“A STUDY TO ASSESS THE KNOWLEDGE AND PRACTICE REGARDING MANAGEMENT OF MINOR DISORDERS OF PREGNANCY AMONG PRIMIGRAVIDA MOTHERS IN DISTRICT HOSPITAL TUMKUR,
WITH A VIEW TO DEVELOP INFORMATION GUIDE SHEET”
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Mrs LAKHWINDER KAUR
Obstetrics & Gynaecology Nursing
AKSHAYA COLLEGE OF NURSING
S. I. T. Main Road, Tumkur.
RAJIV GANDHI UNIVERSITY OF HEALTH SECIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the Candidate : Mrs LAKHWINDER KAUR
Address : M.Sc., (N) 1st Year,
AKSHAYA COLLEGE OF NURSING,
S.I.T. MAIN ROAD, TUMKUR
2. Name of the Institution : AKSHAYA COLLEGE OF NURSING,
S.I.T. MAIN ROAD, TUMKUR
3. Course of Study & : M.Sc., (N) 1ST Year,
Subject Obstetrics & Gynaecology Nursing
4. Date of Admission : 30-10-2009
5. Title of the Topic : “A study to assess the knowledge and practice
regarding management of minor disorders of pregnancy among primigravida mothers in District Hospital Tumkur, With a view to develop information guide sheet”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Thousands of women could be saved each year if they had access to skilled care during pregnancy and child birth, and access to emergency obstetric care. Mostof theinterventions they need are simple, affordable andhighly effective”
“DarleenJungWok”
Many women experience some minor disorders during pregnancy. These disorders should be treated adequately as they may escalate and become life threatening.
minor disorder may occur due to hormonal changes, accommodationchanges, metabolic changes and postural changes1.
Every system of the body is affected bypregnancy. the mother needs knowledge to cope with the experience of pregnancy. she also needs knowledge when she presents with discomforting or worrying symptoms. The common minor disorders during pregnancy are nausea and vomiting, heart burn,constipation,back pain,legcramps,freque- ncy of micturition,insomnia etc1.
Pregnancy is the vital event in the life of a women, it need special attention from the time of conception to the postnatal stage, every pregnancy is a unique experience for that women and each pregnancy the women experience will be new and adequately different. This is why it is so important that the midwife has knowledge and understanding of the common disorders of pregnancy in order to advice the women on strategies that will help her to hope with the condition and minimize the effect she experiences2.
The prenatal period is a time of physical and psychological preparation of birth and parent hood. Prenatal health supervision permit the diagnosis and treatment of pre-existing maternal disorder or disorder that may develop during pregnancy in India most of the mothers have poor knowledge about antenatal and intranatal care available to them.Illiteracy, poverty and lack of communication and transportation facility make them vulnerable to serious consequences, even though they are prominent care providers with the family the fundamental right health is denied to them in most part of the world . The death of the mother increase the risk to the survival of her young child and family can’t substitute a maternal role3
Women pregnant for the first time are confronted with symptom that would be considered abnormal in the non pregnant state, much of the prenatal care requested by such women is prompted by the need for explanation of the causes of minor disorders and for advice on ways to relieve the discomfort Nurses can do much to allay a first time mother’s anxiety about such symptom by telling her about them in advance using terminology that the woman can understood such women who understood physical discomforts of pregnancy are less able to become very anxious about their health in addition to understanding the rationale for treatment promotes their participation in their care.4
In India the morbidity among women may also increase with the decreasing consumption of food and increasing work burden, Cheshire has remarked that women’s minor disorders ahead with or without medication. Good understanding of both traditional and modern medical view will go along the way in minimizing the disorders associated with pregnancy.5
