Abstract
The age of 40 and 60 years is the time when a female organism undergoes several changes. It is usually called menopause and characterized by such symptoms as irregular or no periods, uncontrolled hot flashes, sleep problems, mood and weight changes, and unpredictable headaches. In this paper, the researcher seeks to determine the relationship between stress and migraine among elderly women who are past menopause and how this problem can be solved. Quantitative methods are used to answer the PICOT question developed in the paper and clarify of a head massage may be defined as an appropriate intervention for caring for women after menopause who suffer from stress migraines.
Introduction
Practice Issue
Migraine is a medical condition that is very common among middle-aged people. Allais, Chiarle, Bergandi, and Benedetto (2015) define migraine as “a recurrent throbbing headache that typically affects one side of the head and is often accompanied by nausea and disturbed vision” (p. 25). It is common among women than men because of the hormonal factors and susceptibility to stress (Pavlovi et al., 2016; Zimmerman et al., 2016). After the menopause, the level of migraine among women varies considerably and has to be studied from different perspectives.
Background
Migraine often affects people aged 15 to 55 across both genders. Hormonal imbalance is caused by the production of estrogen and progesterone as the primary trigger of migraine among pre-menopausal women. Stress that women could face at work and home is another leading cause of migraine (Pavlovi et al., 2016). However, it is not yet clear why some women still get regularly affected by migraine at their advanced age. As a nurse working at ABC Health Center, the researcher has to understand this problem and find ways to help women.
Aim of the Project
The primary aim is to determine if stress is the primary cause of migraine among women after menopause. The study seeks to determine how stress-related migraine can be managed among these elderly women.
PICOT Question
In women after menopause who suffer from stress migraine (P), how effective is a head massage as the main intervention (I) compared to other alternatives such as the drugs’ prescription (C) in decreasing the level of pain (O) during the recovery time and the ages after 40 (T)?
Significance of the Project
The issue under investigation is very important because of the associated costs. The nation spends a lot of caring for the elderly, and pain management is one of the issues that affect this population. Poor management of migraine may lead to over expenditure, the strain among healthcare givers, and pain among patients in healthcare institutions. As such, it is important to address this problem effectively. It is expected that through this problem, a more effective solution to the problem of migraine among the elderly women shall be obtained, and a head massage will be proven as an effective intervention in research.
Evidence Review and Synthesis
Databases
The researcher uses medical and nursing research databases to identify reliable journal articles that could provide the needed data for the study. Cochrane Library is an important database that provides articles and systematic reviews in the healthcare field. CINAHL also offers evidence-based research articles on the topic under investigation and introduces credible healthcare literature that could be used to explain migraine and stress characteristics. EBSCO, JSTOR, and MedlinePlus are also important databases that may help to find the articles for this research project. The main task is to find the articles and studies that are no older than 5 years, and these databases allow researchers to choose important tools.
Keeper Studies
Recent keeper studies help to obtain the data needed for the study. In the chosen databases, several articles, studies, and reviews may be found. Four keeper studies are the articles by Ripa et al., Cheng et al., Zimmerman et al., and Puig et al. Ripa et al. (2015) discuss migraine in menopausal women and explain how to deal with it using various therapies. Cheng et al. (2015) develop a study about the relationship between the lifestyle of urban Chinese women and migraine. The scholars clarify how lifestyle changes may help to deal with migraine and stress management. Zimmerman et al. (2016) focus on the perception of stress and its relation to migraine among elderly adults. Puig et al. (2015) discuss the quality of life and burden of caregivers of the elderly.
Body Evidence Synthesis
The above articles prove that migraine is one of the common medical problems among elderly women. Stress is defined as the main reason for such neurological disorders as migraine. Regarding the fact that these women are past menopause, the main cause of migraine is current behavioral and emotional changes and stress but not menstrual hormones. At the same time, caregivers provide patients with effective treatment and therapies. Therefore, it is necessary to make a correct and well-grounded choice.
