D/O RAMJIPRASAD GUPTA
GOVERNMENT COLONY,
2/27, 4TH FLOOR,
BEHIND LALA COLLAGE,
KESHAV RAO KHADYE MARG,
HAJIALI, MUMBAI-400034
2 / NAME OF INSTITUTION / S.B. COLLAGE OF NURSING,
YELAHANKA NEW TOWN,
BANGALORE-64
3 / COURSE OF STUDY AND SUBJECT / M.Sc. NURSING
(OBG Nursing)
DISSERTATION PROTOCOL
4 / DATE AND ADMISSION TO COURSE / 25.10.2009
5 / TITLE OF THE TOPIC:
“ASSESS THE EFFECTIVENESS OF SELF INSTRUCTIONAL
MODULE ON KNOWLEDGE AND PRACTICE REGARDING THE PREVENTION OF URINARY TRACT INFECTION AMOUNG PRIMIGRAVIDA MOTHER ATTENDING ANTENATAL CLINIC IN A SELECTED MATERNITYHOSPITAL, AT BANGLORE”.
DISSERTATION PROTOCOL
1
6: BRIF RESUME OF THE INTENDED WORK
6.1: NEED FOR THE STUDY
Antenatal care is the care of the women during pregnancy. The primary aim of antenatal care is to achieve at the pregnancy a healthy mother and healthy baby. In every country mothers and children constitute a major segment of the population, there for service to women during pregnancy is tremendously significant in health care system and it help to reduce the mortality and morbidity rate of both1,6.
Urinary tract infection plays important role in spontaneous preterm labour.So to reduce the prevalence of low birth weight babies, we should identify in early the high risk pregnancy, taking more care of primigravida, treating clinical and subclinical infection in time to prevent spontaneous preterm labour, diagnosing and managing the intra uterine growth restricted babies in time.Urinary tract infections are one the most common infections out there, affecting more than 10 million men and women every year. Women are much more likely to contract a urinary tract infection, with 50% of women experiencing at least one urinary tract infection in their life time. Though painful, urinary tract infections are easily treatable and do not usually result in health risk. With careful prevention, women can avoid ever having to deal with a urinary tract infection 2,3.
Normally, urine is sterile. It is usually free of bacteria, viruses, and fungi but does contain fluids, salts, and waste products. An infection occurs when tiny organisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. The urethra is the tube that carries urine from the bladder to outside the body. Most infections arise from one type of bacteria, Escherichia coli(E.coli), which normally lives in the colon. Microorganisms called Chlamydia and Mycoplasma may also causeUrinary tract infections in both men and women, but these infections tend to remain limited to the urethra and reproductive reproductive system. UnlikeE.coli, Chlamydia and Mycoplasmamay be sexually transmitted , and infections require treatment of both partners.The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps wash bacteria out of the body. In men, the prostate gland produces secretions that slow bacterial growth. In both sexes, immune defenses also prevent infection. But despite these safeguards, infections still occur 3,4,5,6 .
Astudy stated that every minute in the world, 380 women become pregent, 190 face unplanned or unwanted pregnancy; 110 experience pregnancy related complication and one women dies from pregnancy related cause. According to recent estimates by WHO and UNICEF, nearly 5,85,000, women die each year world wide from complications related to pregnancy and childbirth. Unfortunately about 99% of those deaths occur in developing countries alone, of which 55% occur in Asia. In 2003 about 1,36,000 maternal deaths occurred in India11,20,21.
One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear. Pregnantwomen seem more prone to urinary tract infections than other women. However, when a does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine during pregnancy . Women who use adiaphragmare more likely to develop a lower urinary tract infection than women who use other forms ofbirth control. Recently, researchers found that women whose partners use a condom with spermicidal foam also tend to have growth ofE. colibacteria in the vagina 2,5,6,7.
United national fund for the population activity reported that cause of maternal mortality rate in the world revealed that 80% of deaths are due to direct causes and 20 % of death due to indirect cause like, malaria, heart disease, anemia, urinary tract infection. The direct causes were unsafe abortion (14%), severe bleeding(12%), infection(18%), toxaemia(8%), and classified causes(9%). A study mentioned the most of the primigravida women (88.2%) were more likely to have poor knowledge in the relation to antenatal care compared to 11.8% of women whose gravida was less than five. India’s National Family Health survey (1998-1999) found that reasons for not seeking antenatal care include those who do not think check that necessary (60%) or customary(4%),inability to meet the coast of visiting a health care facility(15%),and not being allowed by their families to have these checkup (99%),lack of knowledge on antenatal care and poor access to health centre were the other reason cited.1,16,18,19.
Urinary tract is made up of two sections: the lower urinary tract and the upper urinary tract. Infections most commonly occur in the lower urinary tract, which contains bladder and urethra. Infection of the urethra, or urethritis, occurs when bacteria, usually from rectum, travel into urethra and grow there. Bladder infection, or cystitis, occurs when bacteria travel up past the urethra and lodge in the bladder. Bladder infections are the most common form of urinary tract infection, and can often occur at the same time as urethritis. Upper urinary tract contains two kidneys and the tube that connects them, called the ureters. If it is not treated, the bacteria can easily travel up the ureters into the kidneys, causing chronic urinary tract infections. A kidney infection is called pyelonephritis, and requires immediate care. Kidney infections can cause kidney damage or even failure if left untreated for an extended period of time 3,5.
