M.Sc. Nursing Dissertation Protocol Submitted to
RajivGandhiUniversity of Health Sciences, Karnataka, Bangalore
By
Mrs. LUCINDA DAMARIS PRETTY .J
M.Sc Nursing 1st Year
2010-2012
Under the Guidance of
HOD, Department of OBG Nursing
Nightingale College of Nursing
Guruvanna Devara Mutt,
Near Binnyston Garden,
Magadi Road,Bangalore-560023
Rajiv Gandhi University of Health Sciences, Karnataka
Curriculam Development Cell
Information for Registration of Subjects for Dissertation
Registration No.
Name of the Candidate / : Mrs. LUCINDA DAMARIS PRETTY.J
Address / : Guruvanna Devara Mutt, Near Binnyston, Bangalore - 23
Name of the Institution / : NightingaleCollege Of Nursing, Bangalore
Course of Study and Subject / : MSc Nursing in OBG
Date of Adimission to Course / : 20/05/2010
Title of the Topic / :A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE KNOWLEDGE AND ATTITUDE OF POSTNATAL COMPLICATIONS AMONG HIGH RISK ANTENATAL MOTHERS IN SELECTED MATERNITY CENTRES IN BANGALORE
Brief resume of the intended work / : Attached
Signature of the Student / :
Guide Name / : Mrs.Jayakadambari
Remarks of the Guide / : The Study is suitable and feasible
Signature of the Guide / :
Co-Guide Name / :
Signature of the Co-Guide / :
HOD Name / : Mrs.Jayakadambari
Signature of the HOD / :
Principal Name / :
Principal Mobile No. / :
Principal E-mail ID / :
Remarks of the Principal
/ :
Principal Signature / :
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE – II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1: / Name of the candidate and address (in block letters) / MRS.LUCINDA DAMARIS PRETTY.JIst YEAR M.Sc NURSING
NIGHTINGALE COLLEGE OF NURSING
MAGADI ROAD
BANGALORE.
2: / Name of the Institution / NIGHTINGALE COLLEGE OF NURSING
MAGADI ROAD
BANGALORE.
3: / Course of Study and Subject / M. Sc. NURSING
OBG NURSING
4: / Date of Admission to the Course
5: / TITLE OF THE STUDY:
A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE KNOWLEDGE AND ATTITUDE OF POSTNATAL COMPLICATIONS AMONG HIGH RISK ANTENATAL MOTHERS IN SELECTED MATERNITY CENTRES IN BANGALORE
6:
7
8. / BRIEF RESUME OF THE INTENDED WORK
6.0 .INTRODUCTION
Mother and child health is one of the major concerns of public health throughout the world. Health education and increased knowledge of mothers in relation to their health is an important strategy for improving maternal health1
Even with the best possible antenatal screening, any delivery can become a complicated one requiring emergency intervention. Therefore, skilled assistance is essential to delivery care. In the absence of midwives or nurses, TBAs (who usually perform home deliveries, often as a source of income) should be trained to identify complications, provide immediate first aid, and know when and where to refer Mothers for additional care. It should also be remembered that the first priority for a delivery is to be safe, atraumatic and clean; and most maternal deaths are due to a failure to get skilled help in time for delivery complications1
Assessment includes not only determining the pregnant woman's overall health status, but also identifying factors which may adversely affect pregnancy outcome. These factors include: age (younger than 17 or older than 40), grand multipara, significantly short stature, and obstetric history of any previous complications, including surgery. While this screening may help identify some Mothers who will develop complications, it will not identify all of them. Thus it is critically important to identify and manage complications as they arise among all pregnant Mothers1
The normal patient who is having no difficulties during the puerperium should return for examination at the end of the sixth week of the puerperium. Postnatal clinics are better organised in connection with child welfare clinics where the mother can be seen at the same time as the baby. It is better still if this can be combined with a family planning clinic. At this time, her general physical condition should be checked, the blood pressure taken, urine examined for protein, the condition of the abdomlnal wall noted, the breasts inspected and a thorough pelvic examination carried out. Such abnormalities as cervicitis can be treated at this time and arrangements made for further treatment or examination when indicated. Contraceptive advice should be given to all mothers3
6.1NEED FOR STUDY:
Post natal complications are that which happens after the delivery, upto six weeks. In urban areas the estimate of MMR (267) has gone down but in rural areas (619) it seems to have increased substantially even though it may not be statistically significantly different. The most common causes of maternal deaths are hemorrhage (ante partum or post partum), eclampsia, pre-eclampsia, infection, obstructed labor and complications of abortion; they are generally same throughout the world. The studies in India of causes of maternal mortality by and large show similar results. One difference is that the data on cause of maternal mortality from the Registrar General of India show large proportion of maternal deaths attributed to anemia which is not reported from other countries3
