Portfolio Project

EDUC 765: Trends and Issues in Instructional Design

By: Beth Tietz

Submitted February 26, 2016

PROJECT PROPOSAL REDUCE & RESOLVE PELVIC PAIN IN WOMEN

Sponsoring Organization
The Tie that Binds Us: Endometriosis
Bringing awareness, education, and hope to potential and confirmed endometriosis suffers.

Project Description
Pelvic pain can be more common in women than in men due to several factors. A female has several more organs in her pelvis, and
those organs are together in the lower left quadrant. Pelvic pain is often mistaken as a woman exaggerating menstrual cramps,
appendicitis, irritable bowel syndrome, ectopic pregnancy, pelvic infection, ruptured ovarian cysts, ovarian torsion, interstitial
cystitis(IC), and other pelvic disorders.
Across the globe for 1/10 women, this pelvic pain is endometriosis. The pain from endometriosis and interstitial cystitis can feel like
an appendicitis attack, but the pain tends not to be recognized by society. Because of this, the average time for a woman to receive
an official endometriosis diagnosis is 10 years.
When a woman hits the 10 year mark, she may have irreversible damage of multiple internal pelvic organs, including bladder,
intestines, colon, appendix, and gall bladder. Endometriosis can be very aggressive in causing permanent damage. It has been found
is every organ but the spleen. Endometriosis is the 3rd leading cause for infertility.
Any woman old enough to menstruate should not be ignored while in chronic pain, deserves appropriate care, and the best quality of
life possible.

Aim

Promote better care for general pelvic pain in girls and women, narrow down what may be causing pain, and advocating for
appropriate care.
Girls and women experience best results when early detection of endometriosis and diagnosis are sought after.
Potential endometriosis patients can be empowered through education to prevent long term, debilitating effects.

Target Audience

Menstruating girls and women.

Mothers of girls and women.

Other family members of women.

Delivery Options

Instruction for this project will be delivered with an online option, as well as a workshop option.
This option is chosen because endometriosis is a worldwide epidemic that needs more attention and research.
The online method will be able to reach a wide audience, and the workshop will facilitate sharing local resources

FRONT-END ANALYSIS: INSTRUCTIONAL NEED

Problem Identification:
There is a great need for an instructional intervention for women with pelvic pain. For the medical community, this is an existing
performance problem. This project will focus on the strategy development to instruct women in pain, as well as mothers with
daughters in pain. There is a lot of potential to address the reduction of time needed to recognize pelvic pain
A comparative needs analysis can utilize data to compare the general population of women versus women with confirmed
endometriosis.
Girls and women can track symptoms, adjust diet, learn stretches, to become better advocates for their health care.
There can be more education to determine which pelvic organ is causing pain-stomach, appendix, ovaries, uterine cramping, gall
bladder, bladder issues, and UTI.

Summary of the studys purpose

The instructional need for this project was determined though utilization of a needs assessment to help identify gaps in care for women
with pelvic pain, and most have confirmed through a laparoscopic surgery that endometriosis was active.
Women that have confirmed endometriosis have been in pain on average of 10 years before reaching the diagnosis. This is a group of
women has either felt needs, or expressed needs because they don't want young girls and women to be told their pain is normal.
Women tend to be proactive in seeking out care and supporting other patients.

Summary of the process

I started my needs assessment by asking 3 open ended questions in an online support group for endometriosis to help shape my 10
survey questions to determine the largest gap in pelvic pain care.

Summary of the Results

Out of 100 women, 30% have been to pelvic floor therapy, and 70% have not.
Some of the comments received included the following:

It has never been recommended/never heard of it

I'm not comfortable with that kind of treatment
Will try anything to get relief
No referral
No insurance
Never been recommended
Just learned it existed

Of 100 women, 66% of women have tried dietary changes to reduce pelvic pain, and the popular item removed was gluten. 33% have
not considered a dietary intervention

Necessary Recommendations:
The largest gap was not what I expected to it, which I foresaw as a diet need, but it turns out that more women could be benefiting
from pelvic floor therapy.

Method:

Discovering training and learning needs

Literature research
Interviews
Surveys
Observations

FRONT-END ANALYSIS: LEARNER CHARACTERISTICS

Learner Analysis
Primary Audience

Women able to menstruate.

Women in pelvic pain.
Mothers.

Secondary Audience

Medical Community.
Insurance Companies.
Spouses & other family members.
Schools.
Sorority National offices.
Girl Scouts.

General Learner Characteristics

99.9% Female.
Menstruating age and older, in chronic pain.
42% of women age 25-34; 33% age 35-44.
Most work part time or full time; but 12% of survey reports disabled and unable to work.
More than 55% go to the doctor 5 or more times a year.
Wide education range and work experience.
Most are able to walk, and gentle lifting.