Narrative of the Articles
Article 1
The article by Ripa et al. (2015) provides a high level of quality evidence about migraine in menopausal women. It clearly outlines the triggers of migraine among women falling within the chosen group. This article is significantly important for the study because it provides information about the well-known causes of migraine among women and the ways of how the problem can be managed. It also makes it easy to understand why this problem is uncommon among elderly women. This article will be critical in policy formulation at ABC Healthcare Center in terms of how migraine patients are handled. If the findings of the study are effectively implemented, the management of this hospital will be able to find better ways of managing migraine among elderly women. In this institution, nurses often subject patients to medications (Ripa et al., 2015). However, this study suggests other therapies that can be used. The offered alternatives to the medicine may help patients overcome complications and get well in a short period. Some patients should not be subjected to constant medications because of their advanced age.
The proposed intervention in this article is broad. It primarily involves dealing with the triggers. The emphasis is laid on having preventive measures instead of focusing on treating it. The approach reduces the cost of managing migraine and eliminates pain among the affected population and reduces the work burden among the caregivers. Nurses and other caregivers can focus on other responsibilities within this institution.
Article 2
The article by Cheng et al. (2015) helps to develop the study and create an effective background for discussions. Evidence given in the article is of high quality in terms of the nature of the investigation conducted. It focuses on the importance of a properly chosen lifestyle among the affected population and explains the conditions under which the chosen lifestyle may be related to the problem.
At ABC Healthcare Centers, the caregivers are often forced to deal with the problem. When elderly patients start suffering from stress and develop numerous stressful situations because of their lifestyles, they tend to ignore the initial symptoms that play an important role. They may develop depression which may then advance into a migraine if not properly managed (Cheng et al., 2015). They opt to visit healthcare facilities when the pain becomes unbearable.
In this article, the scholars look at the lifestyle of the elderly women and its possible association with stress and how the stress may cause migraine. The intervention plan recommended in the study may be applied to this healthcare institution. The management of ABC Healthcare Center may learn a lot from this article when it comes to managing migraine among elderly women. Instead of constantly prescribing medications, caregivers may be required to investigate the lifestyle of the patients with the primary aim that is to identify the triggers of stress. If triggers are based on their lifestyle, it is possible to find a way of changing the style of life and eliminate the triggers. The elimination of the causes of the problem is better than the process of treating the problem itself.
Article 3
The study by Zimmerman et al. (2016) is another critical article chosen for this project. The quality of the evidence presented is fairly good, and the article is relevant in regards to the unique approach taken in investigating this problem. In their report, the authors note that African American women are more susceptible to migraine than White women. They admit that most African Americans are not as financially endowed as the White population of the country. As such, they face numerous stressors which are directly related to migraine.
The intervention proposed in this article is the necessity to learn how to manage socio-economic challenges in their lives. The desire to lead a life is explained by the possibility to spend it with friends and relatives (Zimmerman et al., 2016). Still, if some changes or losses occur, they create several reasons for stress and migraine as a result of stress. The mind gets troubled as soon as a person tries to lead a lifestyle beyond their means. The realization that a given lifestyle is beyond their reach causes frustration which may lead to stress.
Regarding the findings of the article, there is a need for a change in policy at the chosen hospital. The caregivers have to focus on counseling their patients on how to handle their everyday life, how to cope with stressful situations, and how to behave when some changes occur. The affected population should learn to live within their means. This intervention will be used in the project proposal because it helps to define the measures to which caregivers may handle their patients beyond the idea to offer drugs as the main treatment.
Article 4
The article by Puig et al. (2015) contains information that is also crucial for the study. Though the main focus of the article is not patients and their needs, it helps to discover the main aspects of migraine management in different healthcare institutions, and ABC Healthcare Center may be compared with the Catalan Institute of Health. The quality of research is high, and the evidence provided is significant in addressing the issue under investigation.
