RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCESKARNATAKA, BANGALORE.
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / Name of the candidate and address / ANILU THOMAS A,FIRST YEAR M. Sc. NURSING,
CANARA COLLEGE OF NURSING,
PRAFUL ENCLAVE, HALADY ROAD,
POST KOTESHWARA-576222,
KUNDAPUR TALUK,
UDUPI DISTRICT,
KARNATAKA.
2. / Name of the Institution / CANARA COLLEGE OF NURSING
KUNDAPUR.
3. / Course of study and subject / M. Sc. NURSING
PSYCHIATRIC NURSING
4. / Date of admission to the course / 15.06.2011
5. / Title of the study:
EFFECTIVENESS OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE OF STAFF NURSES REGARDING SELECTED POSTPARTUM PSYCHIATRIC DISORDERS IN SELECTED HOSPITALS OF UDUPI DISTRICT, KARNATAKA
6. / BRIEF RESUME OF THE INTENDED WORK
6.1 Need for thestudy
"The sweetest sounds to mortals given are heard in Mother, Home, and Heaven."
-William Goldsmith Brown.
Motherhood is essential to society’s survival. Without mother one would not exist. Mothers only have the unique privilege of nurturing the foetus for nine months, of nursing the child for much longer, of doing the work that consists of thousand details both practical and spiritual that children require, and the work of raising adolescents and later, often of looking after their children inturn1.
Early studies found that 50 % to 75% of women experience postpartum blues during the first few weeks after delivery. American psychiatric association estimated that accordingly, one out of eight postnatal women may experience blues in their life time, it affects 11.5 million people every year. In India, the prevalence of postpartum psychiatric morbidity was 33.4% and 6.5% of cases had major illness with postnatal depression and psychosis. In India, the incidence of depressive disorders are more in the states of Goa and rural South India are detected depressive disorder in 23% and 16% respectively, with depression persisting six months after child birth in 11-14% of women2.
Hippocrates wrote a woman “who becomes restless and sleepless, six days after the birth of a twin, she later become delirious and died three weeks post partum”.Postpartum psychiatric disorders can be viewed as a spectrum of conditions that present with an onset as early as the first postpartum day and as late as several months after delivery, which includes post partum blue, postpartum depression and postpartum psychosis. Post partum blues appears during the first few weeks after delivery. Postpartum depression typically emerges over the first two or three postpartum months but may occur at any point after delivery. Postpartum psychosis is the severe forms, which occurs at the first forty eight to seventy hours after delivery and in most of the cases develop symptoms within the first two postpartum weeks 3.
The various stressors during the postpartum period include endocrine changes, changes of body image, activation of unconscious psychological conflicts and intra psychic recognition of becoming a mother. On the light of these changes, etiological factors classified into biological, psychological, social and interpersonal factors. The most accepted biological factors for postpartum psychiatric disorders are the sudden change in reproductive hormonal levels, past and family history of depressive disorder, sleep pattern changes. Most common psycho-social and interpersonal factors for postpartum depression, especially in Indian set up are gender bias include preference to male child, violence against women, economic deprivation, obstetrical practices affect the psychological needs of mother and poor social support3.
The symptoms of postpartum psychiatric disorders include feelings of sadness, mood liability, tearfulness, anxiety or irritability in postpartum blues, depressed orsad mood, tearfulness, loss of interest in usual activities, feelings of guilt, feelings of worthlessness or incompetence, fatigue, sleep disturbance, change in appetite, poor concentration, suicidal thoughts in postpartum depression and rapidly shifting depressed or elated mood, disorientation or confusion, and erratic or disorganized behaviour, delusion and hallucinations in postpartum psychosis4.
A descriptive survey was conducted on health professional'sknowledge and awareness of perinatal depression in Australia. A sample size consists of 246 general practitioners, 338 maternal child healthnurses and 569 midwives were selected by random sampling method. The tool used for this studywas questionnaires. The study result shows that the overall response rates among general practitioners, maternal child healthnurses and midwivesare 23%, 55%, and 57% respectively. Maternal child healthnurseshad higher levels of awareness of perinatal depression. Both general practitioners and maternal child healthnurseswere more likely than midwives to recognize the need for providing help to women with emotional distress5.
