, rotation of the legs, and rolling up, has a major effect on decreasing the signs

and indicators of PMS to a significant level, and thus plays a vital role in healing PMS

symptoms. A quasi-experimental study has been conducted on midwifery students for

three months with the help of a Pilate expert trainer. The researcher took a control and

experimental group, and a premenstrual scale was used for the pretest and post-test.The

result was much appreciated because the score of the experimental group was significantly

lower at the end of the workout than at the start of the exercise. The alteration was

statistically restrained at a higher level of (p 0.001).Furthermore, PMS symptoms are

significantly lower in athletes than in women who do not exercise and live sedentary

22
lifestyles. The significance of Pilates exercise in the cure of PMS indications cannot be

ignored. Furthermore, routine screening among women is also important to reduce the risk

of such issues, and Pilates exercise is one of the best remedies to reduce the symptoms of

PMS and enhance physical and mental health (16, 17).

Premenstrual syndrome (PMS) remains a cyclical late luteal stage condition of the

menstrual cycle in which mental and physical symptoms have a significant undesirable

effect on women's everyday functioning and worth of life. PMS is not widely understood

in the United Arab Emirates (UAE). The purpose of conducting the study was to measure

the frequency and severity of PMS among university undergraduates in Sharjah, United

Arab Emirates, as well as its relationships to dietary practices, lifestyle choices, and

anthropometric characteristics. (18)At the University of Sharjah in the United Arab

Emirates, a cross-sectional survey of female college students was done. Anthropometric

measurements and self-administered questionnaires were used to obtain the data(19).

This study sheds light on the notable prevalence of PMS within a specific demographic,

namely female university undergraduates in the UAE. What's intriguing is that the

research unveiled a significant correlation between eating habits and lifestyle choices

(such as smoking and consumption of high-calorie, high-fat, sugary, and salty foods) and

the severity of PMS. On the contrary, a protective link was observed between PMS and

fruit consumption. Interestingly, this investigation did not find any association between

physical characteristics and the severity of PMS. It is evident that there is a need to

enhance the identification and management of PMS among female university students to

ensure that they are not deterred from seeking appropriate medical guidance.

Consequently, it is imperative to create educational initiatives that increase awareness

among female university students about risky behaviors, risk-reduction strategies related

to diet and lifestyle, and the symptoms of PMS. These overall findings should act as a

23
foundation for further research into the hormonal, molecular, and genetic changes

associated with PMS in UAE university settings and among older female populations.(20,

21).

2.3.5 PMS AND MENSTRUAL CHARACTERISTICS

One of the key signs of reproductive health is menstruation. Investigating

menstruation health and symptoms is therefore vital to enhancing the reproductive health

of young adult and adolescent women. This descriptive cross-sectional correlational study

remained through to define the menstrual phase patterns of young women, the frequency

of premenstrual syndrome (PMS) and polycystic ovary syndrome (PCOS), besides the

correlations between various health-related factors and PCOS and regular

menstruation(22). In the first stage of the study, 462 women took part and answered

questions about their menstrual health and health-related activities. 88 women who had

irregular periods in phase one underwent blood tests and had measurements of their body

composition in the second phase. Menarche appeared in the irregular menstruation group a

little later as a result. Women who had regular periods experienced a normal pattern of

menstruation. In conclusion, this study assessed the capacity, occurrence, duration, and

consistency of young adult women's menstrual cycles; evaluated the prevalence of

clinically significant PMS and PCOS; and examined the connections among the two

dietary consumption and health-related behaviors. The study's strength was its up-to-date

basic data on Korean young adult women's menstrual fitness and the frequency of PMS

and PCOS, both of which are clinically significant. The study did have certain drawbacks,

though, most notably the tiny participant pool and the restrictions on using diagnostic

criteria (23, 24).

24
2.3.6 HEALTH EDUCATION AND PMS

An RCT study was conducted by Sultan Ayaz-Alkaya et al to assess the influence

of a health education agenda established on the Health Belief Model (HBM) on coping

with premenstrual syndrome in late adolescence (PMS). Both the intervention and control

groups each contained thirty women. To manage PMS, the HBM-based education program

was used. Three cycles of PMS symptoms were monitored in both the intervention and

control groups. Premenstrual Syndrome Scale and a questionnaire were used to gather the

statistics. In the frequent measures of the mediation group, there remained a statistically

major variance among the pre-test mean marks and the first, second, and third sequel mean

scores, as well as among the first follow-up mean score and the second and third follow-up

mean scores (p.05). In the context of managing PMS, this study recommends the

implementation of health education programs based on the Health Belief Model (HBM).

