SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
SUBMITTED BY:
Ms. ARATHI DINESH,
FIRST YEAR M.Sc. NURSING
OBSTETRICS & GYNAECOLOGICAL NURSING
(2009-2011 BATCH)
WOCKHARDT INSTITUTE OF NURSING
#20/5, YELACHENAHALLI,
KANAKAPURA ROAD,
BANGALORE-560 078.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE.
PROFORMA FR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1 /NAME OF THE CANDIDATE AND ADDRESS
/MRS. ARATHI DINESH
1STYEAR M.Sc. NURSING
WOCKHARDT INSTITUTE OF NURSING,
#20/5, YELACHENAHALLI,
KANAKAPURA MAIN ROAD,
BANGALORE – 560078
2 /NAME OF THE INSTITUTION
/WOCKHARDT INSTITUTE OF NURSING, BANGALORE – 560078
3 /COURSE OF STUDY AND SUBJECT
/MASTER’S DEGREE IN NURSING,
OBSTETRICS AND GYNAECOLOGICAL NURSING
4 /DATE OF ADMISSION TO THE COURSE
/31-10-2009
5 /TITLE OF THE TOPIC
/ “A STUDY TO ASSESS THE STRESS AND COPING STRATEGIES OF ANTENATAL MOTHERS ATTENDING ANTENATAL CLINICS IN SELECTED MATERNAL HOSPITALS,BANGALORE”.6.0. A BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
“A healthybabybegins with a healthy pregnancy.
Being stress free will help promote a healthypregnancy.”
Being a woman is just a human but being a mother is divine. Having a baby is one of the most important events in a woman’s lifetime and, as well as being a time of great joy. Having a child is a major life change, and mothers need support from those around them, both during pregnancy and after the baby arrives.1
Stress is a feeling that's created when we react to particular events. It's the body's way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness. Stress is a subjective phenomenon and can be defined as an individual's physical and psychological response to a situation where they feel that the demands placed on them exceed their ability to cope.The events that provoke stress are calledstressors,responds to stressors by natural reaction is known as thestress response.2
All human beings suffer from stress, and within reasonable amounts, and with the correct reaction to cope up with those situations. The problems arise when people are unable to cope due to too much stress, or worse. For some people, it is not the fact that they are stressed, but rather the way they deal with it. Because people can’t eliminate all the stress in their life, it is important to find strategies which will help to deal with the stress.3
Every pregnant woman experiences stress of some sort, whether it is financial fears or just how to assemble the crib correctly. These sorts of stress are common during pregnancy. But some women suffer extreme stress during pregnancy. Certain situations such as domestic violence, workload, worries over being a single mother, and medical worries can cause some pregnant women to endanger themselves and their babies.4
Yoga,meditationandbreathing exerciseswill be helpful for managing stress during pregnancy, and may even make for an easier delivery. Regular practice of stress management techniques can also provide with some resilience toward stress.A large source of stress for manypregnantwomen involves concerns about labour, the health of their baby and how they will cope once the baby arrives. 4
Stress management involves controlling and reducing the tension that occurs in stressful situations by making emotional and physical changes. The degree of stress and the desire to make the changes will determine how much change takes place.4
6.1 NEED FOR THE STUDY
Even a normal pregnancy can result in some stress in women. As per research, there is an excessive secretion of hormones during pregnancy. This process creates emotional stress, which can be very severe.Stress is unfortunately a common and ordinary side effect of living. Stress can however be particularly harmful during pregnancy, thus it is important that mothers work to reduce their stress and anxiety levels during pregnancy as much as possible.