Literature review shows that the postpartum psychiatric disorders is prevalent among the postnatal mothers. Nurses are the workers, whose main responsibility is to provide safe and effective care within constantly evolving health care systems, also should be alert for the signs of postpartum psychiatric disorders and be prepared to help, promote attachment between mother and baby, referral of the mother and the family for support services and counselling, and assisting the family in prioritizing and performing necessary family functions. The nurse can help the mother acknowledge her new staff and new role and to maintain supportmaternal role and bonding. To provide optimum care to postnatal mothers, the nurse should have adequate knowledge in post natal mental health and its management6.
A self instructional module is a self contained instructional unit that includes one or morelearning objective, appropriate learning material and methods and associated criterion reference measures7. According to this study the self instructional module consists of definition, etiology, classification, clinical features, prevention and treatment of selected postpartum psychiatric illness.
Literature review shows that risk of becoming mentally ill during the puerperium is greater than at other times in the women’s reproductive life. But only very few studies was conducted on assessing the knowledge of staff nurses regarding postpartum psychiatric disorders as well as investigators personal experiences specially in gynaecological unit for one year made to select this study to assess the knowledge of staff nurses that helps in implementing proper interventions in nursing care.
6.2Review of literature
Review of literature is an identification, selection, critical analysis and written description of related materials pertaining to the area of study or topic of interest to expand existing knowledge or to develop new knowledge.8
The related literature of the present study have been collected, organized and presented as follows:
Section I: Studies related to prevalence of postpartum psychiatric disorder
A descriptive study was conducted on the prevalence of postnatal depression among primi postnatal mothers admitted at Government Hospital, Dharapuram, India. A sample size of 60 primi postnatal mothers were selected by purposive sampling technique. The data was collected by structured interview scheduleusing ‘Edinburgh postnatal depression scale’. The study results shows that 64% of the mothers had depression scores from 13 and above, 26% of the mothers had depression scores from 10-12, 10% of the mothers had depression scores below9 and it reveals that most of the primi postnatal mothers (90%) reveals various levels of depression during the post natal period. The mean scores of the level of post natal depression Mean is X =14.48 and the standard deviation is SD=4.17. 9
A prospective study were conducted regarding infanticidal ideas and infanticidal behaviour among Indian women with severe postpartum psychiatric disorders by Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India. A sample size of 50 women were selected by purposive sampling technique. Thestudy results shows that nearly half (43%) of the mothers reported infanticidal ideas, 36% reported infanticidal behaviour, and 34% reported both infanticidal ideas and behaviour. Infanticidal ideas and behaviour co-occurred frequently (r =0.80)10.
An epidemiological study was conducted on post partum psychiatric illness among mothers in Chennai, India. A sample size of 478 mothers were selected by interview method. The interview method were used for data collection with general healthquestionnaire and Edinburgh Depression Scale. Chi square test was used for statistical analysis. The study results shows that prevalence of postpartum psychiatric morbidity was 33.4% and 6.5% of cases had major illness with postnatal depression and psychosis. Edinburgh Depression Scale shows that diagnosis of postnatal depression was made in 5.9% of cases and postpartum psychosis in 0.063% . The results reveal that the prevalence was high in women in nuclear families (9.4%) as compared to that in those in joint families (1.2%) and also in women who had non arranged marriages (17.7%). Women whose husbands were unskilled workers suffered more (8.2%) compared to those with skilled worker husbands (2.2%)11.
