RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / Ms.TINTU ELIZABETH EAPEN I YR M.Sc NURSINGN.D.R.K COLLEGE OF NURSING
B.M. ROAD HASSAN
2 / NAME OF THE INSTITUTE / N.D.R.K COLLEGE OF NURSING, HASSAN
3 / COURSE OF STUDY AND SUBJECT / MASTER IN NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 / DATE OF ADMISSION TO THE COURSE / 14-05-07
5 / TITLE OF THE TOPIC / THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE REGARDING DETECTION AND MANAGEMENT OF POSTPARTUM DEPRESSION ON KNOWLEDGE OF STAFF NURSES IN SELECTED MATERNITY HOSPITALS OF HASSAN.
6 / STATEMENT OF THE PROBLEM / A STUDY TO EVALUATE THE EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE REGARDING DETECTION AND MANAGEMENT OF POSTPARTUM DEPRESSION, ON KNOWLEDGE OF STAFF NURSES, IN SELECTED MATERNITY HOSPITALS AT HASSAN.
6.0 BRIEF RESUME OF INTENDED WORK
6.1 INTRODUCTION :
The birth of a baby represents a profound and permanent life change for the parents
and other family members. After nine months of pregnancy and the stresses of labor and birth, a family is born or enlarged. For new parents the challenges are numerous – recovery from birth, total responsibility for a tiny dependent new born, sleeplessness, emotional adjustment, mastery of infant feeding and care; understanding of and adjustment to the unique personality of there baby and household organization. Sometimes the physical or emotional health of the new mother or baby is compromised.1
With all these challenges, it is clear that the importance of support, advice and assistance in the weeks and months following birth cannot be over emphasized. The ways in which the woman, baby, partner and siblings make the transition to a new family unit have a long-term impact on their physical and emotional health. Changes in mood coincide with the drop in the hormones estrogen and progesterone, which reach their lowest level on those days. The post-partum is a high risk period for the occurrence of anxious and depressive episodes. 1
Postpartum emotional disorders generally fall into one of the 3 categories' blues, depressions, or Psychoses. Maternity blues occur in approximately 80% of child births. The blues are a transient time of emotional joy, weepiness, and feeling overwhelmed. Women who experience the blues usually report that symptoms subside within 2 weeks. In contrast the symptoms of post partum depression include anxiety, insecurity emotional liability, guilt, shy for not measuring up to " good mothering", sleeping / eating, disturbances, mental confusion, and loss of interest in previously enjoyable tasks. Women may also have suicidal thoughts. Women need to understand that if their maternity blues symptoms progress beyond 2 weeks postpartum, they may have depression. 2
Postpartum depression was more likely to occur in women who were single were less than 20 years old at the birth of their first child, were unhappy with their relationship with their partner, had a history of previous psychiatric hospitalization. Cultural factors such as arranged marriage or gender of the new born also had impacts.3
It is also important that most of the depression around birth is caused by how birth is conducted. The midwives have a lot of control over how women feel about a disappointing birth, where a woman feel about a disappointing birth, where a women has no control over the rituals and protocols around be and even less control over the people around her, can lead to the blues. These blues can, in turn, lead to full-blown depression. So the mission of midwives is to make birth circumstances normal so that mom starts off on a joyful path of motherhood. 4
6.2 Need for the study:
Postpartum depression is characterized by a changing mood, anxiety, irritability, depression, panic and obsess ional phenomena. In general post partum depression seems to be the same illness as depression, at other times in life. There is considerable evidence that the childbearing years represent a time when women are highly vulnerable to developing mood disorders. Prospective, cross-sectional and retrospective studies have demonstrated that more than 10% of new adult mothers will experience a major depressive episode during the first postpartum year. 5
Recent studies identify a much higher incidence of post partum depression than had previously been acknowledged and show that a mother’s depression may have a highly deleterious effect on the early development of her infant. 9-15% of women who have recently given birth experience post partum depression. Statistical analysis of the data revealed that 17.4% of the total population has a potential risk of developing post partum depression. 6
Almost, 80% of new mothers experience slight depression after childbirth or 'baby blues'. About 20% suffer from more serious post partum depression or post partum depression. In New Jersey, that's nearly 16000 annually. The National institute of mental health calculates 800000 cases nationally. The biological and Psycho-social pathogenic factors, unique to the puerperal period, are not yet known. 6