Most of the studies often ignore the effect of job satisfaction on the quality of services that nurses may deliver. In this article, a new intervention approach is offered to help deal with the problem. The focus of the article is medical practitioners and their possible contributions. The management of the chosen healthcare facility must be defined as the best way to improve the output of the staff and ensure that employees are satisfied (Puig et al., 2015) In the current project proposal, a new plan may be needed to promote caregivers with the idea that their interests have to be taken into consideration because they help to deliver the best output in their practice. In comparison to other articles where the attention to nurses and their readiness to take several activities to deal with the problem of migraine among elderly women is paid, this article underlines that caregivers are those, who have to ensure that they can deliver the best results in their work and promote the improvements that are crucial to health care.
Theoretical Framework
Purpose of the Project and Intervention
The main purpose of this project is to determine the relationship between migraine and stress among women past menopause and prove that the chosen intervention is an effective alternative in treating the chosen group of patients. Women, who approach their menopause and suffer from migraine because of the menstrual hormones and the level of stress they have to deal with both at work and home, are taken into consideration. However, women of the advanced age have to deal with these problems rarely. Most of them are retired and experience their menstrual cycle without any problems. Some of them have to worry no longer about caring for their children at an advanced age.
These situations and the necessity to deal with routine affairs are usually defined as the actual causes of stress-related migraine among the chosen population. The project also seeks to determine the best interventions that can be used to deal with the problem among the patients of ABC Healthcare Center. Recently, the institution offered drugs to patients as the main options with several positive outcomes include fast recovery and the possibility to manage pain. However, the study seeks to go beyond the use of prescription drugs. Changes in lifestyle and living standards and the improvement of the working environment for caregivers are new approaches proposed in addition to the use of prescription drugs. In this project, a head massage is the main intervention that is chosen as the alternative to drugs’ prescription. It may help women relax and consider their options during the massage time. Besides, additional benefits of head massage may be discovered during research.
Theoretical Framework
It is important to support the arguments proposed in this study with the existing theories about pain management. Migraine is often associated with intense pain on one or both sides of the head. Although the study aims to find ways of eliminating triggers of migraine, the primary goal of caregivers is to relieve their patients of the pain they are going through. One of the existing theories about pain management is the Gate Control Theory of Pain. This theory is diagrammatically shown in the figure below.
The theory proposes the introduction of the mechanical stimulation that activates inhibitory neurons to reduce the transmission of pain to the brain. The rationale for choosing this theory is its recognition of the physical stimulation as the alternative that could be opposed to the use of drug prescription to manage pain. In a case of migraine management, a head massage may be the best alternative intervention to the use of drug prescription among elderly women. When using this alternative intervention, the patient’s pain is managed without exposure to the drugs which may be harmful in regards to the advanced age of patients.
Clinical Questions
The following clinical questions help to collect the data and investigate different aspects of pain management:
- What is the population affected by this problem in the country?
- What is the best intervention approach, in terms of therapies, that can be used to address the problem?
- What is the alternative approach to address the above problem that compares closely to the above intervention?
- What is the expected outcome if the proposed interventions are used effectively?
- What is the time frame within which the intervention should yield the desired outcome?
Research Methods
Study Design
An experimental research design is chosen in the project. There is a process of randomization in this study. Subjects are assigned to different groups and then subjected to different treatments. It is important to determine if the proposed interventions are capable of giving the expected outcome in this study. Research is based on quantitative methods such as questionnaires and an experiment. After experimenting, the researcher gets access to the quantitative data obtained from the study to determine the extent to which the intervention may help in addressing the problem. Quantitative methods enable the researcher to determine the degree to which the planned intervention.
Setting and Sample
This study takes place in a clinical setting. ABC Healthcare Center is the location of this study. The researcher has been working at the institution for some time and understands the setting. The permission to conduct the study at this institution has already been obtained from the relevant authorities. The participants for the study are expected to be elderly female patients who are diagnosed with migraine. Several elderly women address the hospital with their complaints on moderate to severe headache because of migraine.
