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) / BINNY THOMAS
I YEAR M. Sc. NURSING
LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA
MANGALORE
2. / Name of the Institution / LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA
MANGALORE
3. / Course of Study and Subject / M. Sc. NURSING
OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / Date of Admission to the course / 01.06.2011
5. / Title of the Topic
EFFECTIVENESS OF SLOW PACED BREATHING ON BEHAVIOURAL RESPONSES AMONG PRIMIGRAVIDA WOMEN DURING FIRST STAGE OF LABOUR IN SELECTED HOSPITALS OF MANGALORE
6. / Brief resume of the intended work
6.1 Need for the study
Pregnancy is a time of great change for a woman, not only for the obvious physical change in her body, even her emotional state changes several times throughout the day. Each woman comes into labour with a set of expectations: fear, preparation, pain threshold, personality and behavioural makeup, and ways of experiencing what is happening to her, which has to be maintained effectively. The time of labour and birth, though short in comparison with the length of pregnancy, is the most dramatic and significant period of pregnancy.1
Labour pain is the most severe pain experienced by the women. Parity also influences labour pain, that is, primigravida women experience more pain during labour than multigravida mothers.2 Recent studies have shown that the incidence of caesarean sections is increasing throughout the developed and developing countries. Majority of women (68%) are requesting for caesarean section because of psychological indications. Women with adequate psychological support and relaxation techniques had reduced the incidence of caesarean section and 38% of them agreed for normal vaginal delivery. Relaxation techniques, mainly breathing exercises, had brought 50% reduction in caesarean section for psychological indications.3
Breathing technique is one of the widest, safest, and commonest method of pain relief measures. The theory behind childbirth breathing patterns is based on the concentration required to focus on breathing. During a contraction, thought process is redirected from a pain response to breathing technique.1 Among various breathing exercises, slow paced breathing exercise is one of the simplest. It is slow, deep breathing that increases relaxation. This naturally brings about slower breathing, similar to that during sleep. It can be used as long as possible during labour because it promotes relaxation and oxygenation.4
A quasi-experimental study was conducted to evaluate the effectiveness of slow paced breathing on pain perception during first stage of labour among
primipara mothers. Slow paced breathing was taught to the experimental group before the labour pain started which they practiced during labour. Pain perception level was measured using pain intensity scale and facial pain scale. The investigator concluded that mothers who practiced slow paced breathing reported significant reduction in pain perception, mean value of 4.28 and 6.22 in the control group using pain intensity scale. Reduced pain perception in experimental group value 2.24 and control group mean value 3.19 with facial pain scale.1
The investigator during her clinical posting and interaction with mothers in labour had observed that they were having limited knowledge about slow paced breathing exercises to be performed during labour. They showed various behavioural responses like crying, hitting the labour table, biting of teeth tightly, etc. Since there is no such provision for providing advice during intrapartum period, mothers are not prepared mentally and physically to deal the happenings of pregnancy. Hence, the investigator is interested to evaluate the effectiveness of slow paced breathing on behavioural responses among primigravida women. This study will help in providing better care during intrapartum period which gives a positive childbirth experience to the mother.
6.2 Review of literature
An experimental study was conducted to determine the effectiveness of breathing exercises on the duration of labour and behavioural responses among 40 gravid women during the first stage of labour in Mangalore. Breathing exercises were taught to 20 women in experimental group using planned teaching programme. The routine hospital measures were followed for 20 women in control group. Purposive sampling technique was followed to allot the sample. Research design used was quasi experimental one-group post-test only control group design. The tools used for data collection were two structured observational checklist, one for assessing the performance of breathing exercises and the other for assessing the behavioural responses. Findings of the study showed that the mean percentage score of Group I was higher (94.04%) than that of Group II
(62.55%). The computed t value showed a significant difference in the behavioural responses of women in labour who performed breathing exercises and those who did not (t38=23.19, p<0.05). It found that there was a positive correlation between the breathing exercises and behavioural responses of women in labour.5
An experimental study was conducted to evaluate the effective nursing interventions on pain during labour among 60 primi mothers. Nursing interventions such as massage, breathing exercises, and positions were given to 30 primi mothers in the experimental group. Routine hospital measures were followed for 30 primi mothers in control group. Simple random sampling technique was followed to allot the sample. Research design used was true experimental basic experimental design before and after only design. The tool used for data collection was structured questionnaire for assessing demographic variables and Visual Analogue Scale for pain assessment. Findings of the study showed that there was significant difference between the pre- and post-assessment level of pain perception of primi mothers (t29=4.384).6