Section II: Studies related to effectiveness of self instructional module
A experimental study was conducted to assess the effectiveness of structured teaching programme onselected postpartum psychiatric illness in terms of knowledge and attitude among primi caesarean mothers in Kasturba Memorial Hospital at Dindugal, India. The tools used for this study are structured knowledge questionnaire and five point Likert scale. A Samplesize of 50 were selected by purposive sampling technique. The study results shows that there was significant difference between pre-test and post test knowledge score (‘t’ value =21.6) and attitude (‘t’ value =19.13). The mean score of pre test and post test knowledge and attitude are 7.46, 14.84, 19.44 and 44.52 respectively . The relationship between the mean post test knowledge and attitude score of primi caesarean mothers showed that there was positive correlation (r =0.92). The finding shows that the increased knowledge in post test was highly significant. 2
A experimental study was conducted on the effectiveness of structured teaching programme on knowledge of staff nurses regarding postnatal depression in selected hospitals at Tumkar, Karnataka. A sample size of 50 staff nurses were selected by purposive sampling technique. The data was collected by structured knowledge questionnaire. The finding shows that the increased knowledge in post test was highly significant. Staff nurse’s postnatal depression knowledge scores ranged between 1 and 8, with a median score of 6 12
6.3Statement of the problem
A pre-experimental study to assess the effectiveness of self instructional module on knowledge ofstaff nurses regarding selected post partum psychiatric disorders in selected hospitals of Udupi district, Karnataka.
6.4Objectives of the study
- To assess the pretest knowledge score of staff nurses regarding selected postpartum psychiatric disorders in selected hospitals of Udupi district, Karnataka.
- To evaluate the effectiveness of self instructional module on knowledge of staff nurses regarding selected postpartum psychiatric disorders in selected hospitals of Udupi district, Karnataka.
- To find out the association of pretest knowledge score of staff nurses regarding selected postpartum psychiatric disorders with selected demographic variables.
6.5Operational definitions
- Effectiveness: Effectivenessis defined as the capability of producing adesired effect13.
- Knowledge: Knowledgeis a familiarity with someone or something, which can include information, facts, descriptions, and/or skills acquired throughexperienceoreducation14.
- Postpartum psychiatric disorders: Any psychiatric symptoms appearing within six weeks period after delivery are called postpartum psychiatric disorders, ifthey do not fulfil the criteria of major psychiatric disorders15 .
- Staff Nurses:A person who is qualified in the art and science of nursing and meets certain prescribed standards of education and clinical competence or a person trained to care for the sick or infirm, especially in a hospital or give medical and other attention to a sick person13.
- Self instructional module: A self instructional module is a self contained instructional unit that includes one or more learning objective, appropriate learning material and methods and associated criterion reference measures16.
- Hospitals:An institution that provides medical, surgical, or psychiatric care and treatment for the sick or the injured17.
providing care for mothers having selected postpartum psychiatric disorders.
6.6Assumptions
The proposed study assumes that:
- The self instructional module will increase the knowledge regarding postpartum psychiatric disorders among staff nurses.
- Staff nurses will willingly take part in the study.
- Staff nurseshave some basic knowledge regarding postpartum psychiatric disorders.
- Knowledge regarding postpartum psychiatric disorders among staff nurses tends to affect their nursing interventions towards the same.
6.6 Delimitations
The study is delimited to:
- The staff nurses who are working in selected hospitals of Udupi district, Karnataka.
- The staffnurses who are present at the time of data collection in selected hospitals of Udupi district, Karnataka.
- The staff nurses who are willing to participate in the study with written informed consent.
6.7Hypotheses
H1: The mean post test knowledge score of staff nurses regarding selected postpartum psychiatric disorders will be significantly higher than their mean pre-test knowledge score.
H2:There will be significant association of pre-test knowledge scores of staff nurses regarding selected postpartum psychiatric disorders with selected demographic variables.
7 / Material and methods
7.1Sources of data
Staff nurses who are working in the selected hospitals of Udupi district.
7.1.1Research design
A pre experimental research design
7.1.2Setting
The proposed study will be conducted in selected hospitals of Udupi district.
7.1.3Population
The staff nurses working in the selected hospitals of Udupi District.
7.2.1Sampling procedure
Non probability purposive sampling technique will be used to select thirty staff
nurses based on sampling criteria.
7.2.2Sample size
In this study, the sample size will be approximately 30 staff nurses in selected
hospitals of Udupi district.
7.2.3Inclusion criteria
- Staff nurses who are available at the time of data collection in selected
- Staff nurses who are present at the time of data collection
- Staff nurses having an experience in the profession for a period between 1 to15
- Staff nurses who are able to read, speak and understand English or Kannada.
7.2.4.Exclusion criteria
- Staff nurses who have already exposed to this type of study within the last six
- Staff nurses who are not willing to participate in the study.
