NEED FOR STUDY

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFOMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1NAME OF THE CANDIDATE AND ADDRESS MRS.ASHLEYBABITHA MASCARENHAS,COLUMBIA COLLEGE

OF NURSING, BANASWADIBANGALORE.

2NAME OF THE INSTITUTION

COLUMBIA COLLEGE

OF NURSING, BANGALORE.

3COURSE OF STUDY AND SUBJECTM.SC.NURSING 1 YEAR

OBSTETRICS &

GYNAECOLOGICAL NURSING

4DATE OF ADMISSION TO THE COURSE25.4.2011

5TITLE OF THE TOPICEFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE OF PRIMIGRAVIDA MOTHERS REGARDING PERINATAL PERIOD IN SELECTED MATERNITY HOSPITALS AT BANGALORE.

INTRODUCTION

Thousands of women could be saved each year if they had access to skilled care during pregnancy and child birth, and access to emergency obstetric care. Most of the interventions they need are simple, affordable and highly effective1Dr.Lee Jong Wook

Perinatal care plays a vital role in both mother and child life.Each and every individual is important ,specially women during pregnancy.It is interesting to note that about 80% of maternal deaths are to direct causes i.e. obstetric complications of pregnancy, labour and pueperium to interventions or incorrect treatment. Most maternal deaths are preventable.1The low status of women in the society coupled with their low literacy levels prevents the women from taking postnatal care even if services are available. Hence the womans knowledge regarding postnatal care and complication of neglected postnatal care can prevent the maternal mortality rate.

Most women who deliver vaginally at hospital usually go home within 24-48 hours after delivery. This challenge the nurse caring for the woman in the early postpartum period to do through assessment to pick up on any complications that might be developing and to use every available opportunity to do teaching regarding self and newborn care2. Midwife therefore need towards changes in the system of care provision. Which would facilitate them in providing care which is satisfying for themselves, the woman and the community they care for? This time of transition is an important point of contact when woman are experiencing enormous changes and kin to receive support and information in order to mange it well.

Women need not die in childbirth. We must give a young woman the information and support regarding her needs to control her reproductive health, help her through a pregnancy and care for her and her newborn well into childhood. The vast majority of maternal deaths could be prevented if the women have necessary knowledge & skill regarding the care during pregnancy, childbirth and the first month after delivery. Thus the researcher would like to assess the knowledge of primigravida mothers regarding the immediate postnatal care in order to help in the prevention of maternity death3.6.1 NEED FOR THE STUDY

Perinatal care, according to the Perinatal Foundation, is care that is relating to childbirth, from three months before pregnancy to one year after birth. It is crucial to receive proper care for you and your new baby in all aspects of pregnancy to ensure he or she has the very best start possible4.Before conceiving your baby, it is important to see your doctor to discuss your plans to get pregnant and any risk factors or health conditions you or your partner may have. Being proactive about these risks early can prevent preterm birth and health problems for your baby later on. Your doctor can recommend medical tests and lifestyle changes to give your baby the optimal conditions to develop and grow. Some recommendations include taking a folic acid supplement to lower the risk of certain birth defects, smoking cessation, stopping alcohol use, having any health conditions under control, listing any over-the-counter or prescription medications you may be taking and having up-to-date vaccinations5.

Prenatal care during your pregnancy is a must to make sure you and your baby stay healthy. Your doctor could specialize in obstetrics and gynecology, be a general practitioner or be a midwife. Throughout your pregnancy, your doctor monitors your health and the health of your baby, and manages any risks that appear. Check-ups are generally scheduled once per month through the last month of pregnancy when your appointments will be more frequent -- usually once per week. Your doctor also manages any prenatal or maternal testing you may have, such as ultrasounds, blood work or amniocentesis6.

Childbirth classes are an excellent way to prepare for labor and delivery. These classes cover all aspects of what goes on once labor begins through the postpartum hospital stay. You learn your options for managing labor pains, different childbirth methods and experiences, and any interventions that may need to take place in an emergency, such as a cesarean section. The classes may also include a tour of your hospital's maternity ward, labor and delivery rooms, and nursery. When you arrive at the hospital in labor, it is important to be prepared. Your hospital bag should be ready in advance and contain any items to make you more comfortable during your stay, such as your birth plan, comfortable sleepwear, slippers, snacks, toiletries and a going-home outfit7.

During pregnancy, need to interview and choose a health provider for new baby. A pediatrician specializes in children's health care, or may choose to see a family practitioner and keep family's medical care in the same practice. Both options are equally viable and a matter of preference. While in the hospital after the birth of baby, will be given tutorials in basic child care. These classes are usually mandatory for first-time parents and offer a wealth of useful information. During this perinatal period learning newborn care, including diapering, bathing and feeding are important. So the investigator has found knowledge about perinatal care is important to prevent maternal and newborn mortality rate8.6.2 REVIEW OF LITERATUREA review of literature related research and theory on a topic has become a standard and virtually essential activity of scientific research projects Literature review is a critical summary of research on a topic of interest, often prepared to put a research problem in contact or as the basis for an implementation project. Review of literature was undertaken to gain in depth knowledge on various aspects of the problem under study.

