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PREPARING THE ASSIGNMENT
Format and Special Instructions
1. Paper length: 6 pages minimum; 8 pages maximum, excluding title page and reference page.
Points will be deducted for not meeting these requirements.
2. A minimum of 6 (six) scholarly references are required. References must be current – not older
than 5 years, unless a valid rationale is provided and the instructor has approved them. Consult
with the course instructor about using an older source.
3. A dictionary, required textbooks for this course and Chamberlain College of Nursing lesson
information, may NOT be used as scholarly references for this assignment.
4. Title page, running head, body of paper, and reference page(s) must be in APA format as
presented in the 6th edition of the manual
5. Ideas and information from readings and other sources must be cited and cited correctly.
6. Grammar, spelling, punctuation, and citations are consistent with formal academic writing as
presented in the 6th edition of the APA manual
DIRECTIONS AND ASSIGNMENT CRITERIA
Assignment Points
Criteria
Introduction
30
%
11%
Description
The introduction for this paper includes:



Description of
Issue
or
Concern
80
29%
General statements on the idea of nursing theory being
applied to solve problems/issues in nursing practice.
A one-paragraph summary of the selected specific nursing
theory is required.
Information identifying the sections of this assignment.
The selected issue or concern must be clearly identified as
being as being significant to the professional area of either
leadership, education, informatics, healthcare policy or advance
clinical practice. The issue or concern must be presented
comprehensively, but concisely by answering each of the
following questions.




What is the specific issue or concern being presented?
Why should the nursing profession care about this issue
or concern?
What does the nursing literature have to say about this
issue or concern including its frequency of occurrence?
Who are the stakeholders or the people affected by the
issue or concern?
It is expected that a minimum of 3 (three) nursing scholarly
references will be used to present and support the provided
answers.
Application of
Selected
Nursing
Theory
to
Issue
or
Concern
90
Conclusion
30
33%
This section of the assignment focuses on using the selected
nursing theory to resolve the described issue or concern.
Required information includes:


Restating the selected nursing theory to be used
Identification of one strategy useful in resolving the
identified issue or concern. The strategy should be
presented in depth with the following information being
required:
o A specific description of how the selected
nursing theory can help to resolve the issue or
concern
o A specific and detailed description of the
strategy to be used
o A specific and detailed description of how the
strategy can be implemented
o A specific and detailed description of one ethical
or legal aspect related to the selected strategy
o A specific and detailed description of one
suggestion for future research into either the
selected nursing theory or selected issue or
concern.
It is expected that a minimum of 3 (three) nursing scholarly
references will be used to present and support the provided
answers.
11%
This section provides a summary or review of the key elements
of the assignment including the selected nursing theory and its
application to the issue or concern.
The concluding statements include self-reflection on the new
knowledge gained about applying nursing theory to a
professional issue or concern.
Paper
Requirements
10
4%
Paper meets length requirements of 6 to 8 pages
Minimum of 6 scholarly references
A dictionary, required textbooks for this course and
Chamberlain College of Nursing lesson information, may NOT
be used as scholarly references for this assignment.
References are current – within a 5-year time frame unless a
valid rationale is provided and the instructor has approved
them.
APA Format
Citations
Text
Writing
Mechanics
in
15
5%
Title page, running head, body of paper, and reference page
must follow APA guidelines as found in the 6th edition of the
manual. This includes the use of headings for each section or
topic of the paper. [one deduction for each type of APA style
error].
10
4%
Ideas and information that come from readings must be cited
and referenced correctly.
10
4%
Rules of grammar, spelling, word usage, and punctuation are
followed and consistent with formal written work as found in
the 6th edition of the APA manual.
Reference
References
Pittet, V., Rogler, G., Mottet, C., Froehlich, F., Michetti, P., de Saussure, P., & … Vader, J.
(2014). Patients’ information-seeking activity is associated with treatment compliance in
inflammatory bowel disease patients. Scandinavian Journal Of Gastroenterology, 49(6),
662-673. doi:10.3109/00365521.2014.896408
References
Carthron, D. L., Johnson, T. M., Hubbart, T. D., Strickland, C., & Nance, K. (2010). “Give Me
Some Sugar!” The Diabetes Self-Management Activities of African-American Primary
Caregiving Grandmothers. Journal Of Nursing Scholarship, 42(3), 330-337.