In the Nineties, we have begun to understand how the stress and mother's emotional state affects her foetus. Studies proved that, if a mother experience excessive stress or suffers from an emotional trauma, her baby may be born with certain defects, which may persist into adulthood and cause more complications.5
Some research studies suggest that a high stress levels can increase the mother’s heart rate, blood pressure and produce chronic anxiety. None of these side effects are good for the baby. Just as what the mother eat affects your baby, so too does mothers stress level and emotional health. It is important that mothers minimize their stress and anxiety during pregnancy to provide the baby with an optimal environment in which to grow.2
If pregnancy is at the advanced stage, the anxiety would increase by each passing day. The woman has to be strong physically as well as emotionally to face the final part of the pregnancy leading to the birth of the child. 2 In a large community sample of pregnant women, found that 21% had clinically significant anxiety symptoms and, of these, 64% continued to have anxiety in postnatal period also. 2
To counter stress during pregnancy, mothers need to be well as far as the emotional aspect is concerned. This is very important during this period of 9 months. Reduction and management ofstresswill have apositive impact on the development of the foetus.Pregnancy is a boon from god. Stress is not good for the mother during the term. It can have adverse side effects. It is very important for the mothers to remove anxiety. This is also a part of thestress managementprocess. . Anxiety during pregnancy is very harmful. It may result in false labour or premature birth. It can also cause hypertension. The effects can be disastrous for the unborn foetus.7
Because pregnancy brings with it such a major role change it can be a time of extreme stress for a woman. This stress of pregnancy, likely any, stress can make it difficult for the woman to make decisions, be as aware of her surroundings as usual, or maintain time management with her usual degree of her skill.7
During pregnancy, she may feel especially stressed, leading to acute loneliness, depression, and a further inability to function. A woman who begins a pregnancy with a strong support person and then loses that person through trauma, illness separation, or divorce needs special attention in regard to loneliness. She should be evaluated carefully and given extra support, because her loneliness is likely to be extremely acute. A loss of this kind has the potential to interfere not only with the mothers own health but also with parent child bonding.7
There is some evidence, however, that an emotionally disturbed pregnancy, one filled with anxiety and worry beyond the usual amount, could produce physiologic changes through its effect on the sympathetic division of the autonomic nervous system. The primary changes this could cause include constriction of the peripheral blood vessel (a fight or flight syndrome) if the anxiety is prolonged, the constriction of uterine vessel could interfere with the blood and nutrient supply to a foetus. 7
These phenomena are characteristic only of long term, extreme stress, not of the normal anxiety of pregnancy. Illness or death of one’s partner, difficulty with relatives, marital discord, and illness or death of another child is examples of stressful situations that might provoke excessive anxiety.7 Helping a woman resolve these complex problems during pregnancy is not easy. If maternal stress is severe, however, securing counselling is as important as ensuring good physical care7.
Maternal stress during pregnancy is also found to cause of asymmetry in coordination of ears, fingers, feet, elbows, etc. As a result intelligent quotients of such children are found to be lower. Maternal stress is also linked with imperfections in the developing nervous system which can lead to problems of perception, thinking, and memory.
All of us want happy children. Happy children grow out of happy babies. Happy babies are born to happy mothers. Therefore, partners, families and friends of expectant mothers should do their best to make an expectant mother happy and relaxed. 5
A study conducted on Stress and preterm labour and birth in Black women. Fifty-nine Black women: 39 were recruited in preterm labour from a Prenatal Evaluation Centre, and 20 experiencing healthy pregnancies were recruited from the prenatal clinic in the North East. Stress was measured using 2 paper and pencil test and corticotrophin-releasing hormone. There was not a high correlation between stress measures. They found Screening for stress in Black women at 28 weeks requires further research as perceived stress levels in Black women experiencing preterm labour around 28 weeks.8
In the light of the above facts and from the previous experiences, the researcher felt the need to assess the stress and coping strategies of antenatal mothers.