Urinary tract is second only to the respiratory tract in acquiring microbial infection, especially in females. It is more common in pregnant than in non-pregnant women. Studies from different parts of India have indicated that urinary tract infection during pregnancy leads to low birth weight babies, increased perinatal mortality and premature births along with acute and chronic sequelae in mothers. This study was conducted to explore different aspects of urinary tract infections during pregnancy 5,8.
Further, the investigator during her clinical practice in the hospital observed that most of the primigravida mothers had misconceptions and lack of knowledge and practice about antenatal care. Hence, the investigator intended to test that the effectiveness of structured instructional module on knowledge and practice of antenatal care among primigravida mother.
6.2 REVIEW OF LITRATURE:
Antenatal care should be used to maintain the physiology of pregnancy and to prevent or detect the earliest and to treat any untoward complication such high blood pressure, urinary tract infection, diabetes, to educate women about obstetric danger sign and to motivate women to seek appropriate referred care 1,9.
A project study stated that during pregnancy physical as well as emotional changes in a women’s life is considered a challenging event for primigravida mother. The primigravida mother are prone to get a variety of and infection, misconceptions , ignorance regarding pregnancy, labour and delivery 10 .
WHO and UNICEF estimated that about 70% of women in the developing are attended atleast once during pregnancy by skilled health personnel. The rate is lowest in south Asia that is 54%. In India, only 15% of mothers receive complete antenatal care and only 58% receive iron or folic tablets or syrup. A study mentioned the most of the primigravida women (88.2%) were more likely to have poor knowledge in the relation to antenatal care compared to 11.8% of women whose gravida was less than five. India’s National Family Health survey (1998-1999) found that reasons for not seeking antenatal care include those who do not think check that necessary (60%) or customary(4%), inability to meet the coast of visiting a health care facility(15%), and not being allowed by their families to have these checkup (99%), lack of knowledge on antenatal care and poor access to health centre were the other reason cited 9,11.
Physical assessment and laboratory test, regular follow up, maintaining records of all health related problem should be kept. Health education given in pregnancy was not effective, many women could not follow the practical advice given to them. The pregnant women agree that there should be greater use of other methods such as use of written maternal for women to read at home with their spouse, which would be effective. They arrived better prepared and better informed, with knowledge to help the healthy development of the foetus at an early stage in pregnancy. Self instructional module is a learning package planned and prepared from the beginning till end with an aim to facilitate self learning. It is self- explanatory, self-sufficient, self-directed, and self-motivating and self –evaluating above all it should facilitate self-learning 9,11,12.
The national child survival and safe motherhood program was formerly launched in 1992 to meet the total health needs of both the mother and child. This was replaced by RCH programme in 1994 with one of the goals to reduced maternal mortality from 4 to 2 per 1000 live birth1,7.
Research funded by the National Institutes of Health (NIH) suggests that one factor behind recurrent urinary tract infections may be the ability of bacteria to attach to cells lining the urinary tract. A recent NIH-funded study found that bacteria formed a protective film on the inner lining of the bladder in mice. If a similar process can be demonstrated in humans, the discovery may lead to new treatments to prevent recurrent urinary tract infections. Another line of research has indicated that women who are "non-secretors" of certain blood group antigens may be more prone to recurrent urinary tract infections because the cells lining the vagina and urethra may allow bacteria to attach more easily. Further research will show whether this association is sound and proves useful in identifying women at high risk for urinary tract infections. Pregnant women seem no more prone to urinary tract infections than other women. However, when a does occur in a pregnant woman, it is more likely to travel to the kidneys. According to some reports, about 2 to 4 percent of pregnant women develop a urinary infection. Scientists think that hormonal changes and shifts in the position of the urinary tract during pregnancy make it easier for bacteria to travel up the ureters to the kidneys. For this reason, many doctors recommend periodic testing of urine during pregnancy 14,15.
In the future, scientists may develop a vaccine that can prevent urinary tract infection from coming back. Researchers in different studies have found that children and women who tend to get urinary tract infections repeatedly are likely to lack proteins called immunoglobulins, which fight infection. Children and women who do not get urinary tract infection are more likely to have normal levels of immunoglobulins in their genital and urinary tracts. Early tests indicate that a vaccine helps patients build up their own natural infection-fighting powers. The dead bacteria in the vaccine do not spread like an infection; instead, they prompt the body to produce antibodies that can later fight against live organisms. Researchers are testing injected and oral vaccines to see which works best. Another method being considered for women is to apply the vaccine directly as a suppository in the vagina 8,13.
The groups of women younger than 16 and older than 35. Pregnancy after 30 is at a twofold and after 35 at a six fold greater risk. The treatment of preterm delivery requiresevaluation of the current obstetric situation. Medical history, pregnancy history, gynecological examination, and cardiotocography should be analyzed. Additional exams to be carried out are blood cell count, electrolytes, kidney and liver function tests, vagina and cervix canal culture, urine test, and obstetric ultrasonography. Theresults of these examinations enable choosing the appropriate mode of treatment, estimating the chances of success, and determining the benefit/risk ratio16,17.