doi:10.1111/j.1547-5069.2010.01336.x
References
Wong, C. L., Ip, W. Y., Choi, K. C., & Lam, L. W. (2015). Examining Self-Care Behaviors and
Their Associated Factors Among Adolescent Girls With Dysmenorrhea: An Application of
Orem’s Self-Care Deficit Nursing Theory. Journal Of Nursing Scholarship, 47(3), 219227. doi:10.1111/jnu.12134
References
Knox, L., Douglas, J. M., & Bigby, C. (2013). Whose decision is it anyway? How clinicians
support decision-making participation after acquired brain injury. Disability &
Rehabilitation, 35(22), 1926-1932. doi:10.3109/09638288.2013.766270
Reference
Wolff, G., Strecker, K., Vester, U., Latta, K., & Ehrich, J. H. H. (1998). Noncompliance following renal transplantation in children and adolescents.
Pediatric Nephrology, 12(9), 703-8.
doi:http://dx.doi.org/10.1007/s004670050531
Wolff, Strecker, Vester, Latta, & Ehrich
CLINICAL SCHOLARSHIP
Examining Self-Care Behaviors and Their Associated Factors
Among Adolescent Girls With Dysmenorrhea: An Application of
Orem’s Self-Care Deficit Nursing Theory
Cho Lee Wong, PhD, RN1 , Wan Yim Ip, PhD, RN2 , Kai Chow Choi, PhD3 , & Lai Wah Lam, PhD, RN4
1 Professional Consultant, The Chinese University of Hong Kong, Hong Kong
2 Associate Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
3 Assistant Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
4 Professional Consultant, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong
Key words
Dysmenorrhea, Orem’s self-care deficit nursing
theory, path analysis, self-care
Correspondence
Dr. Cho Lee Wong, Room 628, Esther Lee
Building, The Chinese University of Hong Kong,
Hong Kong.
E-mail: jojowong@cuhk.edu.hk
Accepted: February 2, 2015
doi: 10.1111/jnu.12134
Abstract
Purpose: To test a hypothesized model that examines the relationship between selected basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea using Orem’s self-care deficit
nursing theory as a framework.
Design: This was a predictive correlational study conducted with a total of
531 secondary school girls.
Methods: Self-care agency, self-care behaviors, and 11 variables that have
been theoretically or empirically justified in previous studies as relevant to
basic conditioning factors were selected and collected by means of structured
questionnaires. Path analyses were performed to test the hypothesized linkages
among variables.
Findings: Path analysis revealed that age and received menstrual education had both direct and indirect effects through self-care agency on self-care
behaviors. Mother’s and father’s educational level, pain intensity, and selfmedication used when experiencing dysmenorrhea only affected the self-care
behaviors directly.
Conclusions: This is the first study that provided information about the relationship between basic conditioning factors, self-care agency, and self-care behaviors among adolescent girls with dysmenorrhea. Knowledge of the factors
influencing self-care behaviors in these adolescent girls will assist healthcare
professionals in developing effective interventions to promote self-care and
ameliorate the adverse impact of this condition.
Clinical Relevance: Interventional strategies that aim at promoting self-care
behaviors among adolescent girls with dysmenorrhea should strengthen girls’
self-care agency and should target those with a younger age, higher pain intensity, mother with a higher educational level, father with a lower educational
level, and those who do not take self-medication for dysmenorrhea.
Dysmenorrhea is a common menstrual problem among
adolescent girls (Banikarim, Chacko, & Kelder, 2000;
Bettendorf, Shay, & Tu, 2008). Prevalence rates have
been reported ranging from 20% to 90% (Campbell &
McGrath, 1999; Davis, Westhoff, O’Connell, & Gallagher,
2006). Dysmenorrhea is a distressing condition affecting
Journal of Nursing Scholarship, 2015; 47:3, 219–227.

C 2015 Sigma Theta Tau International
not only the academic and social aspects of adolescent
girls, but it is also the leading cause of their short-term
school absenteeism (Banikarim et al., 2000). Adolescent
girls prefer performing self-care to relieve their discomfort instead of seeking medical advice (Chiou & Wang,
2008; Lau, Yu, Cheung, & Leung, 2000). The important
219
Self-Care Behaviors for Dysmenorrhea
role of self-care in relieving dysmenorrhea has also
been reported (Cheng & Lin, 2010; Wong & Ip, 2012;
Wong, Lai, & Tse, 2010). However, little is known about
how adolescent girls exercise self-care and the factors
associated with it. Understanding adolescents’ self-care
behaviors and their associated factors could help healthcare professionals to identify potentially harmful or
ineffective behaviors, and therefore formulate appropriate management and education plans (Hillen, Grbacac,
Johnston, Straton, Keogh, 1999).