Entry Characteristics

Prerequisite skill and knowledge:

o Familiar with painful periods that Advil and Midol do not help
o Painful periods and/or ovulating
o Frequent UTIs and/or yeast infections

o Needs advanced pain management past Advil & Midol

Learner has been to multiple doctors and not finding answers.

Contextual Analysis
Orienting Context

Goals that the learners will have for this instruction are the following:
o Reduce pelvic.
o Determine the source of the pelvic pain.
o Find proper medical intervention.
Learners perceived utility of the instruction:
o Will be welcomed as useful information to help them leverage the medical community.
o Will help empower them to make life style changes.
o Will empower to use their network to find the best providers.
Learners perception of accountability of the instruction:
o Will be a higher engagement because the pelvic pain can interfere with the quality of life.
The following are the learners potential misconceptions towards pelvic pain:
o Pelvic pain is normal.
o Women are exaggerating severity of menstrual cramps.

Instructional Context

Workshop: Saturday morning at 10 a.m. to give time for rest, and for potential pain meds to kick in.
Lighting should be adjustable.
Noise should be minimal so learners can listen easily.
Temperature can be cooler so participants can use heat for pain.
Seating can be grouped at tables.
Accommodations to include filtered water and herbal, gluten free, and anti inflammatory snacks.
Microwave

Participants will provide their own transportation.

Technology Inventory

Computer, tablet, or mobile device.

Transfer Context

Opportunities to transfer the knowledge and skills to new situations include the following:
o Advocate for best treatment by asking questions
o Gain research skills
o Become detail orientated
o Improved ability to navigate the medical system

INSTRUCTIONAL IMPACT BASED UPON LEARNER CHARACTERISTICS

Application of Learning Theories
Social-cognitive theory was utilized because there is a great amount of information exchanged and learned when in a
cooperative setting. A lot of times, it seems like the medical community is baffled, and have a hard time relating to patients.
The more open the learner can be to seeking out social networks, the benefit of reaching a proper diagnosis sooner will bring a
better quality of life.
Pelvic pain matches with adult learning theories:
Adults are problem centered, especially if pelvic pain is preventing them from life.
Adults are seeking solutions.
Adults want results with their learning.
Adults may be motivated to be a resource, and to share their knowledge and experience.

Application of Motivational Theories

By using the Kellers ARCS Model of Motivational design, participating in this program could:
Engage in real stories of how women have been failed by the health system, but also real stories in how well life can be
when you advocate for the proper care.
Feel the camaraderie and community of sisterhood.
Will experience me too support.
Bring relevance to symptoms and will know their bodies better.
Through learning assessments and scenarios, women will gain confidence.
Satisfaction and success will be continuous when comparing previous life quality to each months improved quality.

Impact of a Diverse Audience on Instruction

The impact of a diverse audience is hard to gauge, as other cultures may not be as open to sharing pelvic pain
symptoms.
There are a lot of misconceptions and myths about the female body.
It will be extremely important to be sensitive when explaining and reacting.
Many females have been told this pain is all in their head, and they need to be validated.

INSTRUCTIONAL OBJECTIVES
Project Goal
Help women identify and learn about unexplained pelvic pain; then minimize pain through wellness and diet, manage, and find
appropriate care.

Terminal Objectives and Enabling Objectives

Terminal Objective: Upon completion of the instruction, the learner will be able to recognize pelvic pain. (CognitiveKnowledge).
Enabling Objectives:
Recognize pelvic pain & symptoms.
Know where endometriosis can grow, and long term effects.
Recognize it is not normal to be in pain for your period, for cramps, for ovulating, and for intercourse.
There is no such thing as a bad period.
Killer cramps are not normal.
Terminal Objective: Upon completion of the instruction, the learner will be able to (Cognitive-Comprehension and
Application).
Enabling Objectives:
List pelvic pain symptoms.
Track pelvic pain symptoms.
Be able to identify family members with pelvic pain, and possibly their diagnosis.
Identify other common medical conditions that accompany endometriosis.
Notice if certain foods trigger pain.
Try an anti-inflammatory diet or elimination diet.

Terminal Objective: Upon completion of the instruction, the learner will be able to create wellness routines and healthy
habits. (Cognitive-Comprehension and Application).
Enabling Objectives:
Learn stretches/yoga.
Have a walking or swimming schedule.
Heat and Cold therapy.
Epsom salt baths.
Vitamins.
Diet changes.
Make and take an Epsom salt, baking soda, and vinegar bath.
Learn stretching.
Heat and cold therapy.
Terminal Objective: Upon completion of the instruction, the learner will be able advocate for the best possible care. (All
domains).
Enabling Objectives:
Understand treatment options and solutions to manage pain.
Pelvic floor therapy.
Know the difference between ablation and excision surgeries.
Be able to ask for a referral for an excision specialist, and to pelvic floor therapy.