These educational initiatives are intended to enhance understanding of the necessity for

lifestyle modifications among individuals experiencing PMS and to motivate them to

embrace these changes., and identify the challenges and rewards associated with the

condition (25).

2.3.7 PREVALENCE OF PMS

Premenstrual syndrome (PMS) prevalence and severity in teenagers were

evaluated, and possible correlations between PMS and premenstrual dysphoric disorder

(PMDD) and phase, location, dietary behaviors, heaviness, worry, genetic influence,

menorrhagia, and dysmenorrhea were found(26). A cross-sectional study was conducted in

the schools of Gujarat's Anand District India Were studied 1702 girls between the ages of

8 and 23 who had reached menarche. Principal Outcomes came, through the use of the

self-administered Premenstrual Symptoms Screening Tool for Adolescents (PSST-A), the

prevalence of PMS and PMDD. 19.3% of women had moderate-to-severe PMS, while

25
4.6% had PMDD. 94.8 percent of females reported having at least one PMS symptom,

with 65.7 percent reported moderate-to-severe symptoms. Now 71.2% of the teenagers, we

discovered dysmenorrhea, and in 15.2%, menorrhagia(27). Family physicians are the first

line of primary care; hence, the study's implications are pertinent to this profession. Those

who experience PMS symptoms and menstruation issues. They can spot patients who have

early menarche, menorrhagia, dysmenorrhea, PMS, or PMDD; they are also able to check

for positive family histories of PMS or menstrual abnormalities, greater stress intensities,

an advanced body mass index (BMI), and higher intakes of fast food, coffee and tea,. They

were able to inform the patients about these connections and how modifying their

standard of living can help them feel better. They can recognize the suffering and

functional impairment that dysmenorrhea, menorrhagia, and physical PMS and PMDD

symptoms produce (28, 29).

The second half of the menstrual cycle indicates the onset of premenstrual

syndrome, a collection of psychosomatic illnesses. It disturbs a large percentage of

females in child bearing age and significantly restricts their everyday activities.

Premenstrual syndrome was examined as it relates to female students in a Kathmandu,

Nepal teaching hospital to determine its prevalence, severity, and effects(30).

Over the course of three months, a cross-sectional study was conducted among

female students at a public hospital in Kathmandu. The Pre-Menstrual Symptom

Screening Test was employed to assess the extent of the symptoms and how they impacted

daily activities. Additionally, the economic status and profiles of the patients were

recorded. Data was collected, entered into the Statistical Package for Social Sciences, and

then analyzed. Subsequently, the results were assessed using the chi-square test. It was

found that female students at the healthcare facility commonly experienced PMS, which

26
had a significant impact on their day-to-day activities, although the severe form of PMDD

was less prevalent. The severity of heavy periods and the amount of menstrual blood loss,

as well as physical activity level and family medical history, all are linked to PMS (31,

32). Premenstrual syndrome (PMS) is a common problem affecting women during their

reproductive age, and its impact extends to their family and work lives. Herbal remedies,

such as saffron, have been proposed as a potential solution for PMS treatment. This

research aimed to investigate whether saffron could alleviate the severity of PMS

symptoms among female university students. A study was conducted randomized, triple-

blind, controlled clinical trial involving 78 female students aged 18-35 years, all residing

in university accommodations. The intervention group received daily capsules containing

30 mg of dried saffron stigma extract, while the control group received placebo capsules

over two menstrual cycles. Data were collected using questionnaires, the DASS21 scale,

and a premenstrual symptoms assessment form. Initially, there were no significant

differences in the mean severity of PMS between the two groups (P = 0.81). However, by

the end of the study, the mean severity of PMS had shown significant changes compared

to the beginning: P < 0.001 for the intervention group and P = 0.04 for the control group.

Overall, the two groups exhibited significant differences in the changes of mean PMS

severity over time (P < 0.001).the study suggests that saffron may be effective in reducing

the severity of PMS symptoms. Nevertheless, further research is necessary to establish

saffron's effectiveness as a viable treatment for this syndrome(33).