6.2 REVIEW OF LITERATURE:
6.2.1 STUDIES RELATED TO THE STRESS AND PREGNANCY:
A study was conducted on stress and pregnancy among African-American women. This study explicitly examined social factors such as experiences of discrimination, either racial or sexual, and neighbourhood crime as predictors of stress. They also examined cortisol and stress as predictors of blood pressure. A subsample of 94 African-American pregnant women, aged 18-39 years, who were enrolled in a longitudinal study of pregnancy and exposure to lead in the environment were used in this analysis. The women were patients at an obstetrics clinic at Magee Women's Hospital in Pittsburgh, PA, USA. Younger age, higher income, lower education and experiences of discrimination, both racial and sexual, were related to greater perceived stress; however, life events were not related to perceived stress. As a body of evidence suggests that stress can have deleterious effects in both pregnant and non-pregnant women, especially racial discrimination, as a possible reason for the disparity in adverse pregnancy outcomes between African-American and White women.9
Another study was conducted on Maternal, obstetric variables, perceived stress and health-related quality of life among pregnant women in Macao, China. A cross-sectional, exploratory quantitative study was conducted in an antenatal clinic of a university-affiliated regional public hospital in Macao. A community-based sample (n=1151) of pregnant women in the second trimester of pregnancy were the samples. perceived stress was measured using the Perceived Stress Scale, and health-related quality of life was measured using the standard Short Form-12 Health Survey. A multiple linear regression analysis revealed that pregnant women who were younger , single, divorced, separated or cohabiting had a lower level of education , worked long hours or who had an unplanned pregnancy with late initiation of antenatal care or poor physical or mental health-related quality of life had higher levels of perceived stress. Preliminary information was provided about Macao pregnant women who had higher perceived stress during pregnancy that was associated with the demographic, socio-economic, obstetric and health-related quality-of-life variables. 10
6.2.2 STUDIES RELATED TO THE EFFECT OF STRESS ON PREGNANCY
A study was conducted on effects of maternal stress on low birth weight and preterm birth outcomes across neighbourhoods of South Carolina. The purpose of the study was to examine the relationships among neighbourhood contexts, prenatal stress, and birth outcomes. They evaluated this objective by using South Carolina Pregnancy Risk Assessment and Monitoring System (PRAMS), 2000-2003 data linked to the 2000 U.S. census data for 8064 women (N = 8064). Maternal stress was significantly associated with increased risks of low birth weight and preterm deliveries. Neighbourhood high poverty and low education (upper quartiles) were independently associated with low birth weight but not preterm deliveries and stress appeared as a partial mediator of contextual effects on birth outcomes. The interaction models showed that the relationship between stress and LBW or PTB was modified by neighbourhood contexts with risks being greater for infants born in disadvantaged neighbourhoods. The result shows that effects of maternal stress on LBW and PTB outcomes may be different for mothers living in different neighbourhood contexts. 11
6.2.3 STUDIES RELATED TO THE MANAGEMENT OF STRESS DURING PREGNANCY:
Another study was conducted on a stress reduction project for pregnant black women. Approximately 12% of pregnant Black women deliver prematurely regardless of their age, education, income, or marital status. Stress has been indicated as a cause of preterm labour. The program evaluation revealed that 86 pregnant Black women of various ages as well as educational and income levels had significant (p=0.003) reduction in perceived stress, and their mean post-intervention salivary cortisol (a biological indicator of stress) did not show the expected 50% increase. Lessons learned from this community-based project suggest that three one-on-one educational sessions can reduce stress in this population.12
A study conducted on effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood. In this study, they aimed at eight-week mindfulness-based intervention directed toward reducing stress and improving mood in pregnancy and early postpartum. Then conducted a small randomized trial (n=31) comparing women who received the intervention during the last half of their pregnancy to a wait-list control group. Measures of perceived stress, positive and negative effect, depressed and anxious mood, and affect regulation were collected prior to, immediately following, and three months after the intervention (postpartum). Mothers who received the intervention showed significantly reduced anxiety (effect size, 0.89; p<0.05) and negative affect (effect size, 0.83; p<0.05) during the third trimester in comparison to those who did not receive the intervention.13
6.3 STATEMENT OF THE PROBLEM
“A study to assess the stress and coping strategies of antenatal mothers attending antenatal clinics in selected Maternity hospitals, Bangalore”.