- Staff nurses who are not present at the time of data collection.
7.2.5Instruments intended to be used
The data collection instrument proposed for this study are:
- Socio demographic proforma.
- A structured knowledge questionnaire on selected postpartum psychiatric disorders
- Self instructional module on selected postpartum psychiatric disorders.
7.2.7Data analysis plan
Data will be analyzed using the descriptive and inferential statistics and findings
will be presented in the form of tables and figures.
7.3Has ethical clearance been obtained from your institution in case of 7.3?
Yes, ethical clearance has been obtained from the concerned authorities and study subjects.
8 / Bibiliography
- PhyllisssZelkowitz, Tamara H.Milet. The course of postpartum psychiatric disorders in Women and their Partners. JNMD. 2001. Vol.189 (9): 575-58.
- Sampoornam W. Postpartum mothers’ knowledge of mental problems. Nightingale nursing times. 2011July. (7):6-10.
- Shubhangini Parker, Smita A Pandit and Shah LP. Text book of post graduate psychiatry. Vol.1 (19):369-375.
- MCH centre for women’s mental health. Reproductive and psychiatry information centre, Postpartum Psychiatric Disorders General Information: Available from: UDL:
- Buist A,Bilszta J,Milgrom J,Barnett B. Women birth, Health professional'sknowledgeand awareness of perinatal depression: results of a national survey. Journal of Australian college ofmidwives. 2006Mar. 19(1):11-6. Available from:URL:
- McConachie S,Whitford H. Mentalhealthnurses' attitudes towards severe perinatalmentalillness. vol.65. 2009Apr: 65(4): 867-76, Available from: URL:
- Stedman's medical dictionary. 26th ed. Baltimore: Williams & Wilkins; 1995 self instructional module. p. 551
- Hungler P Bernadette. Essentials of nursing research: methods, appraisal and utilization. 5th ed. Philadelphia:p. 2001.
- Glory Suramanjary. Postnatal depression among mothers. Nightingale Nursing Times. 2009June. Vol.5(3). p: 51-4.
- Chandra PS,Venkatasubramanian G,Thomas T. Infanticidal ideas and infanticidal behaviour in Indian women with severe postpartum psychiatric disorder. JNMD. 2002July. 190(7):457-61. Available from: URL:
- ThangappahRadhabhaiPrabhu and T V Ashokan. Postpartum psychiatric illness. The journal of obstetrics and gynaecology of India. Vol.55 (4). 2005Aug. p:329-3.
- URL:
- Barbara F. Weller. Bailliere’s nursing dictionary. 23rd ed. BailliereTindall. p:280, 211
- URL:
- Niraj A. A short text book of psychiatry. Jaypee. 5th ed. 2006. P: 152-3.
- Learning & Performanc Dictionary, Available from: URL:
- Holey G Hawlker. Oxford Senior Learners’ Dictionary. 4thed. New Delhi: Oxford University Press; 20
- Medical news from around the world,Postpartum psychiatric disorders. 2006Mar.22. Available from: URL:
- Zekoski EM,Philipps LH,Wright EJ. Controlled prospective study of postpartum mood disorders: comparison of childbearing and no childbearing women. Journal of Abnormal Psychology,Vol 99(1). 1990Feb. p:3-15.Available from: URL:
9 / Signature of the candidate
10 / Remarks of the guide
11 / Name and designation of (in block letters)
11.1 Guide / MRS. PRATHIBHA LYDIA BRAGGS,
ASSOCIATE PROFESSOR,
H.O.D PSYCHIATRIC NURSING,
CANARA COLLEGE OF NURSING,
KUNDAPURA.
11.2 Signature
11.3 Co-guide / MRS. JEMNA SREEDHARAN,
LECTURER,
CANARA COLLEGE OF NURSING,
KUNDAPURA.
11.4 Signature
11.5 Head of the
department / MRS. PRATHIBHA LYDIA BRAGGS,
ASSOCIATE PROFESSOR,
CANARA COLLEGE OF NURSING,
KUNDAPURA.
12 / 12.1 Remarks of
Chairman
and principal
12.2 Signature
1