One of the important strategies in the care of pregnant women is impairing knowledge. It is essential to give advice to specific problem which the women is experiencing .Minor disorders which are related to pregnancy can cause sleeplessness, interfere with good nutrition, and results in much discomforts and the response of the disorders depending upon the severity of symptoms.6
6.1. NEED FOR THE STUDY
Problems of pregnancy range from the mildly irritating to life threatening condition regular antenatal checks beginning early in the pregnancy are undoubtedly valuable they help to prevent many complication and their ensuring problems, contribute t timely diagnosis and treatment.2
The practical nurse can play a significant role in the process of providing patient education during pregnancy. The prenatal patient especially the first time mother, may have many questions and concerns about this period in her life, much of the information she may have is probably inaccurate and complete information about self care concerns,diet need, management of common disorders and the dangers with in the environment which may effect the health of the unborn infant.7
The goal of the maternity care is a healthy pregnancy with a physically safe and emotionally satisfying out come for the mother, infant and family. How ever may maternal adaptations are unfamiliar to pregnant women and their families, helping the pregnant women to recognize the relationship between her physical status and the plan for her care, assist her in making decisions and encourages her to participate in her own care.3
Minor disorders are common during pregnancy may lead to serious complication like morning sickness that develop into the hyper emesis gravid a condition that begins as a minor disorder and become life threatening abnormality. So make the mother as alert as possible to any complication and referral is important, for that she must always educate when the changes of pregnancy are understood and it is easier to tolerate and avoid unnecessary anxiety.3
A study was conducted to estimate the prevalence of nausea and vomiting in a population based sample of pregnant women. a random sample of 193 pregnant women were recruited, of the 193 women in cohort study 130(67.4%) reported experience nausea and vomiting ,or 87(45.1%) experienced only nausea, of the 43 women(22.3% of the cohort) who experience vomiting, 18(9.3% of the cohort)reported weight loss.8
The cost of educating management of minor disorders is minimal, and the results are great. It enhances the mother to progress on health status health education of management of minor disorders is also with in the scope of nursing practice so it is mandatory for the mother to gain the knowledge to equip herself to cope with the experience of pregnancy and also gain specific knowledge, when she presents with a worrying symptom or discomfort.6
A longitudinal study was conducted to estimate the incidence of constipation in pregnancy,100 women were enrolled with mean(+/- standard deviation) age of 28(+/-5)years,54% were nulliparous and 92% white.constipation incidence rates were 24%(95%confidence interval 16-33%),26%(95% CI 17-38%),16%(95%CI 8-26%) and 24%(95%CI 13-36%) in the first ,second,and third trimester and 3 months postpartum respectively.9
The researcher during her clinical experience found that primigravida mothers had poor knowledge regarding management of minor disorders, personal interview with the mothers in various hospital found that there was lack of knowledge regarding management of minor disorders of pregnancy so the investigator felt that there is a need to give sufficient health education regarding management of minor disorders of pregnancy.
6.2.REVIEW OF LITERATURE
A Review of literature is a body of text that aims to review the critical points of current knowledge and methodological approaches on a particular topic, the role of the literature review is to formulate and clarify the research problems, to ascertain what is already known in relation to problem of interest, for developing a broad conceptual context, facilitate cumulating of scientific knowledge for interpreting the result of the study.
