RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE KARNATAKA
ANNEXURE II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 / NAME OF THECANDIDATE AND
ADDRESS / Mrs. JINCY JOHN P
1ST YEAR MSC NURSING
RATHNA COLLEGE OF NURSING
B.M.ROAD HASSAN KARNATAKA
2 / NAME OF THE INSTITUTION / RATHNA COLLEGE OF NURSING
B.M ROAD HASSAN KARNATAKA
3 / COURSE OF STUDY
AND SUBJECT / MASTER OF SCIENCE IN NURSING
(OBSTETRICS AND GYNAECOLOGY)
4 / DATE OF ADMISSION
TO COURSE / 13/07/11
5 / TITLE OF THE TOPIC / “EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED HOME BASED POST NATAL CARE AMONG PRIMI POST NATAL MOTHERS UNDERWENT CAESAREAN SECTION.”
5.1 / STATEMENT OF THE PROBLEM / “A STUDY TO EVALUATE THE EFFECTIVENESS OF STUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED HOME BASED POST NATAL CARE AMONG PRIMI POST NATAL MOTHERS UNDERWENT CAESAREAN SECTION IN SELECTED HOSPITALS AT HASSAN.”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“When you are a mother you are never alone in your thoughts. A mother always has to think twice one for herself and one for her child.”
- Sophia Loren
Throughout pregnancy, mother was center stage. The partner, family, doctor and mother herself were concentrating on various aspects of her health and care in pregnancy and labour. The fetus growing inside was a secondary patient. Now that she has delivered, the focus of everybody’s attention, seems to have shifted suddenly from mother to baby. However, there are many things about mother’s body that are still going to change. This post delivery period is extremely important, and to recover to her pre-pregnancy health.1
Postnatal period is the time just after the delivery and through the first six weeks of life. And this period is called puerperium. This period is usually considered to be six weeks in duration.2 By six weeks after delivery, most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non pregnant state.The immediate postpartum period most often occurs in the hospital setting, where the majority of women remain for approximately 2 days after a vaginal delivery and 3-5 days after a cesarean delivery. During this time, women are recovering from their delivery and are beginning to care for the newborn. This period is used to make sure the mother is stable and to educate her in the care of her baby especially the first-time mother. 3
An essential care during this period is necessary for mother and child for their healthy outcome. Care in the period following birth is critical not only for survival but also to the future of mothers and newborn babies. Major changes occur during this period that determines their well-being and potential for a healthy future. Postnatal care is pre-eminently about the provision of a supportive environment in which a woman, her baby and the wider family can begin their new life together.4
Lack of knowledge regarding post natal care may lead the mother to wide range of postpartum problems. Common problems experienced by the mothers include postpartum infections, including uterine, bladder, or kidney infections, excessive bleeding after delivery, pain in the incision area, vaginal discharge, breastproblems such as swollen breasts, infection and clogged ducts, marks, hemorrhoidsandconstipation, urinary or fecal incontinence, depression, discomfort during sex etc.5
In order to prevent all these problems, prompt post natal care is very essential after the delivery of the baby till the sixth week. During this period the care is essential not only for the mother but also for the child. The general post natal home based care include provision of adequate rest and ambulance, diet, sleep, care of the breast, importance of postnatal exercise, family planning advice and guidance, importance of post natal check up for the mother, and adequate breast feeding and newborn care.6
Post natal care is necessary to ensure that no complications have developed in the woman after childbirth. It is important that mothers and their partners are informed of what normally happens during this period, and that make sure there are no danger signs which can compromise the health of the mother or the newborn. Post partum maternal health care influences the health of both mothers and their children. Recommendations to promote maternal health include establishing polices regarding post partum maternal health, re evaluating and reforming the program of routine post partum health care, encouraging family support, offering support groups, designing long term educational programs and conducting research focused on post partum maternal health.7
6.1 NEED FOR THE STUDY
“If new mothers thrive, it means that the healthcare system is working, and the opposite is also true…” LaurieGarrett
During the period of pregnancy and child birth, the body of a mother undergoes several changes, which takes time to get back to the pre- pregnancy stage. After a child birth it is essential for the mother to take care of herself so that she can enjoy with her new baby and rest of the family. Taking care of the baby and feeding the baby is very tiring and requires energy. So thepost natal care of the mother is very important especially those who underwent cesarean section8
Maternal morbidity and mortality rates remain unacceptably high across the developing world. Every minute, a woman dies from complications related to childbirth or pregnancy. Complications of pregnancy and childbirth are a leading cause of death and disability among women of reproductive age (ages 15 to 44) in developing countries. While most maternal deaths are preventable, poor health services and scarce resources limit women’s access to life-saving, high-quality care. Although there have been some notable advances, efforts to adequately address maternal health remain fragmented.9
Problems women can experience during the postnatal period include: tiredness, breast problems, backache, hemorrhoids, constipation, depression, anemia, headache and urinary symptoms. Postpartum care and recovery length varies widely from woman to woman. It can take weeks, even months for mother’s body to heal and return to its pre-pregnancy state. Women who have had surgery (C-section) usually need a longer recovery period than those who had vaginal birth.