There is a gap in all literature review that does not clear the effect of PMS on job

performance among nurses. This study will cover that gap by finding association between

PMS and job performance among nurses by using an adopted questionnaire.

27
2.3.8 SUMMARY

The inclusion and exclusion of research papers from the literature review has been

explored in this chapter's discussion of literature search methodologies. The results of a

search of both national and international literature also emphasized.

28
 CHAPTER 03

METHODOLOGY

3.1 INTRODUCTION

The methodology section of a research study is a crucial component that outlines

the systematic approach used to gather and analyze data, as well as the overall design of

the research. This section serves as a roadmap for readers, providing a clear understanding

of how the research questions are addressed and how the study's objectives are achieved.

In the context of the thesis titled "Association between Premenstrual Syndrome and Job

Performances among Nurses Working at Tertiary Care Hospital," this introduction to the

methodology will elaborate on the research design, data collection methods, and data

analysis techniques employed to investigate the relationship between premenstrual

syndrome and job performance among nurses in a tertiary care hospital setting. The

methodology section will provide a comprehensive approach to investigating the

relationship between premenstrual syndrome and job performances among nurses at a

tertiary care hospital.

3.2 Study Design

The research study was conducted in the critical care area of tertiary care hospitals

of Peshawar from March 2023 to September 2023.The study design used for this study

was cross-sectional analytical.

3.3 Study Setting

The setting was the critical care units (ICUs, CCU, and Emergency Departments)

of tertiary care hospital (Lady Reading Hospital MTI Peshawar, Hayatabad Medical

Complex Peshawar and Khyber Teaching Hospital Peshawar) of Peshawar.

29
3.4 Sample Size

The total population for this study was 346.Out of 346 population 240 nurses were

taken from LRH, 58 from KTH and 48 from HMC Peshawar. The sample size was

calculated via Rao soft software. The calculated sample size was 183, the participants

from LRH was 127, KTH =31 and from HMC the sample size was 25.The detail was:

Margin of error 5%
Confidence Interval 95%
Total population 346
LRH 240/346*183 127
KTH 58/346*183 31
HMC 48/346*183 25
Total= 183

3.5 Sampling Technique

A purposive sampling technique was used for data collection. Before giving them the

Questionnaire, the Questionnaire was briefly discussed with concerned Nurses.

3.6 Sample Selection

3.6.1 Inclusion Criteria

Nurses (Reproductive age) working in a critical care area departments of public tertiary

care hospitals in Peshawar.

3.6.2 Exclusion Criteria

Nurses working in a critical care area departments of public tertiary care hospitals of

Peshawar having age more than 45 year.

3.7 Data Collection Tool

Data was collected upon the approval of ASRB, ERB, and permission letter from

tertiary care hospitals of Peshawar. Informed consent was signed by concerned unit RNs.

30
 The adopted tool for data collection was with (Cronbach’s alpha PMS=0.75(34),

and Cronbach’s alpha job Performance 0.83 Likert scale) used in this study(1). The tool of

data collection comprised of four parts. Section A included demographic data, section B

consisted of general knowledge and menstrual characteristics, section C contained

symptoms that appears during PMS, and section D consisted of job performance(35).

3.8 Ethical Considerations

After the approval from ASRB, the study was approved by Ethical Review Board

KMU as well, the permission letter was generated from the Director of Nursing Office

Institute of Nursing Sciences (KMU) Peshawar to the Director of nursing of tertiary care

hospitals (LRH, KTH, HMC).Moreover permission was obtained from these hospitals as

well and approved from ERB departments of all these hospitals. Before data collection

informed consent was signed by the participants.

3.9 Data Analysis

Data has been analyzed via SPSS version 22 .For the study variables, frequencies

and percentages were calculated-Mean as well as standard deviation has been calculated

for continuous variables. Moreover to find out the association between PMS and Job

performance as well as for inferential statistics Pearson correlation test was applied. While

for descriptive statistics graphs and tables have been used for the displaying of the data.

3.10 SUMMARY

The research technique has been covered in detail in the present chapter, including

the study design, setting of the study, study population, inclusion and exclusion criteria,

specifics of the data collecting instrument, data collection methods, ethical approval, and

strategy for data analysis.