Review of literature is the reading and organizing of previously written materials relevant to specific problem to be investigated frame work and methods appropriate to perform the study10
A study was conducted to assess the women’s awareness of minor disorders of pregnancy and danger sings of obstetric complication in a rural district in Tanzania (2009). A total 1118 women were interviewed, result reveals that more than 98% of women attend antenatal care at least once half of the women knew about at least one obstetric danger sign and few women knew one or two minor disorders. It shows that the women had low awareness of danger signs of obstetric complication and minor disorders of pregnancy. 11
A study was conducted to assess the practice of pregnant women regarding directory intake of fiber in Southern Brazil(2009). A cross sectional cohort study was conducted in eighteen general practices in among 578 pregnant women. The mean energy intake was 2776 kcal/d. The mean fiber intake is 30.2 g/d, was slightly above the recommended. Yet 50% of the women failed to meet the recommendation. The study concluded that practices regarding dietary fiber intake of pregnant women is in adequate.12
A study was conducted to determine the effect of ginger in nausea and vomiting of pregnancy in Isaac (2009). It was a single blind clinical trial study. The subject included sixty seven pregnant women who complained of nausea and vomiting from Isaaccity hospital. The participants were randomly assigned to two groups an experimental group and a control group. The experimental group received ginger 250 mg capsules for four days and the control group received placebo with the same prescription form. The gingers was demonstrated a high rate of improvement than the placebo users (85% versus 56% :P<0.01). The result shows that ginger is an effective herbal remedy for decreasing nausea and vomiting during pregnancy.13
A study was conducted regarding Gastro esophageal reflux disease and management in advanced pregnancy in Germany (2009). A prospective study was conducted among 135 consecutive pregnant women in the third trimester were included in the study. Result reveals that the prevalence for gastro esophageal reflux disease in this unselected population was 56.3%. Among symptom regurgitation was the most frequent with 47.3%, where as heart burn was graded as the most severe symptom. The impact of Gastro esophageal reflux disease on the quality of life of the pregnant women was significant (P<0.001). 22.9% of the gastro esophageal reflux disease population required medication. Gastro esophageal reflux disease in advance pregnancy requires more attention and better therapeutic management. 14
A study was conducted to determine whether decreasing iron exposure can mitigate nausea and vomiting symptom in pregnancy in Tornado (2009). Data collected from a prospective cohort at the mother sick programme in Tornato, 97 women seeking advice on managing severe nausea and vomiting were advised to discontinue prenatal multivitamin administration and switch to folic acid. Two thirds (63 out of 97)(P<0.001) of those women qualitatively reported an improvement in nausea and vomiting symptom after discontinuation of iron-containing prenatal multivitamins. These data suggest that avoiding iron-containing prenatal multivitamins in the first trimester is effective in improving morning sickness. 15
A study was conducted to explore knowledge of primigravida mothers regarding minor disorders of pregnancy and obstetric complication in pregnancy in an urban health centre in Malawi (2007). A descriptive study was conducted participants were selected by means of purposive sampling, 45 primigravida from the urban settings were interviewed. The findings showed that 60% of the participants were knowledgeable about minor disorders and obstetrics complication in pregnancy,but participants had limited knowledge of complication that may need immediate treatment during pregnancy. The findings suggest there is a critical need for giving sufficient information to the mothers, regarding obstetric complication and minor disorders.16
A study was conducted to assess the effect of treatment to relieve the symptom associated with varicosity in pregnancy and to reduce leg edema in South Africa (2006). Four trails of threedifferent treatments were included. In one trail, women give rutoside capsules in the last 3 months of pregnancy noted an improvement in symptoms compared with placebo (relative risk 0.54%, 95%, CI 0.32, 0.89). In other trail women were treated with external pneumatic intermittent compression for 30 minutes to reduce leg edema in another trail compression stocking prophylatically reduced the emergencies of leg symptoms (relative risk 0.74 95% CI 0.59, 0.93). Thus the result shows rutosides appear to relieve symptoms of venous insufficiency in late pregnancy, external pneumatic compression appears to reduce ankle swelling and compression stocking reduce leg symptoms. 17
A study was conducted todetermine the prevalence of carpel tunnel syndrome in pregnancy shows that the prevalence of syndrome during pregnancy was about 2%.the mean pain score was 5.6(SD2.0) at referral and this was reduced by 1.2(SD2.2) after wearing an orthosis for a weak.the reduction in score was strongly correlated with loss of the weight gain during pregnancy.18
A study was conducted to assess the preventive intervention and treatment for back pain in pregnancy (2001), randomized trials of any treatment to reduce the incidence and severity of back pain in pregnancy was selected. Trail quality was assessed and data were extracted independently by two reviewers. On trails of 109 women was included. This cross over trail compared the use of a special shaped pillow to fit under the women’s abdomen (ozzlo pillow) with a standard pillow, women experienced less pain in the week when they used the ozzlo pillow than in the week with the standard pillow (odds ratio 0.32%, 9.5% confidence interval 0.18 to 0.58 ). This shows that specially shaped pillow appear to help reduce back pain in late pregnancy and improve sleep.19
A study was conducted to assess the effect of different methods for treating consumption in pregnancy in United Kingdom (2000). Randomized trail of any treatment for constipation in pregnancy was selected. Trail quality assessment and data extraction were done independently by two reviewers one trial of 40 women was included fibre supplements increased the frequency of defecation(odds ratio 0.18, 95% confidence interval 0.05 to 0.67) and lead to suffer stools. Thus the dietary supplements of fibre in the form of bran or wheat fibre are likely to help women experiencing constipation in pregnancy.20
6.3STATEMENT OF PROBLEM
“A study to assess the knowledge and practice regarding management of minor disorders of pregnancy among primigravida mothers in District Hospital Tumkur, With a view to develop information guide sheet”
6.4 OBJECTIVES OF THE STUDY
To assess the knowledge of primigravida mothers regarding
management of minor disorders of pregnancy.