The quality of Home based postnatal care provided to women and families in the first days and weeks after birth can have a significant impact on their experience of the transition to parenthood. First time parents often have very limited experience of the physical and emotional demands of their new roles and responsibilities which can be quite a challenge. Research repeatedly shows more negative comments from service users in relation to hospital postnatal services than about any other aspect of maternity care. It shows that all mothers should be able to access good quality postnatal support in their home.10
During the post natal period mother requires education regarding rest, diet, exercises, breast feeding, hygiene,family planning and new born care. Postpartum care can be categorized to different categories such as external, internal and mental care. For a new mother, she has to make sure she takes good care of herself in these three aspects in order to prevent the post natal complications.11
A study was conducted to assess the effectiveness of home-based postnatal care. The aim of the study was to explore home based post natal care in terms of what is currently provided; what women expect; and how prepared midwives are to provide home-based postnatal care. The study comprises three components. Component one is a web-based survey of all managers of public maternity hospitals in Victoria exploring the guidelines, procedures, and practice of home-based postnatal care. Component two involves interviews with new mothers whose babies are approximately four to five months of age, and who received home-based postnatal care. Component three comprises focus groups with Victorian midwives who provide home-based postnatal care. Study concluded that urgently needed information concerning the structure and content of home-based post natal care. 12
A study to assess the information needed to parents after being discharged directly from the hospital. The purpose of this study was to examine the parents' need of information after early discharge after delivery and to compare their needs with the information given according to the checklist forhome-visits. Forty-two couples completed the study. They were asked to formulate five questions to the midwife at thehome-visit. After the questions were gathered, a content-analysis was done. Three different main groups were identified: questions concerning 1) the child (68%) such as hygiene, bowel movements, burping, vomiting, eating, sleeping and sneezing 2) breast-feeding (21%) questions were asked about position while breast-feeding, nipples and amount of milk 3) the mother (11%) questions concerned after pains, stitches, eating and drinking. The results show that the checklist worked sufficiently well as a work tool, but can be adjusted further according to the parents' need. This study shows that they needed more information about thecareof the infant, primarily concerning hygiene.13
The World Health Organization in Postpartum care of the mother and newborn recognizes the benefits of postnatal care.“Psychological problems in the postpartum period are not uncommon. These problems can be lessened by adequate social support and support from trained care-givers during pregnancy, labour and the postpartum period”. The WHO in Postpartum care of the mother and newborn recommends that the establishment and maintenance of breastfeeding should be one of the major goals of postpartum care.14
Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy or childbirth. That is 515,000 women a minimum, dying every year. Nearly all maternal deaths (99 percent) occur in the developing world--making maternal mortality the health statistic with the largest disparity between developed and developing countries.15
Post natal complications are major health problems in developing country like India. Based on much literatures and investigators experience, it is felt that it is essential to give adequate knowledge regarding home based post natal care to primi para mothers. The knowledge will help them to improve their awareness regarding home based post natal care and help them to promote longer-term physiological and emotional wellbeing.
6.2REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature is the reading and organizing of previously written materials relevant to the specific problems to be investigated: Framework and methods appropriate to perform the study.
