RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE Mrs.SANGEETHACANDIDATE

AND ADDRESS 1ST YEAR MSC NURSING

RAJEEV COLLEGE OF NURSING2. NAME OF THE

INSTITUTE RAJEEV COLLEGE OF NURSING3. COURSE OF

THE STUDY 1ST YEAR MSC.NURSINGAND SUBJECT OBSTETRIC AND GYNECOLOGY NURSING.

4. DATE OF ADMISSION 26/06/2012

5. TITLE OF THE “EFFECTIVENESS OF A STRUCTERED STUDY TEACHING PROGRAMME ON KNOWLEDGE

REGARDING SELECTED RELAXATION TECHNIQUES TO REDUCE STRESS AMONG ANTENATAL PRIMI GRAVIDA WOMEN WHO ARE REFERRED FOR LSCS(LOWER SEGMENT CAESERIAN SECTION) IN RAJEEV HOSPITAL AT HASAAN WITH A VIEW TO DEVELOP A HEALTH EDUCATION LEAFLET.”

5.1 STATEMENT “A STUDY TO ASSESS THE EFFECTIVENESS OF A OF THE STRUCTERED TEACHING PROGRAMME ON PROBLEM KNOWLEDGE REGARDING SELECTED RELAXATION TECHNIQUES TO REDUCE STRESS AMONG ANTENATAL PRIMIGRAVIDA WOMEN WHO ARE REFERRED FOR LSCS (LOWER SEGMENT CAESERIAN SECTION) IN RAJEEV HOSPITAL AT HASSAN WITH A VIEW TO DEVELOP A HEALTH EDUCATION LEAFLET.”

6. BRIEF RESUME OF THE INTENTED WORK

6.0 INTRODUCTION

“Everything about Woman is a riddle,and everything about woman has a

single solution that is pregnancy.”

----Friedrich Nietzsche.

The word ‘Woman ‘ means any adult female human and womanhood is the

period in a female’s life after she has passed through childhood and adolescence.1

The Indian Woman plays a very pivotal role in the society,from an excellent home

maker to professionally qualified and economically independent.Indian woman of today

is adaptable of litters, is handling every situation that comes on her way.2

The importance of woman in our society ,she is responsible for the miracle of birth. She

is also a provider of the family and the epitome and embodiment of Morality. Moreover

god has already amanicipated woman for no responsibility can be greater than that of

continuing the life of birth.She is sacrificing her life only for the sake of mankind.The

half of population consist of woman ,she is everywhere as Barack Hussain Obama says

“ She was the corner stone of our family and a woman of extraordinary

accomplishments,strength and humility.She was the person who encourage and

allowed us to take chance”.3

Pregnancy is one of the three periods in life when a women has difficulty in

adjusting herself emotions( puberty,menopause).The mother wants her baby and may be

indifferent to its coming.Thus she may be filled with joy or very depressed.23

Delivery is the expulsion or extraction of a viable fetus out of the womb. A

spontaneous vaginal delivery is defined as the delivery of a baby through

vagina.Spontaneous vaginal delivery involves the birth of a baby and delivery of a

placenta from uterus through the cervix and the birth canal.A vaginal delivery occurs

after the mother has gone through labour which dilates her cervix to 10cm.

A primigravida is defined as a one who is pregnant for the first time.. Caeserian

Section is defined as “ an operative procedure whereby the fetuses after the end of 20th

week are delivered through an incision on the abdominal and uterine walls.”4

Women’s feeling of confidence and security on arriving at the hospital quickly

change to one of fear and anxiety when they learn that they are going to have caeserian

section. Many stressful events and even anticipated situations cause anxiety and

tension.Stress in the antenatal period threatens the easiness of delivery or well being of

the foetus.

Stress in the individuals is defined as “ any interference that disturbs the person’s

healthy ,mental and physical wellbeing”Stressful events produce anxiety. The anxiety

leads to tension.It adversely affect the function.

Adverse effects of stress is that when an individual is placed under physical or

psychological stress. It increases the period of action of certain hormones like

Adrenaline.These hormones produces marked changes in the heart rate ,blood pressure

levels. These changes in turn lead to high blood pressure , heart ailments ,headache and

constipation. Stress can also adversely affect the immune system causing the body to be

less resistant to a wide range of health problems. Emotional symptoms of stress can be:---

1. loss of interest

2. Inpersonal appearance

3. Inability to concentrate

4. Loss of confidence in personal ability

5. feeling of helplessness

6. Loss of self esteem, etc.

Other symptoms of stress includes shallow breathing ,strong fast heart

beats ,and cold sweaty palms.5

Feeling of Women after they had arrived at delivery ward changed from one of

confidence to one of fear. The decision to undertake caeserian section brought a fear as

operation approaches. There are many causes for inducing stress in the antenatal period.