A quasi-experimental study was conducted to determine the effectiveness of childbirth preparation class in terms of behavioural responses during first stage of labour and outcome of labour in terms of maternal and neonatal outcome among 60 primigravida women in selected hospitals of Udupi district, Karnataka. Non-equivalent post-test only design was used. Thirty primigravida participated in the childbirth preparation class and another 30 made up the control group. The effectiveness was assessed by means of student ‘t’ test and chi-square test. Statistically significant differences between the groups were found in behavioural responses in first stage of labour, nature of delivery, and neonatal outcome. Statistically significant differences in the duration of labour were not observed. The mean behavioural responses scores in the experimental group (31.882) were higher than that of the control group (18.82). The standard deviation in the experimental group was 4.765 while in the control group was 3.7. The ‘t’ value computed for behavioural responses of the experimental and control group was significantly higher (t58=11.858, P<0.05). 7
A study was done to examine the relationship between the use of patterned breathing, a traditional intervention, and the level of fatigue reported during the first stage of labour. A secondary analysis was conducted on a subset (n= 56) of a prospective longitudinal study of fatigue during the intrapartum period. The sample comprised primiparous women in labour whose fatigue was measured every two hours for six hours after admission. At each data point the investigator evaluated the method of breathing that participants used. During the latent phase of labour, women using patterned breathing exhibited significantly more fatigue. In the active phase, differences between groups were not significant. Controlling for age, education, and marital status of participants did not change the results. The study concluded that it is appropriate for nurses, midwives, physicians, and doulas to encourage the use of patterned breathing as an intervention in active labour; however, patterned breathing may increase the mother's fatigue level if begun too early.8
A pilot study was conducted to examine the breathing patterns among 21 women during latent labour. The study also examined the different thoughts or cognitions the women experienced during their early contractions and assessed whether these cognitions, when classified as associative or dissociative in orientation, were related to breathing styles and length of labour. Respiration rate and tidal volume were monitored during and between contractions using a non-invasive plethysmograph system. The breathing results indicated considerable variation among women in individual respiration rate and tidal volume both between and during contractions. In addition, marked variability was found in both the direction and degree of change in breathing frequency and tidal volume in response to contractions. Women who relied predominantly on associative strategies during early labour had lower breathing rates and higher tidal volumes than did women who employed dissociative strategies.9
6.3 Statement of the problem
Effectiveness of slow paced breathing on behavioural responses among primigravida women during first stage of labour in selected hospitals of Mangalore.
6.4 Objectives of the study
The objectives of the study are:
· to evaluate the effectiveness of slow paced breathing in terms of behavioural response in experimental group.
· to compare the level of behavioural response in experimental and control group during first stage of labour.
· to find out the association of behavioural response score with the selected demographic variable.
6.5 Operational definitions
Effectiveness: Effectiveness refers to the change produced by an action or cause, or producing an intended result.10
In this study, effectiveness refers to the extent to which slow paced breathing has its positive impact on the behaviour responses of primigravida women.
Slow paced breathing: It is a type of breathing exercise in which constant, steady, deep breaths are taken through the nose and exhaled slowly through the mouth.3
In this study, slow paced breathing refers to a slow, rhythmic, repetitive breaths which will be half of the normal breathing count which will be demonstrated to the primigravida during the first stage of labour, and the procedure includes:
· Start with a deep cleansing breath, which is done by:
- Inhale through the nose, keeping shoulders relaxed.
- Exhale through the mouth, letting go of all the tensions in your body.
· Inhale through nose to a count of 4 – in, 2, 3, 4.
· Exhale through mouth to a count of 4 – out, 2, 3, 4.
· Repeat inhale and exhale throughout the contraction.
· When contraction ends, deep cleansing breath is taken.
Behavioural response: Behavioural responses refers to the actions or reactions of persons or things in response to external or internal stimuli.10
In this study, behavioural responses refers to the responses shown by the gravid women in the first stage of labour as measured by an observation checklist which includes behaviour during uterine contraction.
First stage of labour: First stage of labour refers to the phase starting from the onset of true labour and ends with full dilatation of cervix.11
In this study, first stage of labour refers to the phase when the cervix is dilated more than 4 cm as identified by per vaginal findings.
6.6 Assumptions
The study assumes that,
· Slow paced breathing reduces stress and anxiety.
· Slow paced breathing exercises have no known harmful effects on labour and childbirth.
6.7 Delimitations
· The study is delimited to primigravids women who are in first stage of labour in the selected hospitals of Mangalore.
6.8 Hypotheses
The hypotheses will be tested at 0.05 level of significance.
H1: There is a significant difference in the behavioural response scores of experimental and control group.
H2: There is a significant association between behavioural response scores and selected demographic variables.
7. / Material and Methods
7.1 Source of data
The primigravida women in the selected hospitals of Mangalore.
7.1.1 Research design
Quasi experimental with interrupted time series post-test design.
E X O1 O2 O3
C O4 O5 O6
E: Experimental group
C: Control group
X: Intervention
O1: First observation of behavioural response after 45 minutes of giving slow paced breathing.