Review of literature for the present study has been recognized under the following headings.SECTION A: Study related to knowledge regarding perinatal period among primigravida mothers.

SECTION B: Study related to knowledge regarding antenatal period among primigravida mothers.

SECTION C: Study related to knowledge regarding postnatal period among primigravida mothers.

SECTION A: Study related to knowledge regarding perinatal period among primigravida mothers

MadukaW.E. (2000) A study was conducted to determine the knowledge pregnant mothers have on the monitoring of foetal movement and its effect onperinataloutcome. The findings of the study were used to develop the content of a health education programme that is contextual and relevant to the needs of pregnant mothers. Aquantitative researchsurvey design was used to obtain information from pregnant mothers. Simple random probability sampling was used. Ninety-seven (97) pregnant mothers agreed to participate in the study. The results indicated that pregnant women who were able to perceive foetal movement during pregnancy regarded it as important9. Heins HC. (2003).the study was conducted to improvesperinataloutcome through social support. Resource Mothers are nonprofessional women who combine warmth, parenting experience, andknowledgeof their local community services to reduce the hazards associated with rural adolescent pregnancy10. Each Resource Mother is assigned to a pregnant teenageprimigravidaand serves as part of her support system throughout pregnancy and until the infant's first birthday. We studied 565 matched pairs (case/control) of rural teenage primigravidas with single pregnancies with and without the social support of the Resource Mother. There were significantly more patients with adequate prenatalcarein the program group (P less than .000001). The frequency of low birth weight infants was significantly less (P = .006), as was the small-for-gestational-age rate (P = .002).SECTION B: Study related to knowledge regarding perinatal period among antenatal mothers

Nancy.W.T.et al,.(1999).a study was conducted to assess the womens awareness of minor disorders of pregnancy and danger sings of obstetric complication in a rural district in Tanzania (2009). A total 1118 women were interviewed, result reveals that more than 98% of women attend antenatal care at least once half of the women knew about at least one obstetric danger sign and few women knew one or two minor disorders. It shows that the women had low awareness of danger signs of obstetric complication and antenatal care12.

Bondas T.(2009) conducted a study to explore and describe women's experiences of antenatalcare. Semi-structured interviews, dialogical interviews and non-participant observation in two phases both during and after pregnancy were analysed according to Colaizzi's phenomenological method. A purposive sample of nine women was interviewed at 36 weeks gestation, three weeks, three months and two and a half years after birth. In the second phase, data were collected for further breadth and depth and 31 women, who were going through different stages of pregnancy, delivery and the puerperium, participated. The findings challenge the antenatalcarethat so far has been focused on the physical health, the needs of theprimigravidaand a blurred family perspective13. The family perspective implies knowing both the pregnant woman and her partner in terms of the pregnancy, the birth and a new parenthood. Humane, scientifically basedperinatal carecan be developed by innovations from these findings, especially considering the multidimensional role of the parent groups.

Mutihir J.T.et al,.(1999) conducted a qualitative study to examine the experiences of first-time mothers following discharge from the hospital after vaginal delivery was done. Participants were primipara within 18 to 35 years of age from an urban location in the northeastern United States. Following the dramatic changes of pregnancy and delivery, the women returned home feeling unprepared to care for themselves and their babies. Because of their lack of preparedness at a time of increased responsibility and vulnerability, they were overwhelmed. Exhausted, feeling unwell and isolated, they struggled to adapt to new role expectations. Propelled into information seeking by their lack of knowledge, they were further hampered by conflicting and fragmented advice14. Family and friends were the primary sources for information for the majority of these new mothers, not healthcare professionals or services. Insight into the experiences of first-time mothers provides a framework for additional research and the development of programs and resources that will address their unique needs15. SECTION C: Study related to knowledge regarding perinatal period among postnatal mothers.

Nance N.W (1987) A phenomenological follow-up study on new mothers experience of postpartum care was conducted. Nine women were interviewed. Three challenges in postpartum care emerge from this study16. These are to understand the meaning of caring, to involve family and other new mothers more consciously, and to see the woman as a new mother who needs both to care and be cared for both by her family and friends and by professional career17.

Ferguson J.E. (2005) descriptive study was conducted to identify the most important content areas to include when teaching postpartum women, either in the hospital or at home, from the perspective of both nurses and postpartum women. Seventy-one registered nurses who provided in-hospital maternity nursing care; 53 registered nurses who provided postpartum follow-up home care visits; and 103 low-risk postpartum mothers from the hospital within 24 hours after delivery were taken for study. The responses of nurses and new mothers regarding teaching topics related to care of mothers and their newborns suggest that new mothers have opinions that differ from those of nurses. Nurses give priority to teaching about infant care, whereas new mothers give priority to their own care18. Ghosh E.a.et al,.(2006)a study was done to describe the factors that influenced first-time mothers' choice of and experiences during the first postnatal week, after early discharge without a domiciliary visit by the midwife. Participants were recruited from the maternity hospital & belong to both urban and rural population. Based on interview one main category and three subcategories emerged. The main category was a feeling of confidence and security and the subcategories were being able to meet the needs of the baby, feeling 'back to normal' and receiving support. Factors that influenced first-time mothers' choice and experience of early discharge were their sense of confidence and security that they had support from their partner and that they could trust the follow-up organization19.