This includes:----

1. Financial burden of the family

2. Fear of future pregnancy

3. Fear of marital relationship

4. Fear on changes in body image

5. Lack of knowledge on wound care

6. Fear of occurrence of infection and all.

Research have shown that pre operative anxiety affects patient on both a

physiological and a psychological level. .On a physiological level anxiety can alter the

way of a person thinks ,feels and acts,anxiety can alter a patient’s vital signs. This may

be the first indications to a nurse in the pre operative area that a patient is

experiencingsignificant anxiety.Anxiety also may be responsible for cognitive and

behavioural changes .Psychological changes are individualized and reflects a person’s

base line personality. Research also have shown that anxiety lowers immunity and delays

healing.

When stressors throws the nervous system out of balance,it is the relaxation

techniques which can bring back into a balanced state by producing relaxation

responses ,a state of deep calmness that is the polar opposite of stress response. The

incidence of caeserian section is steadily rising day by day and hence the stresses ,

anxiety and tensions of mothers too .Here the significance of the stress reduction or

relaxation techniques emerges.6

6.1 NEED FOR THE STUDY

Every women feels that becoming a mother is the most gifted position ,a women

could ever achieve at life time.Primi mothers are more likely to face emotional stress

because it represents the begning of major life changes to women.

Relaxation Therapy is a broad term used to describe a number of techniques that

promotes stress reduction ,elimination of tension through out body and a calm and

peaceful state of mind.22

Stress is an inevitable disease. Stress is generally accepted as a 20 th century

disease. ..Woman’s perception of caeserian section has lowered the self esteem ,left them

with a sense of failure, loss of control and disappointment.7

Stress is necessary in life for creativity, learning and very survival. Stress is only

harmful when it becomes overwhelming and interrupts the healthy state of equilibrium

that one’s nervous system needs to remain in balance.6

The incidence of caeserian section is steadily rising .During the last decade there

has been two or three folds rise in the incidence from initial rate of 10%. 4

The rates of caeserian section in many countries have increased beyond the

recommended level of 15% almost doubling in the last decade ,especially in high income

areas such as Australia,France,Germany,Italy,North America ,United Kingdom of Great

Britian ,North Ireland etc. Similar trends have also been documented in low income

countries like Brazil, China and India.The number of caeserian section birth has increased

sharply in the eastern regions.10

The WHO ,which reviewed nearly 110000 births across Asia in 2007-2008,found

27% were done under knife and in 2005 similar results was reported by WHO from Latin

America ,where 35% of pregnant women survive by caeserian section.11

In Uk in 2008 ,the incidence of CS rate was 24%,in Ireland in 2009 was

26.1%,Canada 26% in 2005-06,Australia it was 31% in 2007,China 46% in 2008. In US,

the rate of caeserian section is at an all time high of 31%. The percentage of all births in

US caeserian section has increasing recent years from 20.7% in 1996,30.2% in 2005,

31.1% in 2006, 31.8 in 2007 respectively. The caeserian section ,currently is the most

common major sure procedure for women in US with more than 1.3million CS per

annually.11

The estimated CS rates in India is 7.1% in 1998 and there is 16.7% in the rates

annually. which is one of the highest among countries. A five year audit from a large

teaching hospital in Kolkata showed a CS rate of 49.9% .Another study in Madras

Showed a CS rate of 50%. At the all India level , caeserian section rate increases from

2.9% in 1992-1993 to 7.1% in 1989-1999 and further to 10.2% in 2005-2006.11

In Andhra Pradesh ,Bihar,Gujarat,Karnataka &Punjab ,the risk of undergoing

caeserian section in private institutions is four or more times than in public sector..10

.According to NFH survey in 2005-2006,the percentage of birth by caeserian section

in Karnataka is 15.3%..12

In Rajeev Hospital, Haasan, Karnataka also the incidence of caeserian section is

increasing rapidly.With the increase in the institutional deliveries and growing access to

obstetrics care , caeserian section deliveries too have shown an increasing trend .As the

incidence rate of caeserian section deliveries is increasing day by day,primi mothers who

are referred for caeserian section will also have an increasing level of anxiety ,tension

and stress.Here the need for relaxation therapy or stress reduction techniques arises.