31
 CHAPTER 04

RESULTS
4.1 INTRODUCTION

The results of a research study are a culmination of rigorous data analysis and

provide valuable insights into the research questions and objectives. In the context of the

thesis titled "Premenstrual Syndrome and Job Performances among Nurses Working at

Tertiary Care Hospital," this introduction to the results section will present a summary of

the key findings obtained from the quantitative analyses conducted on the data collected

from nurses at tertiary care hospitals. The quantitative analysis investigated the association

between premenstrual syndrome symptoms and job performance indicators, such as

absenteeism, work efficiency, and interpersonal interactions. These results offer valuable

insights into how premenstrual syndrome might impact nurses' overall job performance

and the challenges they face during this specific phase.

4.2 SOCIO-DEMOGRAPHIC

The results have been divided into 2 parts, section A includes the socio-

demographic data of the study while in section B the association between PMS and Job

Performance, has been discussed.

Data were collected from 183 participants of the critical care area Nurses, 26 to 30

year of age participants were about 55.7%, 22 to 26 year-old participants were 26.8%

while the lowest percentage was from 42 to 43-year old participants who were 0.5%

respectively shown in .(Figure 1)

55.7%
55.7%

32
 Figure 4.2: Pie Chart Elaborating the Age of Participants

Approximately 0.5% of participants in the study possess the most extensive job

experience, spanning 20 to 23 years. Conversely, the group with the least experience,

consisting of those with only 6 months of experience, constituted about 1.1% of the

sample. Additionally, around 20% of the participants had accumulated 3 to 4 years of

work experience. Shown in. (Figure 2.)

Figure 4.3: Job Experiences of the Participants of the Study

33
The study encompassed a varied mix of participants with different educational

backgrounds. According to the data depicted in Figure 10.4:

A significant majority, constituting 48.6% of the participants, held post-RN qualifications.

This indicates that a substantial portion of the participants pursued further education or

specialization beyond their initial Registered Nurse (RN) training.

Approximately 41% of the participants were individuals who held diplomas in nursing.

This suggests that a considerable portion of the sample obtained their nursing education

through diploma programs, which typically emphasize practical training.

In contrast, only a mere 0.4% of the participants were BSN (Bachelor of Science in

Nursing) graduates. This indicates that the study included a very limited number of

participants with bachelor's degrees in nursing, which typically involve a more

comprehensive and academic approach to nursing education.

The distribution of participants across these educational categories provides valuable

insights into the educational diversity within the study, offering a perspective on how

different levels of nursing education may impact the study's findings or results.

( 4.4)

Frequency Percent Valid Percent Cumulative

Percent

Valid Diploma 75 41.0 41.0 41.0

Post RN 89 48.6 48.6 89.6

BSN 19 10.4 10.4 100.0

Total 183 100.0 100.0

Table 4.4 Education Level of Participants

34
60% participants of the study were unmarried, while 39% of the participants were married,

and only 1% were found as divorced participants shown in (Figure 4.5)

Figure 4.5: Marital Status of the Participants

4.5 MARITAL STATUS AND PMS

The correlation table provided indicates the correlation coefficients between two variables:

"PMS" (Premenstrual Syndrome) and "Marital Status" among the participants in the study.

PMS & Marital Status association (Pearson Correlation): 0.191 (significant at the 0.01

level) This correlation coefficient of 0.191 suggests a negative, albeit relatively weak,

correlation between PMS and marital status among the participants. The value of 0.191

denotes a negative association between the two PMS and MS.The significance level of

0.01 indicates that this correlation is unlikely to have occurred by chance. This correlation

suggests that there is a statistical association between experiencing PMS and being

married or not. In this case, being married shows a slightly lower tendency to be

associated with experiencing PMS among the participants in the study. It’s important to

note that while the correlation is statistically significant, the strength of the relationship is

35
relatively modest. Other factors not considered in this analysis might contribute more

substantially to the presence and severity of PMS symptoms among the participants. This

finding could guide further investigation into how marital status might influence or

interact with the experience of PMS, offering insights for support or interventions within

the workplace, especially among nurses in tertiary care hospitals in Peshawar. (Figure 4.6)

PMS MARITAL
STATUS
Pearson Correlation 1 .191**
PMS Sig. (2-tailed) .010
N 183 183
Pearson Correlation .191** 1
MARITAL
Sig. (2-tailed) .010
STATUS
N 183 183
Fig 4.6
4.6 ASSOCIATION BETWEEN PMS AND JOB PERFORMANCE

The correlation table provided the correlations between premenstrual syndrome

(PMS) and job performance (JP) among the participants in the study. The correlations are

measured using Pearson correlation coefficients, which indicate the strength and direction

of the relationship between the two variables.