Causes of Maternal Mortality Globally
- Severe bleeding 25%
- Indirect causes 20%
- Infection 15%
- Unsafe abortions 13%
- Eclampsia 12%
- Obstructed labour 8%
- Other direct causes 8%
Approximately 15 per cent of pregnant Mothers will develop complications that require essential obstetric care, and up to five per cent of pregnant Mothers will require some type of surgery3
The primary objective of antenatal care is to establish contact with the Mothers, and identify and manage current and potential risks and problems. This creates the opportunity for the woman and her health care provider to establish a delivery plan based on her unique needs, resources and circumstances. The delivery plan identifies her intentions about where and with whom she intends to give birth and contingency plans in the event of complications (transport, place of referral, etc.). At least three antenatal visits are recommended, ideally with the first visit early in the pregnancy. This number may vary based on national policies5
The following topics should be part of the educational activity related to antenatal care:
- choosing the safest place for delivery;
- clean delivery; the major symptoms of complications (bleeding, severe abdominal pain, headache);
- where and when to seek care for complications;
- exclusive breastfeeding;
- maternal nutrition;
- STD/ HIV/ AIDS prevention;
- immunisation;
- and family planning3
A study to examine the trend in maternal postnatal
readmission within six weeks of discharge from childbirth hospitalisation.
It is a retrospective review of the maternity computer records system,
patient’s clinical notes and HIPE data base. All Mothers who delivered babies
weighing >500g and/e 24 weeks gestational age at Our Lady of Lourdes
Hospital, Drogheda, Ireland from 1st January 2005 to 31st December 2008 who
were re-hospitalised within six weeks of discharge from hospital following
child birth were included in the study. A total of 15782 Mothers were
delivered over the four year study period. Of these, 236 were readmitted. A
series of chi-square analysis were conducted to assess the difference in
readmission rates between the year 2008-86(2.03%) and the years
2005-51(1.46%), 2006-39(1.01%) and 2007-60(1.42%). The readmission rate was
found to be significantly higher in 2008 compared with the three preceding
years. Complications of Caesarean section and secondary postpartum
haemorrhage following spontaneous vaginal delivery constitute the major
indications for readmission2
Nurses are in a unique position to educate and empower Mothers, through the phases of child birth, for them to achieve a healthy pregnancy with the optimum outcome of a healthy baby. Despite various measures taken to reduce maternal mortality and morbidity, it remains very high in India. Knowledge and awareness about risks associated with pregnancy among Mothers can help them to seek maternal care services and reduce maternal mortality and morbidity. Hence the investigator had taken up “A study to assess the effectiveness of a structured teaching programme for antenatal Mothers, on high risk conditions in pregnancy
Conceptual framework employed for the study was general systems theory developed byLudwig Von Bertalanffy (1968) and modified by J.W.Kenny. Methods : One group pre-test post-test design was adopted for this study. The setting selected was the antenatal clinics are the Outpatient Department of St.John’s Medical College Hospital. 100 antenatal Mothers between 12-36 weeks of gestation, using purposive sampling technique were selected for the study. A pre-test was administered using a structured questionnaire to assess the knowledge after which the teaching was given. The post-test was conducted after 14-18 days, using the same instrument to identify the changes in knowledge. The collected data were analyzed using descriptive and inferential statistics. Results The mean pre-test knowledge score 11.4±3.6 (M±SD) was less than the post-test knowledge score 19.5±3.7 (M±SD). The ‘t’ value computed between the pre-test and post-test score was statistically significant at 0.001 level (t=44.04, df =99). The findings also denoted a significant correlation between the baseline knowledge of the antenatal Mothers and their education income and occupation. Interpretation and Conclusion The teaching has made a commendable effect in improving the knowledge of antenatal Mothers regarding selected high risk conditions in pregnancy. Dissemination of health related information to the antenatal Mothers at the antenatal clinic is a useful strategy to improve their knowledge and awareness and thus contribute in the reduction of the maternal mortality and morbidity6
A study in relation to the knowledge and practice of Mothers about complications of pregnancy and childbirth.Pregnancy and childbirth-related complications are the leading causes of maternalmortality and morbidity in Bangladesh. An estimate shows that about 28,000 mothersdie each year in Bangladesh due to obstetric complications. Recent estimates also
suggest that there may be as many as 100 morbidities for every maternal death.