To identify the practice of primigravida mothers regarding management of minor disorders of pregnancy.
To associate the knowledge of primigravida mothers regarding management of minor disorders of pregnancy with selected demographic variables.
To associate the practice of primigravida mothers regarding management of minor disorders of pregnancy with selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
Assess : It is the organized and continous process of
collecting data.
Knowledge: It denotes the awareness or information that the
primigravida mothers posses regarding
management of minor disorders of pregnancy .
Practice : It refers to the actual activities done by the primigravida mothers.
Minor disorders : un easiness which may occur with in the 36
Weeks of gestation like nausea and vomit-
ing ,fatigue,constipation,heart burn etc.
Managementof : Measures taken to relieve the uneasiness
Minor disorders which may occur with in the 36
Weeks of gestation
Pregnancy : The condition from conception to the expulsion
Of the fetus.
Primigravida: A women who is pregnant for the first time.
Mothers
Information guide sheet:It refers to a set of written
instructions and information related management of minor disorders of pregnancy.
6.6 ASSUMPTION
- Primigravida mothers may have some knowledge regarding management of minor disorders of pregnancy.
- Information guide sheet will help to enhance the knowledge and practice of Primigravidae mothers regarding management of minor disorders of pregnancy .
6.7HYPOTHESIS
H1: There will be significant association between the knowledge and practice with the selected demographic variables of Primigravida mothers.
7. MATERIALS AND METHODS
The purpose of this study is to assess the knowledge and practice regarding management of minor disorders of pregnancy among primigravida mothers in district hospital Tumkur.
7.1 SOURCES OF DATA
Research approach :descriptive approach
Research design :survey design
Setting of the study :DistrictHospital Tumkur
Population : primigravida mothers
Sample Size : 60 Subjects
Sampling technique : purposive sampling
.
Sampling Criteria
Inclusion Criteria
- Mother who were pregnant for the first time
- Mother who are willing to participate in the study.
- Mother who can understand English and Kannada.
- pregnant mothers below 36 weeks of gestation
Exclusion Criteria
- Mothers who are multigravida.
- Mother who are not available at the timedata collection.
7.2 METHOD OF DATA COLLECTION
- Tool for data collection :Structured Questionnaire method and
check list
Part A : Porforma for collecting demographic Data
Part B : Structured Questionnaire to assess
knowledge and checklist to assess the
Practice on Management of minor
disorders of pregnancy
Method of data analysisand interpretation
Data will be analyzed according to the objectives of the study and by using appropriate statistical techniques and will be present in the form of tables, graphs and diagrams
Duration of the study : 6 weeks
7.3 :Does the study the require any investigation or intervention to be conducted
on the patient or human beings or animal? so please describe briefly
No
7.4: Hasethical clearance been obtained from your institution in case of the above
Yes,Ethical clearance been obtained from the institutions ethical committee