4.6.1 Correlation between PMS and Job Performance

The Pearson correlation coefficient between PMS and job performance was

0.298**. The "0.298**" next to the correlation coefficient indicates that the correlation is

statistically significant. In this context syndrome (PMS) with itself, this is always perfect

and equal to 1. This diagonal value shows the correlation of a positive correlation

coefficient suggesting that as premenstrual syndrome symptoms increase, job performance

tends to decreases as well.

36
4.6.3 Significance (Sig.) of the Correlations

The significance value (Sig.) associated with the correlations is given as 0.000 for

both PMS with job performance and job performance with PMS. This value represents the

probability that the observed correlation is very high. A significance value of 0.000

indicates that the correlation is statistically significant at a very high level, indicating that

there is a relationship between PMS and job performance.

4.6.4 Sample Size (N)

The sample size (N) for both correlations is 183, indicating the number of

participants included in the analysis for both variables.

In summary, the correlation results suggest that there is a statistically significant positive

relationship between premenstrual syndrome (PMS) and job performance among the

participants. However, it is essential to interpret this correlation with caution, as it does not

imply a causal relationship between the two variables. Other factors and variables not

accounted for in this study could also influence the relationship between PMS and job

performance among nurses. Further research and analysis are needed to gain a deeper

understanding of the nature and implications of this correlation. (Figure 4.6)

37
Association between Premenstrual Syndrome And Job Performance

**. Correlation is significant at the 0.01 level (2-tailed)

Variables TEST PMS Job Performance

PMS Pearson Correlation 1 .298**

Sig.(2-tailed) .000

N 183 183

Job Performance Pearson Correlation .298** 1

Sig.(2-tailed) .000

N 183 183

Fig 4.7 Association Between PMS and Job Performance

4.6 SUMMARY

The research study investigated the association between Premenstrual Syndrome

(PMS) and job performance among critical care nurses. In a notable departure from

existing literature, this study uniquely tackled a topic that had not been previously

explored. The outcomes of the research conclusively demonstrated a robust connection

between PMS and job performance among critical care nurses. This significant finding

underscores the potential impact of PMS on the professional realm of these nurses, an

aspect that had remained unaddressed until now. By establishing this link, the study

contributes a fresh perspective to the field and opens avenues for further investigation and

interventions aimed at enhancing the overall well-being and performance of critical care

nurses facing challenges related to PMS.

38
 CHAPTER 5

DISCUSSION, CONCLUSION AND RECOMMENDATIONS

5.1 INTRODUCTION

In this chapter discussion has been done on the significant finding of the study with

comparison and contrast with national and international studies on the same topic with the

same aim and objectives. The basic aim and objective of this study to find the association

between premenstrual syndrome and job performance among nurses working in tertiary

care hospitals of Peshawar. The discussion of this study has been divided into 2 sections.

Section A include demographics of the studies while section B will describe the

association between PMS and job performance.

5.2 DISCUSSION

In our study the socio-demographic data provided insights into the characteristics

of the participants in the study. The majority of the participants were in the age group of

26 to 30 years (55.7%), followed through 22 to 26 years old (26.8%). Notably, there were

very few participants in the older age group of 42 to 43 years (0.5%), which might impact

the generalizability of the findings to older age groups. Regarding job experience, the

study included participants with varying levels of experience. The highest percentage of

participants had experience ranging from 20 to 23 years (0.5%), while the lowest

percentage had only 6 months of experience (1.1%). The most common experience

duration was between 3 to 4 years (around 20%). The diverse experience levels could

provide valuable insights into how PMS might affect job performance at different stages

of a nursing career. Participants in the study had different levels of education, with the

majority being post RN (48.6%), followed by diploma holders (41%), and a smaller

percentage of BSN graduates (10.4%). The education level might be a crucial factor in

39
understanding the relationship between PMS and job performance, as it could influence

coping mechanisms and job-related skills. The marital status of the participants revealed

that 60% were unmarried, 39% were married, and only 1% was divorced. Marital status

might influence how PMS symptoms are managed and how they impact job performance.