. Stress management is an attainable and realistic goal that can achieved by a

number of strategies. It includes :-----

a) Relaxation techniques

b) Time-management skills

c) Counseling

d) Exercise and maintaining an overall healthy lifestyle.

The relaxation techniques to manage stress includes :---

a) Yoga

b) Guided imagery

c) Biofeedback

d) Progressive muscle relaxation

e) Relaxation breathing exercises

f) Meditation

g) Distraction etc.7 A study was conducted on the relaxation education in anxious primigravid

Iranian women to find whether it influences adverse pregnancy outcomes in 2006.The

Study reveals that maternal anxiety and stress are found to be predictors of adverse

pregnancy outcomes including low birth weight and prematurity . 8

A study was conducted to find out whether the guided imagery reduces stress

and increases occupational wellbeing in pregnancy, indicates that high maternal stress

level during pregnancy have harmful effects for child including prematurity, negative

infant temperament, increase incidence of depression. The guided imagery has been

shown to reduce stress in adult women. The psychological stress Measure -9(PSM_9)

was reduced to 75% of time following guided imagery.25

Hence the researcher went to Rajeev hospital at Haasan, met the primigravida

womens who are referred for caeserian section and conduct enquiry regarding their level

of stress and found that mothers are having increased level of stress towards the caeserian

section operative procedures ,its outcomes, problems and future pregnancy etc.So all the

findings emphasize the researcher that CS women do experiences stress, very little

importance is given to this aspects and hence identified a need for providing teaching

programmes to mothers to reduce their stress level and decided to conduct a study to

assess the effectiveness of a structured teaching programme on selected relaxation

techniques to reduce stress among antenatal primigravida women in Rajeev hospital at

Haasan.

6.2 REVIEW OF LITERATURE . A literature review is an examination of research that has been conducted in a

particular field of study.21

“Review of literature is defined as a broad comprehensive indepth ,systematic and

critical review of scholarly publications ,un published scholarly print materials ,audio

visual materials and personal communications.9

This chapter deals with literature review for the proposed study The present

study is aimed at assessing the effectiveness of a structured teaching programme on

selected relaxation techniques to reduce stress among antenatal primigravida women

who are referred for lower segment caeserian section in Rajeev Hospital at Haasan. The

literature review was done in the following areas;--

.6.2.1 Literatures related to prevalence of caeserian section

6.2.2 Literatures related to stress before caeserian section

6.2.3 Literatures related to relaxation techniques in reducing stress.

6.2.1 Literatures related to prevelence of caeserian section:-

In today’s situation when the access to obstetric care is growing day by day there has

been a concern over the rising caesarean rates over the world The concern for the caesarean rates

is due to its rapid increase over the period.The WHO published guidelines regarding caesarean

rates in 1985 which was revised in 1994. The guidelines states that the proportion of caesarean

births should range between five and fifteen per cent.

A study was conducted in US which says that from 1970-2007,CS rate in US rose

from 4.5% from all deliveries to 31.8%.The reason for the continued increase in CS are

not completely understood but some explanation includes the following ,women are

having fewer children thus greater % of birth are among nulliparous who are at increase

risk of CS and average maternal age increase and older women especially nulliparous are

at increase risk of caeserian delivery and the concern for a nonreassuring fetal heart rate

tracing lowers the threshold for caeserian section 24

A study was conducted in India on 2008 to estimate the rates of CS birth in India

and across the state and the result of the study states that the caesarean section rate in

India among all births is 7.8 percent whereas the rateof c-section is 18.6 percent among

the institutional births. The ‘South’ region of India has the highest caesarean section rate,

which is around 17 percent. The ‘Central’ and ‘North- east’ region of India has caesarean

rates below the WHO specified 5 percent mark. The prevalence of c-section is

generallymore in the southern states where as the northern states of India are either

below the five percent level or in the range of five to fifteen percent. The states, which

are above the fifteen percent mark, are Kerala, Pondicherry, Goa, Tamilnadu and Andhra.

Among the states the occurrence of CS is least in bihar.

Kerala has the highest percentage of c-section with 25.74 percent of all births.