This study was guided by Orem’s self-care deficit nursing theory. According to Orem (2001), a person initiates and performs self-care for maintaining life, healthful
functioning, and well-being. He or she must acquire selfcare agency for self-care, and self-care agency is influenced by basic conditioning factors (BCFs). BCFs include
age, gender, developmental state, environmental factors,
family system factors, sociocultural factors, health state,
pattern of living, healthcare system factors, and availability of resources (Orem, 2001). These BCFs may influence
an individual’s ability to participate in self-care activities
or modify the kind or amount of self-care required. On
the basis of Orem’s theory and literature review, potential variables of BCFs postulated as influencing self-care
behaviors or self-care agency of adolescent girls suffering
from dysmenorrhea were identified.
The relationship among age, self-care agency, and selfcare behaviors of adolescent girls suffering from dysmenorrhea was initially examined. Previous studies proposed
that self-agency and self-care behaviors likely increase as
girls increase in age (Moore, 1993; Zhimin, 2003). However, other studies (Cull, 1996; Dashiff, McCaleb, & Cull,
2006; McCaleb & Cull, 2000) documented a negative correlation between age and disease-related self-care.
Family system factors are commonly defined as
mother’s and father’s occupation and education, living
situation, marital status, birth order, and social and emotional support (Moore & Pichler, 2000). Adolescent girls
usually sought advice regarding dysmenorrhea self-care
from their mothers (Chiou & Wang, 2008); educated
mothers may also provide detailed information regarding
dysmenorrhea (Finlay, Jones, & Kreitman, 2000); thus,
a mother’s educational level possibly influenced the selfcare of adolescent girls suffering from dysmenorrhea. A
father’s educational level also possibly influenced selfcare (Cull, 1996; McCaleb & Cull, 2000).
For sociocultural factors, Orem (2001) did not provide
a definition for it but included culture, education, occupation, and experiences as sociocultural factors without further elaboration. In Chinese culture, illness occurs when
there is an imbalance between yin–yang, hot–cold, dry–
wet, as well as “qi” and holism (Ma, 1999). Menstrual
symptoms, such as dysmenorrhea, can be interpreted as
220
Wong et al.
weakness in the general health of women and is caused
by “blood” and “qi” stagnation that results in an imbalance of yin and yang in the body. Given that culture determines the ways in which symptoms, such as menstrual
pain, were handled (McMaster, Cormie, & Pitts, 1997),
culturally specific self-care behavior on dysmenorrhea,
such as the use of herbal remedies and acupressure, were
reported in previous studies (Cheng, Lu, Su, Chiang, &
Wang, 2008; Wong et al., 2010). However, the influence
of culture on self-care agency and behavior of dysmenorrhea are difficult to assess using a quantitative approach;
a qualitative approach is required to develop insights into
the influence of culture on both aspects (Orem, 2001).
For instance, adolescent girls with a high family income may be more resourceful than those with low
family income; thus, the former may exhibit a higher
level of self-care agency and self-care behavior than
the latter (Baker & Denyes, 2008). However, using a
multiple regression model to predict self-care behaviors,
Chang and Chuang (2012) found that the socioeconomic
condition of the family was not significantly associated
with dysmenorrhea self-care behaviors among adolescent
Taiwanese girls.
Measurement of the health state has been either general, such as the presence or absence of health problems
(Callaghan, 2006), or specific to the disease condition,
such as duration of illness (Ailinger & Dear, 1993) or
pain intensity (Zadinsky & Boyle, 1996). The regularity of
the menstrual cycle, duration of menstruation, and pain
intensity were possibly related to self-care behaviors toward dysmenorrhea (Chang & Chuang, 2012; Chia et al.,
2013).
Patterns of living encompass all the actions people perform daily (Orem, 2001). Limitation in daily activities affects self-care, and the relationship of these activities with
self-care was also noted in previous studies (Chia et al.,
2013; Ortiz, 2010). The healthcare system is characterized by disciplines, such as nursing and medicine (Orem,
2001). Study has suggested that medical consultation regarding dysmenorrhea influences self-care (Chiu, Wang,
Hsu, & Liu, 2013).