About 13% of women experience depression in the first year after childbirth. Post partum depression has a deleterious effect on the woman's relationships, her functional status, and her ability to care for her infant. Women with higher quality support had babies with higher APGAR scores and experienced less post partum depression. 7
Undiagnosed post partum depression is devastating nurses have the most contact with post partum women but may be unable or unwilling to screen treat, and / or refer the women. Thus many women with post partum depression are not receiving mental health services. Thus raise the awareness of nurses about post partum depression, thereby eliminating a major barrier to mental health treatments of postpartum women. 7
A sample of six community health centers was selected to evaluate the effect of a web-based course for community nurses in Iceland with regard to outcome of postpartum emotional distress. Findings indicate that the web-based transfer of knowledge to nurses on evidence-based interventions for postpartum emotional distress has a positive effect on distressed women in the postpartum period and warrants further study. 8
In the present setting as the student investigator posted in the postnatal ward; observed that most of the postnatal mothers are having emotional and social adjustmental problems with their new role and the nurses are having insufficient knowledge in dealing with such cases. So it is felt by the student investigator that there was a need for the study as nurses have the most contact with the postpartum women.
6.3 STATEMENT OF THE PROBLEM
" A study to evaluate the effectiveness of self instructional module regarding detection and management of postpartum depression , on knowledge of staff nurses in selected maternity hospitals at Hassan."
6.4 OBJECTIVES :
a. To assess the knowledge regarding detection and management of postpartum depression among staff nurses before administration of self instructional module.
b. To administer self instructional module regarding detection and management of Post partum depression to the staff nurses.
c. To evaluate the effectiveness of self instructional module regarding detection and management of Post partum depression in terms of increase in post test knowledge scores among staff nurses.
d. To identify association between post test knowledge scores and demographic variables of staff nurses, in experimental group.
6.5 HYPOTHESES :
1. There will be a significant difference between pretest knowledge score and post test knowledge score regarding detection and management of postpartum depression.
6.6 ASSUMPTIONS: :
1. The difference in pretest and post test knowledge scores shows the effectiveness of self instructional module.
2. The staff nurses are willing to participate in the study to enhance their knowledge regarding Post partum depression.
6.7 OPERATIONAL DEFINITION :
1. Evaluate: In this study evaluate refers to a process of valuing the effectiveness
of self instructional module regarding Post partum depression.
2. Effectiveness: Refers to the difference between mean knowledge scores of pretest
and posttest of staff nurses regarding detection and management of Postpartum
3. Self instructional module : Refers to information booklet involving
information about incidence , causes, effects, prevention, detection and management
of Post partum depression
4. Post partum depression: It is a depressive disorder occurring in proximity to
activities related to child birth.
5. Knowledge: Refers to the number of correct responses of staff nurses to the
questions stated in the closed ended knowledge questionnaire.
6. Staff nurses : Refers to a registered nurse who has completed the basic education in
nursing and working in selected maternity hospitals at Hassan.
6.8 Inclusion and exclusion criteria:
INCLUSION CRITERIA
This study will include staff nurses , who are;
1. working in selected maternity hospitals at Hassan.
2. willing to participate in the study.
3. present at the period of data collection.
4. having minimum one year of experience.
EXCLUSION CRITERIA
This study will not include staff nurses, who are not ;
1. willing to participate in the study.
2. present at the period of data collection.
3. having minimum one year of experience.
6.9 DELIMITATIONS OF THE STUDY:
1. The study is limited to selected maternity hospitals of Hassan.
2. Sample size is limited to 60 staff nurses.
3. Prescribed data collection period is only 4-6 weeks.
6.10 SIGNIFICANCE OF THE STUDY:
The study signifies the importance of Self instructional module in increasing knowledge of staff nurses regarding detection and management of post partum depression.
6.11 CONCEPTUAL FRAME WORK:
Mercer’s theory in maternal role attainment.