The literature reviewed under following headings:-
6.2.1 Studies related to home based post natal care.
6.2.2 Studies related to post natal care.
6.2.1 Studies related to home based post natal care
A study was conducted to enhance the postnatal education for first-time mothers investigated through an action research cycle. This study sought to benefit women in the transition to motherhood by enhancing the postnatal teaching offered to first-time mothers in hospital following childbirth. The study followed an action research cycle to design, implement and evaluate an educational resource for first-time mothers during the immediate postnatal period. The result of the study showed that first-time mothers considered lack of time as a significant factor in giving and receiving postnatal education. It was also found that the provision of relevant information was important. The study identified that specific information relating to baby-care and self-care are primary educational needs for first-time mothers.16
A study was conducted to assess the effectiveness of postpartumhomevisits extending the continuum ofcarefrom hospital tohome. Crucial maternal, newborn, and family healthcare needs arise during the early postpartum period, providing the opportunity forhomecarenurses to extend the continuum of carefrom hospital tohome. This study identifies common early postpartum problems discovered onhomehealth visits and describes the related interventions ofhome health nurses. Co relational analysis revealed that young mothers, first-time mothers, breastfeeding mothers, and single mothers are priority candidates for follow-uphomecare.17
A study was conducted to assess the effectiveness of postpartum support to improve maternal parenting, mental health, quality of life, and physical health. This review examined the published evidence of the effectiveness of postpartum support programs to improve maternal knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of life, and maternal physical health. Randomized controlled trial evidence was found to endorse universal provision of postpartum support to improve parenting, maternal mental health, maternal quality of life, or maternal physical health. There is some evidence that high-risk populations may benefit from postpartum support.18
A study was conducted regarding postnatal carein the community: report of an evaluation of birthing women's assessments of apostnatalhome-careprogramme.The aim of the study was to evaluate a newpostnatalhomesupport worker introduced into a geographically defined catchment area of a metropolitan hospital in South Australia. The research methods used included interviews with antenatal women about their knowledge of and attitudes to the programe, and interviews withpostnatalwomen about their transitionhomeexperience and assessment of the program. The results demonstrate the importance of well-structuredhomesupport services to maternal satisfaction and maternal well-being through the provision of physical, social and emotionalcareand support in thehome.19
A study to gain a deeper understanding of first-time parents experiences of early discharge from hospital after delivery and home based post natal care. Twenty one parents participated. Three themes emerged: the family strategy, which describes the families expectation of post natal care and their experience of the real situation. Some are flexible concerning going home early, and others have decided in advance. Professional support in the home summarizes the parents experience of the midwife is seen as a support and adviser to the parents.This study shows that parents welcome home-based postnatal care with suits healthy families. We think it will be more important in the future to discriminate between healthy families and those in need of hospital care than to focus on the moment when they leave the hospital, early or late.20
6.2.2 Studies related to post natal care
A study was conducted to assess the maternal health after childbirth. The women who participate gave birth in a two-week period. One or more health problems in the first sixpostnatalmonths were reported by 94% of the women. The research conclude that physical and emotional health problems are common after childbirth, and are frequently not reported to health professionals despite the fact that many women would like more advice and assistance in dealing with them.21
A study was conducted to assess the women's experience of theirpostnatal care. This paper examines women's experience of theirpostnatal carein hospital and at home. It found that over a third of women surveyed had problems caring for themselves and the baby. Breastfeedingmotherswere more likely to have problems than bottle-feedingmothers. There was no relationship between having such problems andparity. Women were particularly dissatisfied withpostnatalservices at home, 45% describing them as inadequate. Satisfaction with services was significantly associated with having sufficient advice from health professionals in hospital and at home. In view of the findings of this paper, it is clear that a strategy is required to identify those most in need ofpostnatal careand target services accordingly.22
A Study was conducted to assess the Stressful events, social support and coping strategies of primiparous women during the postpartum period: 60 women interviewed six weeks after the birth at term of their first child. During the early postpartum period, interaction with caregivers was an important source of perceived stress. Upon returning home, the partner was considered as the primary source of social support, but the first need expressed was for material support. Educational information dispensed by medical staff during the prenatal period was not put into practice during the postpartum period.Mothersexpressed the need to be accompanied and counseled when problems arose and regretted the lack of long-term postpartum support. Both the prenatal education and postpartum social support seem to mismatch women's needs and expectations. Concerted efforts are required by health professionals at the maternity unit and in the community to providemotherswith more adequate postpartum assistance.23
A study was conducted to assess the Women's views and experiences ofpostnatalhospitalcare. The participants were 1616 women who gave birth in Victoria in a 2-week period. The research shows that women rate earlypostnatal carein hospital far less favorable thancarein pregnancy, labor and birth. The findings indicate that interactions with caregivers are a major influence on women's overall rating ofpostnatalhospitalcare. Acting on these findings requires a greater focus on communication and listening skills, attention to staffing levels, and leadership promoting more women-centeredcareinpostnatal wards.24
A study was conducted to assess the comparison of breast feeding after traditionalpostnatalhospitalcareandearlydischarge.304 women were participate with babies of six months of age. Division was made for breast feeding at 2, 4 and 6 months of age. The four main groups were examined for demographic differences. A difference was found in education level;earlydischargemothershad a lower level of education than THCmothers. No significant difference was found for the frequency or duration of breast feeding between theearlydischarge and the traditional hospitalcaregroups, despite the higher education level in the traditional hospitalcaregroup. A possible explanation for this finding is that acareplan aimed at supporting the individual's responsibility and participation, providing relevant knowledge and a subliminal communication of trust in the competence of parent and child, is of particular significance for women with less education. The presence and participation of the baby's father at anearlystage may also be a factor.25