Tamilnadu and Andhra are just above fifteen percent, with csection rate of 7.28 and 17.03

percent respectively. Uttar Pradesh has a rate of 3.91 percent,which is least among all the

states of north and central India. West Bengal is the only state in eastern India, which has

a high rate of caesarean sections with 12.06 percent of all the births.11

6.2.2 LITERATURES. RELATED TO STRESS BEFORE CAESERIAN SECTION

A study on Psychological influences on women’s experiences of planned elective

caeserian section was conducted on 2006.The objective of the study is successful

management of pain from normal to interventional delivery is an important part of

women;s experience of child birth..The study focused on the impact that these variables

have on maternal fear pain during and after delivery.65 women booked for an awake

caeserian section with a regional nerve block and their birth partners were recruited.Data

were collected at three time points for the mother s before ,during the caeserian section

and after delivery on the postnatal ward and at two points for the birth partners.The result

of the study shows that maternal fear responses varied during the operations.In that ,fear

was greatest at the point of administration of the nerve block.Mothers pre natal

perceptions of control over drugs predicted their post operative pain. The conclusion of

the study are maternal fear during caeserian section not only fluctuates but may be

influenced by psychosocial factors including their birth partner 13

A study on caeserian child birth and psychosocial outcomes was conducted on

1996.A comparative literature review with metaanalysis examines the difference between

vaginal and caeserian delivery on23 psychological outcome of child birth. The most

robust finding suggest that caeserian mothers when compared to mothers who delivered

by vaginal delivery expressed less immediate and long term satisfaction with birth where

less likely ever to breast feed. Experienced a much longer time of first interaction with

their infant,had less positive reactions to them at home.14

A study on psychological aspects of Caeserian section was conducted on 2001. The

study reveals that an over view of research relating to ‘psychological aspects of Caeserian

section. It focuss on 4 main questions.

1) What are the ‘psychological aspects of Caeserian section in mother ,her partener

and her relationship with her infants,2) what factors (obstetric, psychological,

attitudinal and health are co related) make wpmen are more vulnerable to adverse

psychological outcomes after a caeserian.

3) What are women depressed about when they have had a caeserian.

4) How can post caeserian psychological distress be prevented .A methodological

critique of existing studies on psychological aspects of Caeserian section also

given. 15

6.2.2. Literatures related to relaxation techniques in reducing stress before

surgery

A study was conducted on behaviour preparations for surgery in 1980 suggests

that elective surgery patients were prepared for surgery with training in muscle relaxation

or with information about sensation they would experiences. The major findings of the

study were relaxation reduces hospital stay,pain and medication for pain and increased

strength, energy and ephinephrine level. Personality variable (deniel, fear,

aggressiveness) were associated with recovery and influenced patients response to

preparation. Less frightened patients.No aggressive patients responds to information with

decreased hospital stay along increased pain, medication and epinephrine. A catharsis or

moderation model is proposed to explain the benefits of relaxation. The study suggests

that behaviour preparations benefits even frightened aggressive or denying elective

surgical patients.16

A study was conducted on anxiety coping strategies and coping behaviours in

patients undergoing surgery on 2001.A prospective descriptive design with 75 population

was used in this study. The state Trait Anxiety Inventory and ways of coping

questionnaire were administered This research study described the relationship between

pre operative anxiety and the use of coping strategies and between post operative self

care and resocialisation in patients undergoing surgery. This study explained the

findings ,there is no significant correlation between pre operative anxiety and the

percentage of problem focused coping strategies used to handle disfiguring surgery.A

high level of anxiety was present ,which was equivalent to the anxiety of people admitted

to a psychiatry treatment center for an acute anxiety reaction. although there is problem

focused coping strategies before surgery ,post operative coping behaviours occurred

early during the recovery period.17

A study was conducted on the effects of information on adaptation to caeserian

birth on 1993 .An experimental group received comprehensive caeserian birth

information as a part of standard child birth preparation class. The control group received

a standard child birth preparation class curriculum that included limited caeserian birth

information. The control group report a slight decline in pain intensity from 1-2 days to

6weeks postpartum where as experimental group showed no change over time.18

A study on the effect of child birth preparation classes on child birth fear among

primiparous women was conducted in 2007 at Milad hospital with 100 population.