Availability of resources influences the means to meet
self-care measures (Orem, 2001). Prior experience of receiving menstrual education may influence the adoption of self-care behaviors for dysmenorrhea (Chiu et al.,
2013); however, Chang and Chuang (2012) found that
knowledge about dysmenorrhea was not significantly
correlated with the adoption of self-care behavior among
adolescent girls. Few studies reported that adolescent girls
from Western countries prefer self-medication for dysmenorrhea (Agarwal & Venkat, 2009; O’Connell, Davis
& Westhoff, 2006). However, self-medication is not under the construct of self-care among adolescent girls with
Journal of Nursing Scholarship, 2015; 47:3, 219–227.

C 2015 Sigma Theta Tau International
Self-Care Behaviors for Dysmenorrhea
Wong et al.
dysmenorrhea in Hong Kong (Wong, Ip, Choi, & Shiu,
2013). Thus, further research is required to test the relationship between self-medication and self-care behavior
in a local context. Likewise, self-care agency influences
self-care, as explained in Orem’s theory and previous
studies (Slusher, 1999; Callaghan, 2006).
In summary, previous studies support the proposition
and provide inconclusive evidence with regard to the relationship between BCFs, self-care agency, and self-care.
However, no study to date was found to examine the
role that BCFs and self-care agency play in the dysmenorrhea self-care behaviors. Even though existing theories provide insight into the factors necessary for self-care
behavior, this should be tested before conclusions are
made. Accordingly, a total of 13 variables were assessed.
Eleven of these variables were BCFs, which included age,
two family system factors (mother’s educational level
and father’s educational level), one sociocultural factor
(family income), three health state factors (regularity of
menstrual cycle, duration of menstruation, and pain intensity), one pattern of living factor (limitations in daily
activities due to dysmenorrhea), one healthcare system
factor (medical consultation for dysmenorrhea), and two
related to the availability of resources (received menstrual education and self-medication used when experiencing dysmenorrhea). The remaining variables were
self-care agency and self-care behaviors for dysmenorrhea. A hypothesized model of self-care behaviors
and their associated factors among adolescent girls with
dysmenorrhea was proposed (Figure 1).
Methods
Design and Sample
A cross-sectional, descriptive correlational design with
a predictive approach was utilized to investigate the
correlates of self-care behaviors among Hong Kong
adolescent girls with dysmenorrhea. The sample size
determination was based on a power analysis in the
assessment of the root-mean-square error of approximation (RMSEA), one of the most commonly reported
fit indices of path analysis (MacCallum, Browne, &
Sugawara, 1996). A convenience sample of 531 girls was
recruited from three secondary schools. Participants were
Figure 1. A hypothesized model of self-care behaviors and their associated factors among adolescent girls with dysmenorrhea.
Journal of Nursing Scholarship, 2015; 47:3, 219–227.

C 2015 Sigma Theta Tau International
221
Self-Care Behaviors for Dysmenorrhea
13 years old or older and had experienced pain during
the last three cycles. Girls who reported a history of
gynecological disease or surgery or suffered from severe
disease were excluded.
Instruments
The Adolescent Dysmenorrhic Self-Care Scale.
The Adolescent Dysmenorrhic Self-Care Scale (ADSCS)
was used to assess the adolescent girls’ self-care behaviors toward dysmenorrhea (Hsieh, Gau, Mao, & Li,
2004). Girls were asked to rate themselves on a 6-point
Likert scale, with higher scores reflecting higher level
of self-care behavior being practiced. The ADSCS has
been translated into Chinese-Cantonese and validated
in Hong Kong adolescent girls with dysmenorrhea with
good reliability (Cronbach’s α = 0.94; Wong et al., 2013).
In this study, the Cronbach’s α coefficient for the entire
scale was 0.92.
The Exercise of Self-Care Agency Scale. The Exercise of Self-Care Agency Scale (ESCAS) was used to
assess the self-care ability of an individual (Kearney &
Fleischer, 1979). It has been translated into ChineseCantonese and validated in Hong Kong adolescent girls
with dysmenorrhea (Wong, Ip, & Shiu, 2012). The 35item Chinese-Cantonese version (CC-ESCAS) measured
four aspects of self-care agency: self-concept, knowledge
and information seeking, passivity, and motivation. The
reliability of the CC-ESCAS was good, with a Cronbach’s
α of 0.92 (Wong et al., 2012). The Cronbach’s α coefficient of the entire scale in this study was 0.91.
The Demographic Information Sheet. The demographic information sheet, consisting of 11 items, was
developed by the researchers with reference to previous
literature to gather information related to selected BCFs
(Chiou & Wang, 2008).
Procedure
Ethical approval was obtained from the ethics research
committee of the study institution. All form two to seven
secondary school female students were given a written
information sheet in their classrooms. The researcher distributed a set of self-administered ano …
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