The study found a statistically significant positive correlation (0.298**) between PMS and

job performance among the participants. This result suggests that as PMS symptoms

increase, job performance tends to decreases as well. However, it is crucial to understand

that association does not imply causation. The relationship between PMS and job

performance might be influenced by various other factors not considered in this study. The

significance level (Sig.) of 0.000 indicates that the observed association between PMS and

job performance is highly unlikely to be due to chance.

In a similar context, a prospective-correlational approach was utilized in a study

involving 858, School of Nursing, The University of Jordan, Amman, Jordan students.

The research collected data encompassing daily observations of PMDD and PMS

symptoms, academic drive, and student engagement. The findings indicated that PMS was

prevalent in 92.3% of the participants, while PMDD occurred in 7.7% of cases. Notable

variations in self-motivation levels were observed between students affected by PMS and

those with PMDD. Both PMS and PMDD symptoms were found to exert an adverse

influence on the academic performance of female students. Consequently, mental health

experts play a crucial role in identifying factors that can mitigate the severity of PMDD

among female individuals(36). This study specifically describes the effect of PMS on

academic performance, which is distinct from job performance.

In contrast, a study was conducted in security forces hospital Madina Saudi Arabia

In this study, 52.0% of the nurses reported experiencing premenstrual syndrome (PMS),

with an average score of 114±32. PMS was more prevalent among younger nurses, those

40
with fewer children, and those who had pain before and during their periods. It was also

more common in student nurses who experienced symptoms disappearing before

menstruation and reappearing with its onset, used regulated medication, and had

dysmenorrhea, cramps, and back pain (p<0.05). The research revealed a significant

negative impact of PMS on nurses' daily work performance (p<0.0001). The study

indicates that PMS affects a considerable portion of student nurses, especially younger

ones with specific symptoms, and significantly influences their ability to perform their job

effectively(37).The study lacks a thorough examination of the influence of PMS on job

performance; its focus remains primarily on illustrating the frequency of PMS among

junior student nurses. As a result, it does not distinctly establish whether PMS has an

effect on job performance or not.

On the other hand, a different research endeavor was carried out within nursing

schools situated in Quetta, Pakistan. This study aimed to provide a comprehensive account

of the occurrence of premenstrual syndrome (PMS) among nursing students. However, it

did not definitively address whether this phenomenon has any impact on the job

performance of these student nurses. The study revealed that among the participants, the

prevalence of premenstrual syndrome (PMS) was 26.5% (n=95). Notably, individuals with

irregular menstrual cycles exhibited a higher likelihood of being diagnosed with PMS,

with 32.6% (n=16) being affected; however, the associated p-value of 0.570 indicated

statistical insignificance. Despite the majority of participants reporting a positive current

health status (57.8%, n=207), a significant portion experienced disruptions in their daily

activities due to pain (72.9%, n=27). A variety of emotional states were reported,

including depression (17.9%, n=64), feelings of energy (26.3%, n=94), social withdrawal

(22.1%, n=79), difficulties in carrying weight (18.4%, n=66), and challenges in managing

household tasks (20.9%, n=75)(8).

41
 Furthermore in a similar context, an online anonymous survey gathered both

quantitative and qualitative data from 125 employed women in the UK. More than 90% of

participants reported experiencing premenstrual symptoms, with 40% encountering them

to a moderate or severe degree. Increased symptom severity was notably linked to increase

absenteeism, intentions to decrease working hours, and higher work-related absenteeism

(including time off, lateness, and early departure). Moderate/severe symptoms showed

significant connections with various personal factors, such as lower perceived overall

health, heightened alcohol consumption, poorer sleep quality, anxiety, depression, use of

hormonal contraception, and fewer coping strategies for managing premenstrual

symptoms. Furthermore, these symptoms were associated with work-related aspects,

including a weaker work-life balance, lower psychological resilience, higher perceived

work demands, and reduced control over work-related matters. Despite this, revealing

premenstrual symptoms and citing them as a reason for work absence were infrequent due

to factors like concerns about appropriateness, gender of line managers (often male), and

the personal or sensitive nature of the topic. Notably, those experiencing moderate to

severe symptoms were more inclined to disclose their absence reasons compared to those

with milder symptoms(38).