Childbirth fear was measured by childbirth fear attitude questionnaire and experimental

and control group consist of 50 samples each. The experimental group attended 9 child

birth preparation classes and control group received routine antenatal care.Primi parous

woman attended childbirth preparation classess showed low score of child birth fear in

comparison to women received routine prenatal care classes. This study results shown

Relaxation Training decreases child birth fear.19

A study on biobehavioural effects of Relaxation Guided Imagery on maternal

stress was conducted on 2009 to investigate the effect of Relaxation Guided Imagery on

perceived stress ,anxiety and corticotrophin releasing level in pregnant African American

woman, The longitudinal study of 59 woman was used with controlled randomized

experimental design over 12weeks,and the findings suggests that the state of anxiety

significantly decrease over time in relaxation guided imagery group and it increased over

time in usual care groups.20

STATEMENT OF THE PROBLEM

A STUDY TO ASSESS THE EFFECTIVENESS OF A STRUCTERED

TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED

RELAXATION TECHNIQUES TO REDUCE STRESS AMONG ANTENATAL

PRIMIGRAVIDA WOMEN WHO ARE REFERRED FOR LSCS (LOWER

SEGMENT CAESERIAN SECTION) IN RAJEEV HOSPITAL AT HASSAN

WITH A VIEW TO DEVELOP HEALTH EDUCATION LEAFLET.

6.3 OBJECTIVES OF THE STUDY

1. To assess the pre existing knowledge of antenatal primigravida women

regarding relaxation techniques to reduce stress.

2. To evaluate the effectiveness of structured teaching programme on

knowledge regarding relaxation techniques to reduce stress.

3. To find the association between the knowledge scores of antenatal

primigravida women regarding relaxation techniques to reduce stress with

their selected socio- demographic variables.

4 . To develop a health education leaflet on Relaxation Techniques.

6.3.1 HYPOTHESIS

H1- There will be significant difference between pretest and post test knowledge

score of antenatal primigravida women regarding relaxation techniques to

reduce stress.

H2- There will be significant association between the level of knowledge of

Antenatal primigravida women regarding relaxation techniques to reduce

stress with their selected socio-demographic variables.

6.3.2 ASSUMPTION

1. Antenatal Primigravida women may have some knowledge regarding

relaxation Techniques.

2.. A Structured teaching programme will enhance the knowledge of Antenatal

primigravida women regarding relaxation techniques.

6.3.3 OPERATIONAL DEFINITION

EVALUATE: It refers to the findings of the value of the structured teaching programme

on knowledge of antenatal primigravida women regarding relaxation techniques to

reduce stress.

EFFECTIVENESS:It refers to determining the extent to which a structured teaching

programme has achieved desired effects as measured in terms of significant gain in the

post test knowledge of the antenatal primigravida women and graded as adequate,

moderate, and inadequate knowledge.

STUCTURED TEACHING PROGRAMME: It refers to the self contained written

material prepared by the investigator and content validated by experts which contain

information about definition, and effects of the stress, different types of relaxation

techniques etc.

KNOWLEDGE: It refers to the antenatal primigravida women’s awareness regarding

relaxation techniques. as measured by scores obtained according to the items on the

structured knowledge questionnaire.

STRESS :-- It refers to a state of tension related to pregnancy period ,surgery and events

after surgery.

PRIMIGRAVIDA :- It means woman who has become pregnant for the first time

LOWER SEGMENT CAESERIAN SECTION :- It refers to a surgically made incision

on the lower segment of a pregnant uterus inorder to deliver the baby safely

RELAXATION TECHNIQUES:----It refers to the therapies that are used to reduce the

stress, anxiety and tension using number of techniques to create a calm and peaceful state

of mind like meditation , progressive muscle relaxation ,relaxation breathing exercises

and distractions such as music.

6.3.4 DELIMITATIONS OF THE STUDY

1.. The samples are delimited to Rajeev Hospital at Haasan.

2. The samples are delimited to high risk antanatal ward.

3. A sample of 50 antenatal primi gravida women who are reffered for LSCS

are selected.

4.. Those who are willing to participate in this study.

5.. The duration of the study is 4-6 weeks.

7.0 MATERIAL AND METHOD OF STUDY

7.1 SOURCES OF DATA ;----

Data pertaining to this research study will be collected from antenatal

primigravida women who are referred for LSCS in high risk antenatal ward at Rajeev

Hospital, Hasaan.