ENABLING OBJECTIVES MATRIX & SUPPORTING CONTENT

Enabling
Objective

Recognize
pelvic pain &
symptoms.

Level on
Blooms
Taxonomy

Knowledge,
Comprehension,
Application

Fact,
concept,
principle,
rule,
procedure,
interpersona
l, or
attitude?
Facts,
Concepts,
Processes

Delivery
Method
Learner Activity
(What would learners do to master this objective?)

Learners will be given a short pretest, with a check sheet. They will be given 5 minutes to
check off line items that they perceive as included in pelvic pain.
Next, learners will sit in small groups. Each group will have a wipe board, dry erase marker
and dry eraser.
They will be shown power point slides, then asked to guess percentage of women (with
suspected/confirmed endometriosis) experiencing daily symptoms, then write the number
on the wipe board.

(Group
presentatio
n/lecture,
self-paced,
or small
group)
Small Group,
and
Presentation.
Could also be
self-paced for
online
access.

The percentage will be revealed, a short presentation about the specific pelvic symptom
will follow, and there will be a short discussion.
Learners will be able to recognize and list pelvic symptoms, as well as given an opportunity
to work through examples.
Learners will be given a worksheet listing pelvic symptoms, and an area to write examples
during the presentation and discussions to bring to their medical practitioner.
This will address irritable pelvic issues, such as bowel syndrome, constipation, urinary tract
infections(check results for blood in urine), recurrent vaginal infections, interstitial cystitis,
and menstrual pain.

Enabling
Objective

Level on
Blooms
Taxonomy

Fact,
concept,
principle,
rule,

Learner Activity
(What would learners do to master this objective?)

Delivery
Method
(Group

procedure,
interpersona
l, or
attitude?
Identify other
common
medical
conditions that
accompany
endometriosis.

Knowledge,
Comprehension,
Application

Facts,
Concepts,
Processes

presentatio
n/lecture,
self-paced,
or small
group)
Learners will have a matching game of pairing other common medical conditions that
accompany endometriosis, and symptoms. The can work alone, or in a small group.
The percentage of women (with suspected/confirmed endometriosis) experiencing other
chronic health issues will be revealed in a short presentation reviewing the game.

Presentation
Could also be
self-paced for
online
access.

Each person will have a worksheet to list and describe their personal symptoms; write
questions and concerns throughout the presentation.
Learners will be given a worksheet listing other medical symptoms and conditions, and an
area to write examples during the presentation and discussions to bring to their medical
practitioner.
This will address other body systems, such as recurrent upper respiratory tract infections,
asthma, allergies, hypothyroidism, arthritis, cancer.
Be able to
identify family
members with
pelvic pain,
and possibly
their
diagnosis.

Knowledge,
Comprehension,
Application

Facts,
Concepts,
Processes

Ask questions/interview grandmothers/aunts/mothers/sisters questions about the following:

Menstruation and ovulation pain.
Trips to the ER for vaginal bleeding.
Ovarian cysts, fibroids.
Age of hysterectomy, & circumstances surrounding it.
Endometriosis history.
Could also request information about history regarding
Recurrent upper respiratory tract infections.
Asthma & allergies.
Hypothyroidism.
Arthritis.
Cancer.

Self Paced

Recognize, Reduce, & Resolve

Pelvic Pain in Women.
Beth Tietz

REFERENCES
Fischer, Col. John R. (no date). Diagnosis & Management of Endometriosis: Pathophysiology to Practice (PDF).
https://www.apgo.org/elearn/endo/endomonon2.pdf
Rosser, Matthew. (8-10-2015). Misery Loves Company(blog). Retrieved from:
http://endo-update.blogspot.co.uk/2015/08/misery-loves-company.html?m=1
Nezhat, Cameron. (2012). Where Does Endometriosis Grow? (Website). Retrieved from:
http://www.nezhat.org/endometriosis/endometriosis_occur.php
Janssen Pharmaceuticals, Inc. (2014). (PDF). Retrieved from:
http://www.orthoelmiron.com/sites/default/files/assets/diet-guide.pdf#zoom=100
Mayo Clinic. (5-18-2013). (Website). Retrieved from:
http://www.mayoclinic.org/symptoms/pelvic-pain/basics/definition/sym-20050898
Staff of HysterSisters.com. (8-5-2015). Explore All of Your Options for Unexplained Pelvic Pain. Retrieved from:
http://www.hysterectomy.org/2015/08/explore-options-unexplained-pelvic-pain
Center for Endometriosis Care. (2016).Understanding Endometriosis. Retrieved from:
http://www.centerforendometriosiscare.com/understanding-endometriosis