This cross-sectional study assessed rural Bangladeshi Mothers's knowledge and
care-seeking A behaviour regarding obstetric complications. The study was done in 7
unions of Mirsarai and 5 unions of Abhoynagar thana in Chittagong and Jessore
districts respectively. During October 1998-May 1999, 1,566 Mothers: 999 from Mirsarai
and 567 from Abhoynagar, who had a pregnancy outcome during the last one year,
were interviewed at their homes. The trained interviewers used a pre-tested semistructured
questionnaire for interviewing the Mothers.
Results of the study showed that more than 80 percent of the Mothers in
Abhoynagar and over half of the Mothers in Mirsarai had knowledge about three and
more types of pregnancy and/or childbirth-related complications. The knowledge was
higher among Mothers in Abhoynagar than those in Mirsarai. Knowledge about postnatal
complications was comparatively limited, more so in Mirsarai. The sources of service for
the management of obstetric complications, majority of the Mothers mentioned the
Thana Health Complex; only one-fifth mentioned about the untrained village allopaths
and homeopaths.
Deliveries of about one-third of the Mothers were attended by the trained
providers, such as trained traditional birth attendants (TTBAs), paramedics, nurses, and
doctors, and about 90 percent were delivered at home. Of the Mothers reported to have
experienced obstetric complications 61 percent Mothers in Abhoynagar and 48 percent
in Mirsarai had delivery-related complications. Postnatal complication was found two
times higher in Mirsarai than in Abhoynagar. Commonly cited obstetric complications
were Oedema, prolonged labour, bleeding and fever for more than three days after
delivery in both the areas. A higher percentage of Mothers, both in Mirsarai and
Abhoynagar, consulted the untrained providers for the management of these problems.
Regarding the management of postnatal complications, 46 percent of the Mothers in
Mirsarai and 30 percent Mothers in Abhoynagar consulted either the trained providers or
visited the government health facilities or the private clinics. With regard to antenatal
care, 58 percent in Abhoynagar and 44 percent in Mirsarai sought care from trained
providers and/or visited health facilities. Over half (55%) of the Mothers in Abhoynagar
and more than one-third (36%) in Mirsarai sought three or more antenatal care visits.
However, use of postnatal care was found to be limited.
Since Mothers of Bangladesh still seek care from the traditional providers for
deliveries and for management of obstetric complications, such providers should be
linked with the referral mechanism, so that they can contribute more by referring
patients to the health facilities in time. The intervention of the Operations Research
Project (ORP) on modified strategy for ensuring referral and linkage for EOC has
involved these local providers in the referral mechanism7
6.3 .STATEMENT OF THE PROBLEM
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING
PROGRAMME REGARDING THE KNOWLEDGE AND ATTITUDE OF POSTNATAL
COMPLICATIONS AMONG HIGH RISK ANTENATAL MOTHERS IN SELECTED MATERNITYCENTRES IN BANGALORE.”
6.4. OBJECTIVES OF THE STUDY
The Objectives of the study are
To assess the knowledge of High Risk Antenatal Mothers regarding post natal complications.
To assess the attitude of High Risk Antenatal Mothers regarding postnatal complications
To evaluate the effectiveness of Structured Teaching Programme.
To associate the knowledge and attitude of High Risk Antenatal Mothers with selected demographic variables.
6.5 .HYPOTHESIS
Thehypothesis will be test at 0.05 level of the significance
H1– There will be a significant difference in pretest to post test scores among High Risk Antenatal Mothers.
