RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1
/
NAME OF THE CANDIDATE
&
ADDRESS
/
Smt. K.KRISHNA KUMARI
VIJAYA COLONY,
CHEEPURUPALLY,
VIZIANAGARAM(DT),
ANDHRA PRADESH.
2
/
NAME OF THE INSTITUTION
/
NOOR COLLEGE OF NURSING

#5, NOOR BUILDING,

BHOOPSANDRA BUILDING, R.M.V 2ND STAGE,

BANGALORE - 560094

3

/

COURSE OF THE STUDY AND SUBJECT

/

M.SC NURSING, 1ST YEAR

OBSTETRICS AND GYNAECOLOGICAL NURSING

4

/

DATE OF ADMISSION

/

01-06-2009

5

/

TITLE OF THE TOPIC

/

“ A STUDY TO ASSESS THE EFFECTIVENESS Of STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING MANAGEMENT OF MINOR DISORDERS AMONG ANTENATAL MOTHERS IN GANGA NAGAR MATERNITY HOSPITALS AT BANGALORE.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“ Before you were conceived I wanted you Before you were born I loved you Before you were here an hour I would die for you This is the miracle of Mother's Love.” -- Maureen Hawkins

Pregnancy is a positive step towards the most wondrous situation of women. Pregnancy can be one of the most important event and magical adventure that women can ever experience. The women most likely feel love, patience and other emotions that bubble up within her. Women also look forward for her baby’s arrival into this world with huge anticipation. Women long for the day physically carry the baby in their arms and look at the baby in the eyes.1

Pregnancy starts from fertilized ovum to 40 weeks. The fertilized ovum (zygote) continues its process through the fallopian tube and reaches the uterus. In the uterus implantation takes place. It develops into placenta and embryo and later into a foetus. Every system of a mother’s body is changes due to pregnancy. During this period many women experience minor disorders due to hormonal changes, accommodation changes, metabolic changes and postural changes. Due to changes in the digestive system women suffered with Nausea and Vomiting, Heartburn, Pthylism, pica and Constipation. During the pregnancy period the women increase weight gain leads to backache, the postural changes, muscle cramps. During first and last trimester of pregnancy there is a pressure of the gravid uterus on the urinary bladder frequency of micturition occurs. Progesterone on blood vessels leads to vasodilatation may cause fainting and also it leads to varicosities in legs anus and vulva. In late pregnancies owning to discomforts caused by the foetal movements frequency of micturition and difficulty in finding a comfortable position, fear and anxiety causes insomnia.2

Health conditions during the period empowering the women to take control over their own bodies and enable them to achieve the safe pregnancy vary from country to country. As with most other afflictions, women in the developing countries face greatest risk during pregnancy. This shows the distressing situation of the women who constitute 50% of the world population. It is estimated that 99% of the maternal deaths are occurring in the developing countries. In developed countries, maternal mortality varies from 4 to 20 per 1,00,000 births. In developing countries maternal mortality rate is 20 to 30 times higher than the developed countries. The maternal mortality rate in India is also considerably high. This is mainly due to improper care during pregnancy. An Indian women has 1 / 40 chances of dying from the pregnancy related causes like Pregnancy Induced Hypertension, Eclamisia, Antepartum hemorrhage, but Northern Europe has only 1 / 10,000 chances of dying. 3

Nausea and vomiting are said to affect to all over 50 % of pregnancies and generally decreases by 16 weeks. A small portion of the women i.e 0.3% to 2 % will develop more serious condition known as hyperemesis gravidarum, which requires urgent referral to the doctor. A 25 % of these affected mothers are dying because of the complications of Minor Disorders like dehydration, ketoacidosis, weight loss and hypokalemia.4

Around 80 % of the women experienced discomforts like, heartburn, constipation, haemorrhoids during pregnancy. Specially 40% of the women with low fibre diet complained of constipation during pregnancy. Among these, 20% faced the problem specially during third trimester.5

Blood flow in the lower limbs slow down during pregnancy leading to dependent oedema and varicose veins. 58% to 60% of women had thrombosis as the complication of varicose veins of the legs. Due to decreased cardiac output (25%) in the supine position the mother may get supine hypotension syndrome. 6

WHO estimated that at least 6,00,000 women die every year from the pregnancy related causes. The life risk of maternal deaths for the women in developed countries is 1 in 1800, in Africa it is 1 in 16. In Asia 1 in 65 . The ratio of mortality rate is 540 per one lakh live births.7

Prenatal care is one of the models of primary and secondary prevention of diseases. There are more maternal deaths in India and in all developed countries. The developed countries succeed in maternal mortality not only by medical improvement, but development in advanced general health education and social position.

Health maintenance is an important aspect of prenatal care. Participation of the mother in the care ensures the prompt reporting of the possible problems. Assumptions of responsibility for health maintenance promote her understanding about maternal adoption for the growth of unborn child and readiness to learn. Nurse can provide information to their health problem and need of self care through following of health care measures. Before developing the plan of care the nurse needs to determine whether the women follow any cultural, religious or other practices.

Nursing care during pregnancy mainly focus on maternal and normal foetal development. Optimum care can be achieved only if the services of the midwife are flexible enough to be driven by the demands of the pregnant women. Nurse has an important role in health promotions. Discrimination of health related information to the client is one of the primary function of the nurse to promote the health of the women for attaining optimum state of well being. Patient education is the process of assisting the people to learn and incorporate health behaviour in everyday life. Providing sympathetic and sound advice regarding the measures to relieve Minor Disorders of pregnancy does much to promote the overall health and well being of the pregnant mother.