6.3: STATEMENT OF PROBLEM:
“Assess the effectiveness of self instructional module on knowledge and practice regarding the prevention of urinary tract infection among primigravida mother attending in antenatal clinic in a selected maternity hospital, at Bangalore”.
6.4: OBJECTIVES OF THE STUDY:
1. To assess the knowledge and practice of primigravida mother on prevention of urinary tract infection.
2. To evaluate the effectiveness of self instructional module on knowledge and practice of primigravida mother on prevention of urinary tract infection.
3. To find out the association between post test knowledge scores of the primigravida mother with their demographic variable.
6.5: RESEARCH HYPOTHESIS
H1: There will be significant difference of knowledge and practices of primigravida mother on prevention of urinary tract infection in pre and post test knowledge score.
H2: There will be significant association between post test knowledge and practice score with demographic variables of primigravida mother.
6.6: OPERATIONAL DEFINITION:
ASSESS:
It refers to the measurement of the knowledge and practice on prevention of urinary tract infection among primigravida mother from the score based on questionnaire and check list.
EFFECTIVENESS:
It is significant improvement in knowledge among the primigravida mother after implementation of self instructional module as evidence by differences in pre and post test.
KNOWLEDGE:
It refers to the correct response of primigravida mother to the knowledge item in the structured, closed ended questionnaire regarding prevention of urinary tract infection.
PRACTICE:
In these study practice refer to correct the verbal response practice questioner to primigravida mother regarding the prevention of urinary tract infection .
SELF INSTRUCTIONAL MODULE:
It is self instructional module it refers self learning information which is well planned and prepared for the primigravida mother to learn and gain more information regarding prevention of urinary tract infection.
URINARY TRACT INFECTION:
The invasion and multiplication of disease producing agent as bacteria, viruses, fungi, animal parasites producing harmful effect to the urinary system.
PRIMIGRAVIDA MOTHER:
It refers a women who are pregnant for the first time between 26-40 week of pregnancy .
ANTENATAL CLINIC:
A place where the diagnosis is made and treatment is given to mother before delivery of child.
7. MATERIALS AND METHODS:
7.1: SOURCE OF DATA:
The source of data will be primigravida mother who will be attending Antenatal clinic in a selected MaternityHospital, Bangalore.
7.2: METHOD OF DATA COLLECTION:
The data will be collected by investigator her-self by using structured closed ended questionnaire and check list.
7.2.1: RESEARCH DESIGN AND APPROACH:
Quasi-experimental design in which one group per and post test design without control group will be selected for the present study.
7.2.2: SETTING:
This study will be conducted in Antenatal clinic in a selected MaternityHospital, at Bangalore.
7.2.3: POPULATION:
The population of the present study will be primigravida mothers who attending antenatal clinic in a selected MaternityHospital, Bangalore.
7.2.4: SAMPLE SIZE:
Sample size will be around50 Primigravida mothers.
7.2.5: SAMPLE PROCEDURE:
Purposive sampling technique will be used for the proposed study.
7.2.6: SAMPLING CRITERIA:
INCLUSION CRITERIA:
Primigravida mother who are,
- Attending antenatal clinic in a selected MaternityHospital, Bangalore.
- Available during the data collection period.
- Able to read and understand Kannada and English.
- Willing to participate in the study.
EXCLUTION CRITERIA:
Primigravida mothers who are,
- Not attending antenatal clinic in a selected MaternityHospital, Bangalore.
- Not available during the data collection period.
- Not able to read and understand kannada and English .
- Not willing to participate in the study.
7.2.7: DATA COLLECTION TOOL:
Questionnaire to assess the primigravida mother’s knowledge on prevention of urinary tract infection in month of March/April 2011.
7.2.8: DATA ANALYSIS METHOD:
1. Appropriate descriptive and inferential statistics will be used for data analysis and presented in form of table graph and figure etc.
2. The significant of relationship between the selected demographic variables and knowledge scores is by used chi-square test.
7.2.8: DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENT OR OTHER HUMAN OR ANIMAL? IF SO, DESCRIBE BRIEFELY.
----- YES -----
7.3: HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3
Required ethical clearance will be obtained from the concerned authority before proceeding with main study.
8 : LIST OF REFERENCES:-
1.Park, k “Test book of preventive and social Medcine”, XVII edition m/s, Banersidas bhanot publishers, 2003, Jaipur, Pp: 359-364.
2.Christopher Haslett, Edwin R. Chilvers, Nicholas, A Boon nicki R colledge, “Principal of medicine and practice of medicine” XIX edition, Churchill living stone publishers, Pp: 147-159.
3.Brunner and Siddarth, “Text book of Medical Surgical nursing”,XI edition, volum II,Suzanne c, smetlzer, Brenda G bare, Janice l. Hinkle, publishers, Wolter Kluwer (India) Pvt Ltd, New Delhi, 2008, Pp: 1571-1575.