6.4. OBJECTIVES OF THE STUDY
1. To assess the level of stress among the antenatal mothers by using stress scale.
2. To assess the coping of antenatal mothers by using coping scale.
3. To find an association between stress and coping.
4. To find the association between stress and demographic variables.
5. To find the association between coping and demographic variables.
6.5.OPERATIONAL DEFINITION
ASSESSMENT
It is a process of measuring the level of stress and coping among antenatal mothers
STRESS
It refers to physiological and psychological imbalance experienced by the antenatal mothers during the pregnancy period.
COPING STRATEGIES
The technique adopted to overcome stress by the antenatal mothers
ANTENATAL MOTHERS
It refers to mothers who are pregnant and who attend to antenatal clinics.
6.6 ASSUMPTION
- Antenatal mothers will be having some stress during pregnancy
- The level of stress and coping strategies of antenatal mothers is differ from individual to individual.
- The sociodemographic factors influence the level of stress and coping strategies among antenatal mothers
- The level of stress and coping influences each other.
6.7.VARIABLES IN THE STUDY
Research variables :Stress andcoping strategies of antenatal mothers
Demographic variables : It refers to age, education,occupation, income, religion,family type, marital status(single mother, divorced, separated, death of spouse, deserted), nature of pregnancy(planned or unplanned), parity, spouse occupation. Previous history of miscarriages,intra uterine death, intra uterine growth retardation.
7. 0. MATERIALS AND METHOD
7.1.0 Source of data : / Data will be collected personally from the antenatal mothers attending selected antenatal clinics, Bangalore.7.1.1Research approach: / A descriptive research approach will be used to assess the stress and coping strategies of the antenatal mother.
7.1.2 Research design :: / Exploratory
7.1.3 Research setting :: / Selected maternity hospitals, Bangalore
7.1.4 Population :: / Population of study includes all antenatal mothers.
7.1.5Sample :: / Sample for the study comprises of antenatal mothers attending selected antenatal clinics, Bangalore
7.1.6 Sampling technique :: / Non probability convenient sampling technique.
7.1.7 Sample size : : / 100 antenatal mothers attendingselected antenatal clinics, Bangalore.
7.1.8 Sample criteria :
Inclusion criteria: / 1.Antenatal mothers in selected antenatal clinics, Bangalore
2.Antenatal mothers who are willing to participate in this study.
3.Antenatal mothers who are available during theperiod of data collection.
Exclusion criteria: /
- High risk antenatal mothers
- Antenatal mothers who are not willing to participate in this study.
7.2 TOOLS FOR DATA COLLECTION
Data collection tool contain items on the following aspects
Section 1: will contain the items of demographic characteristics of antenatal mothers comprising of age, education, occupation , income, family type, parity, nature of pregnancy(planned or unplanned), marital status(single mother, divorced, separated, death of the spouse, deserted,) occupation of the spouse, intra uterine death, intra uterine growth retardation, previous history of miscarriages.
Section 2: structured stress scale will be used to assess the stress of antenatal mothers Section 3: checklist for coping will be used to assess the coping level of antenatal mothers.
7.2.2. METHODS OF DATA COLLECTION
The data will be collected by using a structured stress scale and a checklist for coping strategies.
7.2.3 METHOD OF DATA ANALYSIS
The researcher will use appropriate statistical techniques for data collection and present in the form of tables and diagram. The data obtained will be analyzed by using descriptive and inferential statistics.
- Mean, Median and standard deviation will be used.
- Parametric test: Paired‘t’ test to compare pre and post test stress scores.
- Non-parametric test :X2(chi square)test will be used to find out the relationship between demographic variable and knowledge level of antenatal mothers on stress and its management in selected antenatal clinics, Bangalore.
7.3 DOES THE STDY REQUIRE ANY INVESTIGATION OR INTERVENTION TO BE CONDUCTED ON OTHER HUMAN OR ANIMALS.
No, it is a descriptive study, does not require any investigation or intervention to be conducted on other human or animals..
7.4 HAS ETHICAL CLEARACNCE BEEN OBTAINED FROM THE INSTITUTION