O2: Second observation of behavioural response after 45 minutes of first observation.
O3: Third observation of behavioural response after 45 minutes of second observation.
O4: First observation of behavioural response during contraction.
O5: Second observation of behavioural response after 45 minutes of first observation.
O6: Third observation of behavioural response after 45 minutes of second observation.
7.1.2 Setting
The study setting will be the antenatal ward and labour theatre of the selected hospitals of Mangalore.
7.1.3 Population
In this study, the population comprised of primigravida women.
7.2 Method of data collection
7.2.1 Sampling procedure
In this study, purposive sampling will be used to select the sample from the selected hospitals in Mangalore.
7.2.2 Sample size
In this study, the sample will be 40 primigravida women (20 in the experimental group and 20 in the control group).
7.2.3 Inclusion criteria
Primigravida women who are:
- in labour with cervical dilatation more than 4 cm.
- willing to participate in the study.
7.2.4 Exclusion criteria
Primigravida women,
- with obstetrical complications.
- who have been transferred from other hospital.
7.2.5 Instruments intended to be used
In this study, a structured observational checklist on behavioural responses of primigravida mothers during the stage of labour will be used.
7.2.6 Data collection method
· Prior to the data collection, permission will be obtained from the concerned hospitals authorities for conducting the study.
· Subjects will be selected according to the selection criteria and confidentiality will be assured.
· Written consent will be obtained from the subjects. Subjects will be randomly assigned to experimental group and control group.
· Slow-paced breathing exercises will be taught individually to the subjects of experimental group during first stage of labour with two cm cervical dilatation.
· Behavioural responses will be assessed in subsequent three observations with an interval of 45 minutes, both in experimental and control group, using behavioural response checklist.
7.2.7 Plan for data analysis
Data will be analysed using descriptive and inferential statistics.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly.
Yes, administration of slow paced breathing exercises to the selected primigravida women.
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the concerned authority.
8. / Bibliography
1. Vijayalakshmi S. Pain perception of primigravida mothers during labour with effleurage. Nightingale Nursing Times 2011 Sep;7(6):7-9.
2. Kalaimathy A. Assessing pain perception of primipara mothers during labour. Nightingale Nursing Times 2011 Jul;7(4):28-30.
3. Sjogren B, Thomassen P. Obstetric outcome in 100 women with severe anxiety over childbirth. [online]. Available from: URL:http://informahealthcare.com/doi/abs/10.3109/00016349709034907
4. Patterson J. Labour breathing exercises. Journal of Nurse-Midwifery 1997;42(2):99-103.
5. Saldanha H .A study to evaluate the effects of breathing exercises on duration, outcome of labour and behaviour responses of gravid women during the 1st stage of labour in a selected hospital. Unpublished M. Sc. Nursing dissertation submitted to RGUHS, Bangalore; 2004.
6. Bharathi BJ. Effective nursing intervention on pain during labour among primi mothers. Nursing Journal of India 2010;6(2):46-50.
7. Karkada EC, Noronha JA, D’Souza SRB. Preparing primigravida women for childbirth-behavioural responses to labour pain & outcome of labour. International Journal of Nursing Education 2010;(2):1-17.
8. Pugh C, Gray BS. First stage labour management: an examination of patterned breathing & fatigue. Birth 1998;25(12):241-5.
9. Hesson K, Hill T. Variability in breathing patterns during latent labour. Journal of Nurse-Midwifery 1997;42(18):99-103.
10. Elliot J. Oxford Dictionary & Thesaurus. 3rd ed. New York: Oxford University; 2001.
11. Duncan HA. Duncan’s dictionary for nurses. 2nd ed. New Delhi: CBS Publishers; 2001.
9. / Signature of the candidate
10. / Remarks of the guide
11. / Name and designation of (in block letters)
7.1 Guide / MRS. SANDHYA D’ALMEIDA, M. Sc. (N)
ASSOCIATE PROFESSOR AND HOD
DEPT. OF OBSTETRICS AND GYNAECOLOGICAL NURSING
LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA, MANGALORE
11.1 Signature
11.2 Co-guide (if any) / PROF. (MRS.) THERESA L. MENDONCA
vice principal and PROFESSOR
DEPT. OF CHILD HEALTH NURSING
LAXMI MEMORIAL COLLEGE OF NURSING, MANGALORE
11.3 Signature
12 / 12.1 Head of the department / MRS. SANDHYA D’ALMEIDA, M. Sc. (N)
ASSOCIATE PROFESSOR
DEPT. OF OBSTETRICS AND GYNAECOLOGICAL NURSING
LAXMI MEMORIAL COLLEGE OF NURSING
BALMATTA, MANGALORE
12.2 Signature
13. / 13.1 Remarks of the Chairman and Principal
13.2 Signature
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