6.1 NEED FOR THE STUDY

“Feeling fat last nine months but the joy of becoming a mom lasts

forever.” -- Nikki Dalton

Pregnancy is a creative and productive period in the life of the women. It is one of the vital events, which need special care from conception to postnatal period. The mother aims to enjoy the nine months with baby inside her, the joyful experience of the pregnancy is not always joyful. Sometimes it is associated with problems, which causes discomforts to the mothers during pregnancy. Sometimes women will be able to adjust with these physiological changes, sometimes may not adjust.

As there is increased maternal morbidity and mortality, the health deprivement of the pregnant mothers disturbs in developing countries. Pregnant women are the pivot around the family revolves. Since one fourth of all deaths in developing countries are due to maternal causes, the resulting trauma is severe for all families. “Maternal mortality is said to be the indicator of social inequity and discrimination against women” ( WHO, 1990). It is a neglected tragedy, because the majority of these deaths i.e 50% - 80% are preventable 8.

A Study was conducted on 120 women to assess the extent to which they had suffered leg cramps during pregnancy. The results revealed that 45% had suffered leg cramps during pregnancy, 54% of the women had suffered the condition after the 25th week of pregnancy and 76% of the women had experienced symptoms twice a week or less, which demonstrates that leg cramps are a common Disorder of Pregnancy 9.

A Study was conducted on 100 pregnant women from Isreal and England on oral Iron therapy for anaemia, which is a common cause of constipation. They identified that 11% and 38% of the women from Isreal and England respectively being constipated. The lower rate in women from Isreal is thought to be due to the higher amounts of fresh fruit and vegetables in their diet. It is important that the women also has an adequate fluid intake, which will keep the stools soft and easy to pass.10

The safe motherhood initiative is originated to address scandalous loss of maternal life. More recently WHO has launched the initiative, “making pregnancy safer”, which addresses these strategies: Prevention and management of unwanted pregnancies and unsafe abortion, Skilled care during pregnancy and child birth, easy and immediate access to referral care when complications arise. Planning for care of the mother during first trimester helps her to perform activities of her daily living and dealing with discomforts of pregnancy. The supportive and therapeutic client relationship grows as the nurse implements the nursing process during second trimester. Women experience several new discomforts or changes as maternal adoptions which continues to second trimester. Women who have given birth before, tend to manifest some pregnancy related discomforts earlier than the primi mothers.11

Most of them experience nausea and vomiting during early pregnancy. Heartburn, backache, constipation are also common with manual occupation, minimum education, low income and unplanned pregnancy reported most of the symptoms associated with high social status. A negative attitude to pregnancy is associated with headache .Since mothers usually consider these discomforts as normal happenings during pregnancy. They do not pay attention to the several misconceptions, ignorance and have inadequate knowledge in relation to health care during pregnancy. One of the main action plans adopted to make the maternal and child health programme successful in the developing countries is “provide health education to the community”, then only the goal of “health for all” can be achieved. This real challenge is yet to be met. So we shall be able to steadily improve the health of the mother and skilled care by health education. 12

A Study was conducted to identify the incidence of minor disorders among women in the third trimester of pregnancy and practices they adopted to relieve them. 200 pregnant women who attended antenatal clinic of Assiut university hospital and Kolta MCH center were included in the study sample, an interview questionnaire was developed to collect data. The result revealed that, women whose interviewed in the university hospital had higher incidence of minor disorders during the third trimester of pregnancy, and used traditional methods to relief it more than those interviewed in the MCH center.13

A Research was conducted for the occurrence of antenatal psychiatric morbidity in Chinese population. Epidemiological studies in western societies generally show that depression occur in 10–20% of pregnant women. In their study 238 consecutive women were invited to return for psychiatric assessment. The participants were interviewed using the non-patient version of the Structured Clinical Interview for DSM-IV (SCID-NP). 70 women (29%) declined to participate and another 11 (5%) defaulted the SCID interview. Among the 157 women interviewed, the one month prevalence of antenatal depression was 4.4%. The one month prevalence of all psychiatric diagnoses was 6.4%. The prevalence of antenatal depression and all psychiatric diagnoses for the entire pregnancy was 6.4% and 8.3%, respectively. A significant proportion of Chinese women suffer from psychiatric morbidity during pregnancy.14

A Study was conducted by University of Alabama at Birmingham Hospital, which serves a high-risk clinic and treats high-risk transfers, the number and causes of maternal deaths were determined at autopsy by searching 4307 reports from between January 1, 1991, and March 9, 2007. This search identified 36 cases of maternal death (0.8% of all cases). The age range was 14 to 46 years (mean age, 26.2 years).15

Care during pregnancy provides opportunity for health education, treat minor illness and screen for serious ailments. Structured teaching programme is one of the methods of health education. It helps the antenatal mothers to get adequate knowledge regarding minor disorders of pregnancy and will help them to take self care during pregnancy period. If they are getting enough knowledge that will help them to identify warning signals of complications at the earlier stages and in turn it will help them to seek medical advice in time. So that complications due to minor disorders can be prevented. If Minor disorders are not treated, they arise complications in Digestive system like Dehydration, Ketoacidosis, Weight loss, Hypokelimia , Abortion. Varicose veins are not treated they get complications like Thrombosis. If Constipation is not treated it causes haemorrhoids. If Depression and anxiety are not treated the antenatal mother will suffered with Insomnia .16

Though many studies are conducted in the area of minor disorders during pregnancy, the researchers could not find any valid study to assess the effectiveness of the structured teaching programmes on knowledge regarding minor disorders of pregnancy. Hence the researcher felt the need of finding out the effectiveness of structured teaching programme on minor disorders of pregnancy and its management among antenatal mothers in selected areas of Bangalore.

6.2 REVIEW OF LITERATURE

The review of literature is a key step in research process. Review of literature refers to extensive, exhaustive and systematic examination of publication relevant to research project.