6.12 REVIEW OF LITERATURE:
Review of literature is a standard requisition of scientific research. It means reading and writing the pertinent information of the attempt in research topic to understand better about the proposed topic. It is essential for researcher to analyze the existing knowledge before going into a new area of study.
Studies related to knowledge
A study was conducted in university of Connecticut on beliefs about and screening practices for post partum depression among 2100 certified nurse – midwives. Nurses-midwives sampled believe Post partum depression is serious and common; however their screening practices are irregular and they under estimate the incidence of Post partum depression in their own practice. The study suggested that efforts to improve Post partum depression recognition and treatment should involve nurse – midwives in screening promotion and through education in the use of screening tools. 9
A study was conducted in Kingston, USA, to explore the meaning of nurses caring for mothers experiencing post partum depression, among 10 mothers. The exhaustive description of casing that emerged from this phenomenological study will help sensitize nurses to issues to consider in caring for mothers experiencing postpartum depression. The study illustrated nurses caring for mothers experiencing Post partum depression, having sufficient knowledge about Post partum depression. 10
A study on 52 nurses and 121 mothers to determine their knowledge and attitudes towards the traditional Chinese custom of 1-month confinement following delivery to discover factors influencing the attitudes, and to analyze the correlation between them. A significant difference was found in the women's and nurses scores, with post partum women scoring higher than the nursing staff on average. Both groups held positive attitudes toward the traditional custom. Attitudes and level of knowledge were positively correlated. 8
A study conducted on 303 pregnant women who give birth at home records that they are considerably less prone to mood disturbances during the early puerperium than those who give birth in hospital. The study shows that there was no difference in the incidence of blues and depression between women who gave birth at home and those who gave birth in hospital. 11
A study was conducted among 725 obstetric nurses and 2104 obstetricians to measure their knowledge and awareness of postpartum depression nurses were more aware than physicians and demonstrated more empathy and believed education of Post partum depression does not increase a mothers risk were more aware of the postpartum phenomenon than nurses who were less empathic and who did not hold the same belief. 12
Studies related to teaching
A study was conducted in Sweden; to assess the effectiveness of a midwife led debriefing session during the postpartum hospital stay in reducing the prevalence of maternal depression at six months postpartum among 1041 women who had given birth by caesarean section or with the use of forceps. More women allocated to debriefing scored as depressed 6 months after birth than women allocated to usual postpartum care. Midwife led debriefing after operative birth is ineffective in reducing maternal morbidity at 6 months postpartum. 13
A study was conducted in Rochester, New York on 465 women to determine the incidence of clinically significant depression occurring between 1 and 4 months postpartum and to investigate whether somatic complaints, subsyndromal depressive symptoms or birth – related concerns among non-depressed women at 1 month were predictive of postpartum depression. In a logistic regression analysis, four variables (Maternal age, depression during pregnancy, thoughts of death and dying at 1 month postpartum) were predictive of depression at 4 months post partum. 14
A study was conducted in New South Wales, Australia to examine obstetric risk factors for post partum depression in an urban and rural community sample, with concurrent consideration of personality, psychiatric history and recent life events. The depression status was assessed at 8 weeks post partum among 490 women, The results emphasize the importance of psychosocial risk factors for Post partum depression and suggest that most obstetric factors during pregnancy and birth do not significantly increase risk for this depression. 15
A study was conducted to determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country in a rural community in Rosalinda, Pakistan, among 160 infants of depressed mothers and 160 infants of Psychologically well mothers. Infants of prenatal depressed mothers showed significantly more growth retardation. Chronic depression carried a greater risk for poor out come than episodic depression. Maternal depression in the prenatal and postnatal periods predicts poorer growth and higher risk of diarrhea in a community sample of infants. 16
A study was conducted in Kyushu university hospital , Japan, among 88 mothers about the onset and course of postnatal depression and developing screening system. At 3 wks, 21 mothers were categorized as having had maternity blues and twelve were diagnosed as depression cases. The blues scale score was significantly higher in the depressed mothers compared to the control mothers. The onset of Post partum depression can be with in the first week after delivery. 17