Some of them suffer from recurrent migraine attacks. As such, it should be easy to find the participants and make final choices. The researcher intends to use simple random sampling to select the participants for the study. Only those who are willing to take part in the study will be included as part of the sampled population. It is expected to choose 25 female patients aged from 40 to 60, who have been already diagnosed with migraine and defined in their menopause periods. It is also possible to communicate with 5-10 nurses or other medical workers to clarify the effectiveness of a head massage and the observed achievements in treatment.
Confidentiality
The protection of patients’ confidentiality is the ethical aspect that any researcher has to uphold when conducting research. There are cases when participants may be subjected to intimidation because of their views which may contradict the views of the population. In this study, the researcher should assign the participants with special codes instead of using their names. As such, it will be almost impossible for one to identify the participants. Anonymity is the key to the study.
To enhance the level of confidentiality among the participants, the outcome of this study will be based on the idea to share the results with the professor who supervises the project and several representatives of the academic staff. If it became necessary to publish the article because of its relevance in policy formulation at ABC Center, the codes given to each of the participants would be changed to new ones to ensure that no participants could identify their roles in the study.
Procedure and Intervention
The proposed intervention is the use of therapies other than prescription drugs such as a head massage. The head massage is expected to relieve them of the pressure in the head and promote comfort. It is also important to introduce a session of counseling to help them change their lifestyle for a long-lasting solution to the problem. The plan consists of several stages. First, the identification of stressors in the lifestyles of patients occurs. Then, the ways to eliminate the stressors have to be offered. It is necessary to address the root cause of the problem and find a permanent solution to the use of drugs. A head massage has to be defined as the main priority.
Instruments
During the experimental period, it is necessary to measure the outcomes of the intervention. There is a need to measure the changes in the stress levels among both the experimental and control groups. The instrument for research is the Depression Anxiety Stress Scale (DASS) 42 which has been in use several times (Pavlovi et al., 2016). At this institution, the stress levels of the patients have not been tested before hence it is not possible to determine the reliability and validity of the data under the planned setting of research. However, it is known that this instrument is very effective in determining the stress levels of patients. This useful tool helps to clarify the efficiency of the proposed intervention methods in managing stress and migraine among the women who are past their menopause.
Data Collection
Data shall be collected from the participants for analysis. Given the quantitative nature of the study and the fact that the instrument is used in measuring the outcome, Depression Anxiety Stress Scale 42 is the most appropriate method of collecting data through questionnaires. Before experimenting, the participants are divided into two groups and asked to describe the intensity of their pain using the DASS 42.
The researcher should develop a baseline survey before the intervention. The researcher has to record the outcome of the questionnaire and calculate the number of questions and the answers accordingly. After the experiment, the two groups should be questioned again to determine if there are some changes. The outcome of the final questionnaire should promote the possibility of a comparative analysis using quantitative methods. The use of pre- and posttests can make it possible to determine the changes that occur during the period of the experiment. The determination of the applied interventions is effective in addressing the problem.
Data Analysis and Outcomes
Clinical Question
There is a clinical question that guides the entire process of data collection and subsequent analysis: In women after menopause who suffer from stress migraine, how effective is a head massage as the main intervention compared to other alternatives such as the drugs’ prescription in decreasing the level of pain during the recovery time and the ages after 40?
Intervention
It is the responsibility of nurses to ensure that they take care of their patients in the best ways possible. One of the ways of doing this is to provide patients with guarantees that pain relief is possible as soon as they visit healthcare facilities. In this project, there is an attempt to shift from the use of prescription drugs to the use of alternative therapies such as a head massage. The researcher believes that if this procedure is done properly, it can be the best alternative to the use of drugs in fighting moderate to acute headache. At their advanced age, elderly women should not be subjected to the use of excessive drugs. The researcher has also proposed the use of counseling as a long-term solution to the problem. The aim will be to help the patients overcome negative habits that trigger stress.