Another study was conducted in Taiwan in a different context, to investigate the

efficacy of Yoga exercise on 64 menstruating females who participated in a 12-week yoga

exercise intervention. Before and after the intervention, the subjects completed a

structured self-report questionnaire covering demographics, lifestyle, menstrual status,

baseline menstrual pain scores, premenstrual symptoms, and health-related quality of life.

Among the 64 subjects, 90.6% reported experiencing menstrual pain during menstruation.

After the yoga intervention, there was a significant reduction in the use of analgesics

during menstruation (p = 0.0290) and a decrease in the negative impact of menstrual pain

42
on work (p = 0.0011). The yoga exercise intervention was associated with improved

physical function (p = 0.0340) and reduced bodily pain (p = 0.0087) as measured by the

SF-36 questionnaire. Additionally, there were significant decreases in abdominal swelling

(p = 0.0011), breast tenderness (p = 0.0348), abdominal cramps (p = 0.0016), and cold

sweats (p = 0.0143).Furthermore, the reduction in menstrual pain after the yoga exercise

correlated with improvements in six scales of the SF-36 (physical function, bodily pain,

general health perception, vitality/energy, social function, and mental health). These

findings suggest that employers can educate female employees about the benefits of

regular exercise, such as yoga, as it may help decrease premenstrual distress and improve

the overall health of female employees(39).

No other research in this specific context has addressed the same topic. While

various studies have explored different perspectives such as quality of life and academic

performance among students, the mentioned study uniquely concentrated on PMS in

nurses and its repercussions on job performance. Other research has delved into diverse

facets of PMS and its impacts on overall functioning, encompassing academic

performance and quality of life. The link between PMS and job performance is intricate

and influenced by factors like work environment, individual coping strategies, and

symptom severity. An inclusive comprehension of PMS and its effects can enable

workplaces to implement supportive measures for employees facing challenges due to this

condition, fostering well-being and productivity.

5.3 STRENGTH OF THE STUDY

The strength of this study lies in its pioneering exploration of a previously

unaddressed area of research - the association between Premenstrual Syndrome (PMS) and

job performance among critical care nurses. The scarcity of prior studies on this specific

43
topic highlights the originality and innovative nature of my research. By uncovering a

strong association between PMS and job performance, this study contributes valuable

insights that can potentially guide healthcare institutions in understanding and addressing

the challenges faced by critical care nurses due to PMS. This uniqueness not only

enhances the significance of this study finding but also positions my study as a

foundational work upon which future research and interventions can be built to improve

the working conditions and overall well-being of critical care nurses.

5.4 LIMITATIONS AND IMPLICATIONS

While the study provides valuable insights into the association between PMS and job

performance among critical care nurses, certain limitations need to be considered. The

study's cross-sectional nature does not allow for causal conclusions, and other

confounding variables could be influencing the observed correlation. Additionally, the

relatively small sample size might limit the generalizability of the findings to a broader

population.

The implications of this study are significant for healthcare organizations and

management. Recognizing the potential impact of PMS on job performance, employers

should adopt supportive policies to accommodate the needs of female employees

experiencing PMS. Flexible work arrangements and open communication channels could

help employees manage PMS symptoms effectively and maintain job performance.

5.5 CONCLUSION

In conclusion, this study delved into the unexplored territory of the association

between Premenstrual Syndrome (PMS) and job performance among critical care nurses.

With a dearth of prior research on this specific topic, our investigation has shed light on a

significant relationship between PMS and job performance. The findings underscore the

44
importance of recognizing the potential impact of PMS on the professional lives of critical

care nurses, highlighting the need for further attention and support in this regard. As

healthcare institutions strive to optimize the well-being and productivity of their nursing

staff, our study adds a crucial dimension to the understanding of factors influencing job

performance. Moving forward, interventions and strategies can be tailored to address the

challenges posed by PMS, ultimately fostering a more conducive work environment and

enhancing the overall quality of patient care.

5.6 RECOMMENDATIONS

The current study found a correlation between PMS and job performance

among critical care nurses. Based on the study findings here are some suggested

guidelines for nurses concerning the relationship between premenstrual syndrome (PMS)

and job performance are.

Awareness and Tracking: Nurses should become more aware of their menstrual

cycles and monitor PMS symptoms. This understanding helps them plan and

address potential challenges during those times effectively.