7.2 METHOD OF DATA COLLECTION

7.2.1 RESEARCH APPROACH

Research approach describes the type of research used for the study.The

research approach in this study is evaluative approach.

7.2.2 RESEARCH DESIGN

The research design selected for this study is Quasi experimental design

(one group pre test and post test design) which include manipulation(intervention)

without randomization or control group.

Group Pre test Intervention Post test

Antenatal primigravida women who are referred for LSCS in Rajeev Hospital, Hassan.(50)

O1 X O2

Key:-

Group – Antenatal prinigravida woman who are referred for LSCS X -Intervention,

which is the administration of structured teaching programme regarding relaxation

techniques.

O1- It denotes the pre test assessment of knowledge of primigravida women regarding

relaxation techniques.

O2- It denotes the post test assessment of knowledge of primigravida women regarding

relaxation techniques .

7.2.3 RESEARCH SETTING

The study will be conducted in the high risk antenatal ward in Rajeev Hospital

at hassan.

7.2.4 POPULATION

The population of this study comprised of antenatal primigravida women who are

reffered for LSCS at Rajeev Hospital, Hasaan who fulfills inclusion criteria..

7.2.5 SAMPLE

The sample of the present study comprised of antenatal primigravida women who

are referred for LSCS in Rajeev Hospital ,Haasan.

7.2.6 SAMPLE SIZE

Sample size consist of 50 antenatal primigravida women in Rajeev Hospital,

Hasaan.

7.2.7 SAMPLING TECHNIQUE

In this study convenient sampling technique is adopted for the data collection.

7.2.8 TOOL OR THE INSTRUMENT USED

The tool used for data collection is a structured questionnaire consists of 2sections

Section A Socio Demographic variables.

Section B : Structered Knowledge questionnaire consisted of 30 items knowledge

questions to assess the knowledge regarding relaxation techniques to reduce stress on

antenatal primigravida women.

7.2.9 METHOD OF DATA ANALYSIS AND PRESENTATIONS*-

The data was collected from 50 samples for the purpose of assessing the level of

knowledge of antenatal mothers reffered for lscs before and after the interventions.

Descriptive and Inferential statistics for the analysis of data will be used. Descriptive

statistical analysis includes frequency, percentages, mean, median, standard deviation.

Inferential statistical analysis includes paired ‘t’test,chi square test, co-relation, co-

efficient test

7.2.10 DURATION OF THE STUDY

4—6 weeks.

7.3 CRITERIA FOR SELECTION OF SAMPLES

7.3.1 Inclusion Criteria

1. Antenatal primi gravida women who are reffered for LSCS .

2. Antenatal primigravida women who are willing to participate in the study

7.3.2 Exclusion criteria

1. Antenatal primigravida women who are not available at the time of data

Collection.

2. Antenatal Mothers who do not knows kannada.

7.4 RESEARCH VARIABLES

7.4.1 Dependent variable: In this study the dependent variable is the

knowledge of antenatal primigravida women regarding Relaxation

techniques.

7.4.2 Independent variables : In this study independent variable is structured

Teaching programme on relaxation techniques to reduce stress.

7.4.3 Demographic variables Demographic variables are age, religion,

educational status, occupational status, history of abortion, family

income,type of family,support from the family,social support

system,previous knowledge.

7.5 PILOT STUDY

A Pilot study will be conducted on 10% of the population and the samples will be

excluded from the main study.

7.6 SIGNIFICANCE OF THE STUDY

It signifies the effectiveness of a structured teaching programme on selected

relaxation techniques to reduce stress among antenatal primigravida women who are

referred for LSCS in Rajeev Hospital at Hasaan.

7.7 CONCEPTUAL FRAME WORK

Conceptual Frame Work adopted for this study is based on Reva

Rubin’s, Maternal role attainment theory model .

7.8 DOES THE STUDY REQUIRES ANY INVESTIGATION TO BE

CARRIED OUT ON PATIENT OR OTHER HUMAN ?

Yes,a structured teaching programme with a structured questionnaire will be used

to assess the level of knowledge of antenatal primigravida women regarding the

relaxation techniques to reduce stress in Rajeev Hospital,Hasaan.

7.9 HAS ETHICAL CLEARANCE BEEN OBTAINED ?

Yes ,permission will be obtained from research commity of Rajeev College of

Nursing and the authorities of Rajeev hospital.Informed consent will be obtained from

antenatal primi mothers subject before the data collection.

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