H2 -There will be significantassociation between post test scores with the effectiveness of structured teaching programme regarding post natal complications among High Risk Antenatal Mothers.
H3 _ There will be a significant association between the post test scores among High Risk Antenatal regarding postnatal complications with selected demographic variables.
6.6OPERATIONAL DEFINITIONS:
KNOWLEDGE
In this study it refers to the correct responses of the high risk Mothers to thequestionnaire items regarding post natal complications.
HIGH RISK ANTENATAL MOTHERS
It refers to a woman who is pregnant and has complications during the pregnancy
EFFECTIVENESS
It refers to producing the desired or intended results of structured teaching programme on post natal complications by the instrument and post test scores.
ATTITUDE
It refers to the correct responses of high risk antenatal Mothers to the items listed in the self administered attitude questionnaire regarding postnatal complications.
STRUCTURED TEACHING PROGRAMME
In this study it refers to the systematically developed teaching program to the high risk antenatal Mothers regarding postnatal complications.
POST NATALCOMPLICATIONS
It refers to the complications that occur after delivery, up to six weeks
6.7 ASSUMPTIONS:
The study assumes that:
- Mothersmay have someknowledge regarding postnatal complications.
- The structured teaching program will help Mothers to gain adequate knowledge regarding post natal complications.
The study is delimited to:
- High Risk Antenatal Mothers of selected maternity centres
- Mothers who can read, write either Kannada, English or Tamil
- Study limit period: 4 Weeks
The present study will help the woman to gain knowledge about post natal complications, hence it will help to improve their health status.
MATERIAL AND METHODS
7.1SOURCE OF DATA
The data will be collected from High Risk Antenatal Mothers in selected Maternity centres
7.1.1 RESEARCH DESIGN
The research design adopted for this study is Quasi Experimental
7.1.2 RESEARCH APPROACH
The research approach is qualitative
7.1.3SETTING
The study will be conducted in selected maternity centres in Bangalore
7.1.4POPULATION
The population selected are High Risk Antenatal Mothers
7.2METHODOLGY
7.2.1SAMPLING TECHNIQUE
The sampling technique adopted for this study is Random Sampling
7.2.2SAMPLE SIZE
The sample size is 30
7.2.3INCLUSION CRITERIA
The criteria for sample selection are
- High Risk Antenatal Mothers of Gravida 1 and 2 during their 3rd trimester
- Age group 21 – 49yrs
- Those who are willing to participate in the study
- Those who can read, write Kannada, English and Tamil
- Mothers who are not willing to participate in the study
- More than Gravida 2
- Mothers who were not available at the time of Data collection
Part 1: The tool consists of demographic Performa
Part 2: Questionnaire will be used to assess the knowledge.
SCORING PROCEDURE
For Knowledge assessment
For answersIf answer is yes 1
If answer is no 0
SCORING INTERPRETATION
GOOD : -75-100%
AVERAGE: -57-74%
POOR: -Below 50%
7.2.6DATA COLLECTION METHOD
The High Risk Antenatal Mothers in selected maternity centres will be selected for the study using random sampling. Formal administrative permission will be obtained from the concerned authorities. The data will be collected from 30 High Risk Antenatal Mothers after obtaining their consent. The procedure will be explained to them and confidentiality will be ensured .
7.2.7DATA ANALYSIS PLAN
The plan for Data Analysis are
- The data obtained will be analysed in view of the objectives of the study
- Mean, Median, Mode and Standard deviation will be used for assessing knowledge source.
- Chi-Square test to find out the association between the knowledge and attitude on post natal complications with selected demographic variables. The significant findings will be expressed in tables figures and graphs.
Yes, ethical clearance will be been obtained from the research committee of Nightingale College of Nursing
Consent will be taken from the study subjects before the collection of data
REFERENCES :
9. /
SIGNATURE OF THE CANDIDATE
10. /REMARKS OF THE GUIDE
11. / NAME AND DESIGNATION OF (IN BLOCK LETTERS)11.1 GUIDE
11.2 SIGNATURE
11.3 CO-GUIDE
11.4 SIGNATURE
11.5 HEAD OF DEPARTMENT
11.6 SIGNATURE
12 / 12.1 REMARKSOF THE PRINCIPAL
12.2 SIGNATURE
1