Open Communication: Nurses should feel at ease discussing PMS-related issues

with their supervisors. Open communication fosters understanding and support,

allowing for possible flexibility in work arrangements during challenging days.

Utilize Supportive Resources: Nurses should be informed about available

resources, like counseling or employee assistance programs, to cope with the

emotional and physical effects of PMS, promoting overall well-being and job

performance.

45
 Stress Management: Encourage nurses to practice stress management techniques

such as mindfulness and relaxation exercises to mitigate the impact of stress on

their job performance during PMS.

Address Physical Symptoms: Nurses experiencing physical symptoms should

seek medical advice to manage discomfort and enhance their job performance.

Flexibility in Work Arrangements: Employers could consider offering flexible

work arrangements during times when nurses experience severe PMS symptoms,

such as schedules adjustment or remote work options when appropriate.

Raise Awareness: Organizations should conduct educational sessions to increase

understanding about PMS and its potential impact on job performance,

encouraging support and empathy from colleagues and supervisors.

5.7 SUMMARY

In this section, the notable outcomes of the research were examined within the context of

the prevailing body of literature. The chapter concluded by outlining the studies

limitations, strengths, drawing a conclusion, and offering recommendations based on the

findings.

46
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51
APPENDIX-1 ASRB LETTER

52
53
APPENDIX-II DATA COLLECTION LETTER

54
APPENDIX-II DATA COLLECTION LETTER

55
 APPENDICES 3

PERMISSION LETTER FROM LRH

56
57
58
 No: ____________________ Date: ____________

CONSENT FORM
ASSOCIATION BETWEEN PREMENSTRUAL SYNDROME AND JOB
PERFORMANCE AMONG NURSES WORKING AT TERTIARY CARE
HOSPITAS PESHAWAR

Please signature the box:

I confirm that I read and understand the information form dated __________ for the above
study. I have had the opportunity to consider this information, ask question and answered
satisfactory.

I understand that my participation is voluntary in this study and I am free to withdraw the
study without any reason.

I understand that I can ask any time about information and can destroy it.

I agree to take part in the above study.

_______________________ _________________ __________________

Participants Name Date Signature

________________________ ________________
___________________
Researcher Name Date Signature

59
 ASSOCIATION BETWEEN PREMENSTRUAL SYNDROME AND JOB
PERFORMANCE AMONG NURSES WORKING IN CRITICAL CARE UNIT OF
TERTIARY CARE HOSPITALS PESHAWAR

DEMOGRAPHIC DATA

1. Age (in years) :__________

2. Year of experience (in years) :__________
3. Education (a) Diploma (b) Post RN (c) BSN
(d) MSN
4. Marital status (a) married (b) unmarried (c) divorce
GENERAL KNOWLEDGE

5. Where you stay Hostel With my family House-apart

6. Family income (in Pakistani rupees):______________________

7. Mother's education Primary or Secondary High school

less
8. Father's education Primary or Secondary Bachelor
less
9. mother Employed Not employed
Employment
10. father Employed Not employed
Employment of
11. Personality type Introverted Extraverte Rationa Aggressive Emotiona
d l -strict -angry l
12. Smoking Yes No
13. Height in meter
14. Weight in kg
15. Regular physical Yes No
exercise
Menstrual Characteristics

16. Age at menarche (year)

17. Duration of menstrual cycle

(days)

18. Duration of menstrual flow (days) Short Normal Long

19. Mentioned any drug use for

menstrual regulation

20. Dysmenorrhea Yes No

60
21. Family history (mother/sister) Yes No

Is this symptoms occurring 10 days before menstruation and disappearing at the start of
menstruation

01 Depressive effect Yes No

02 Anxiety Yes No

03 Fatigue Yes No

04 Irritability Yes No

05 Depressive thought Yes No

06 Pain Yes No

07 Appetite change Yes No

08 Sleep change Yes No

09 Abdominal bloating Yes No

10 Painful or tender breast Yes No

11 Rapid mood changes Yes No

Is PMS effect your job performance while you caring for a patient

S/no ITEMS very poor Good Very Excellent

poor good
1 Attendance and punctuality
2 Sick and emergency leave
3 Improving your personal skill
4 Relationship with patients

5 Relationship with supervisor

6 Relationship with colleagues

7 Quality of work

8 Improving work method

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9 Your overall performances as
compared to your co-worker

PLAGIARISM REPORT

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