Outcomes
There are two possible outcomes of the project. On the one hand, it is expected to analyze the level of pain reduction among the patients who complain of moderate to acute headache. As soon as these patients are admitted, they shall be subjected to a head massage as an opportunity to relieve pain. Changes registered by the patients shall be recorded. On the other hand, patients should be asked to determine the level of pain. The pre- and post-test analyses determine if the chosen therapy is effective enough to be used instead of drugs. The experimental group is subjected to counseling and the possibility to change their lifestyle. In this analysis, the focus is to compare two groups (experimental group and control group) and the frequency of coming back to the hospital with the same problem. It is expected that those who are given counseling about lifestyle are less likely to come back with the same problem compared with those who are not counseled.
Statistical Analysis
The researcher plans to conduct a comparative statistical analysis. The use of DASS enables the researcher to measure the level of stress among the participants before and after the experiment. There will be two groups in this project. The statistical analysis involves determining if there is a difference in stress levels between the two groups. The comparative analysis, which is facilitated by the data collection tool discussed above, helps to identify if the proposed intervention can be applied in practice by nurses to help address migraine among elderly women.
Demographic Data
Demographic data includes such factors as age, income, gender, population, race, level of education, occupation, and relationship status. These factors are directly related to stress. For instance, studies have shown that African Americans are more susceptible to stress and migraine than Whites. It is also known that the problem is more common among the less educated poor women than those who are socio-economically empowered. This demographic data will make it easy to determine what kind of help may be offered to each group to overcome stress-related problems unique to their social class.
Expectations
It is expected that if this project is implemented in the manner in which it is proposed, then stress migraine will become less common in the United States among elderly women who are past their menopause. There shall be reduced use of prescription drugs to manage pain meaning that these elderly women will lead a healthier life than was the case before. The cost of caring for these women will also significantly reduce. It is hypothesized that if the ideas were implemented, elderly women would be empowered on how to avoid triggers of migraine.
Stakeholders
The director at ABC Healthcare Center plays a significant role in allowing this project to be conducted. The chief nursing officer takes responsibility for allowing other nurses within this facility to help in the project. Individual nurses who shall be a part of the project in terms of delivering the therapies and other services have to be taken into consideration. Finally, the direct participants (patients) turn out to be the main part of this study because their words and opinions help to collect the needed data.
Potential Barriers
The biggest barrier may be a possible change of mind of the administrators in terms of conducting a study within the institution. This has been addressed by obtaining a signed consent to conduct this study at the institution. There is also the risk of the nurses or patients changing their mind about being part of the study. Possible replacements have already been identified.
References
Allais, G., Chiarle, G., Bergandi, F., & Benedetto, C. (2015). Migraine during perimenopause. The Journal of Headache and Pain, 16(1), 25. doi: 10.1186/1129-2377-16-S1-A25
Cheng, J., Wang, T., Li, F., Xiao, Y., Bi, J., Chen, J.,… Zhao, X. (2015). Self-rated health status and subjective health complaints associated with health-promoting lifestyles among urban Chinese women: A cross sectional study. PLoS ONE, 10(2), 1-10. Web.
Pavlovi, J., Allshouse, A., Santoro, N., Crawford, S., Thurston, R., Neal-Perry, G., … Derby, C. (2016). Sex hormones in women with and without Migraine: Evidence of migraine-specific hormone profiles. American Academy of Neurology, 6(1), 1-7.
Puig, M., Rodriguez, N., Lluch-Canut, M., Moreno, C., Roldán, J., & Montesó, P. (2015). Quality of life and care burden among informal caregivers of elderly dependents in Catalonia. Revista Portuguesa de Enfermagem de Saúde Mental, 1(14), 9-14.
Ripa, P., Ornello, R., Degan, D., Tiseo, C., Stewart, J., Pistoia, F., … Sacco, S. (2015). Migraine in menopausal women: a systematic review. International Journal of Women’s Health, 7(45), 773–782.
Zimmerman, M., Ezzati, A., Katz, M., Lipton, L., Brickman, A., Sliwinski, M., & Lipton, R. (2016). Perceived stress is differentially related to hippocampal subfield volumes among older adults. PLoS ONE, 11(5), 1-8. Web.