Abdel-Hamid H.S. (2006) a qualitative study done to explore mothers' experiences of the support they received from community health professionals. Consent of nine mothers was taken for the interview. The findings explore the concepts of trust, expertise and understanding within the working partnership. It states the mothers' need for reliability, and a preference for professionals who understood women's beliefs about what it means to be a 'good mother'. The results and recommendations are pertinent to those community health professionals who work in the area of early childhood intervention20.

6.3 STATEMENT OF THE PROBLEM

Effectiveness of Structured Teaching Programme on knowledge of primigravida mothers regarding perinatal period in selected Maternity Hospitals at Bangalore.6.4 OBJECTIVES1. To determine the existing level of knowledge of primigravida mothers regarding perinatal period.2. To give Structured Teaching Programme regarding perinatal period among primigravida mothers. 3. To determine the post test knowledge level of primigravida mothers regarding perinatal period.

4. To associate the pre & post test level of knowledge of primigravida mothers regarding perinatal period with selected demographic variables.6.5 OPERATOIONAL DEFINITIONS

1) Effectiveness: It refers to the outcome of self instructional modules in increasing the knowledge of primigravida mothers regarding significant of perinatal care during the pregnancy period.2) Structured Teaching Programme: Refers to a planned instruction to impart knowledge, using relevant teaching methods which provide information regarding perinatal period.3) Knowledge: It refers to the level of understanding and the ability to answer on the perinatal care during the perinatal period by the primigravida mothers as elicited through structured questionnaire.4) Perinatal Care: The care management of the foetus and newborn infant in the perinatal that is before, during and after delivery.5) Primigravida mothers: In this study primigravida mothers are those who have conceived with 28th weeks and above for the 1st time and expecting for delivery.6.6 RESEARCH HYPOTHESIS

H1: There will be significant increase in the level of knowledge of the primigravida mothers following the administration of Structured Teaching Programme

H2: There will be significant association with the post test level of knowledge of the primigravida mothers regarding perinatal care during perinatal period with selected demographic variables.6.7 RESEARCH VARIABLES

INDEPENDENT VARIABLES: Knowledge of primigravida mothers

DEPENDENT VARIABLES : Structured Teaching Programme 6.8 ASSUMPTIONS1) The primigravida mothers will not have proper knowledge regarding the perinatal care during the primigravida period.

2) Administering the Structured Teaching Programme will help in improving the knowledge level of primigravida mothers on perinatal care during the perinatal period

3) Creating awareness on perinatal care during the early perinatal period so as to improve the maternal and child health.6.9DELIMITATIONS: 1. This study is limited to primigravida mothers. 2. This study is limited only the selected maternity hospitals at Bangalore.

7. MATERIALS AND METHODS OF STUDY 7.1 SOURCES OF DATA

The data will be collected from the primigravida mothers in the selected Maternity Hospitals at Bangalore.

7.2METHOD OF DATA COLLECTION:

Research design : Research design is pre experimental design (One

group pre test and post test) will be used for data collection.

Research settings : The study will be conducted in selected Maternity Hospitals at Bangalore.

Population : The population of the study will be the primigravida mothers those who attend maternity OPD in selected Maternity Hospitals at Bangalore. Sample size : The sample consists of 50 primigravida mothers who attend maternity OPD in selected Maternity Hospitals at Bangalore. Sampling technique : Convenient sampling technique will be used for collecting the samples.

7.3. Criteria for sample selection:7.3.1 Inclusion criteria

All the primigravida mothers available at the time of data collection in maternity OPD in the selected Maternity Hospitals at Bangalore.

The primigravida mothers who can read and write Kannada.

7.3.2 Exclusive criteria The primigravida mothers who can read and write Kannada.

Primigravida mothers who are not willing to participate in the study.

Primigravida mothers who are deaf and dumb7.4. TOOLS FOR DATA COLLECTION

The tool for data collection in this study to assess the level of knowledge will be structured questionnaire.7.5.METHOD OF DATA COLLECTION

After obtaining permission from the concerned authority and informed concerned from the samples. The investigator will collect the data pertaining to demographic variable. It may be conducted in the month of July.7.6 PLAN FOR DATA ANALYSIS The data collected will be analyzed by using descriptive and inferential statistics.

Descriptive statistics

Mean, Percentage distribution and Standard deviation will be used.

Inferential statistics Paired t test and chi-square test will be use.

7.7. PROJECTED OUTCOME After administering the structured teaching programme there will be increase in the level of knowledge of the primigravida mothers regarding perinatal care during the early perinatal period and this will enhance the primigravida mothers to improve the perinatal care during the pregnancy.7.8 DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTIONS ?

Yes, structured teaching programme will be administered as intervention for the primigravida mothers.7.9. HAS ETHICAL CLEARANCE BEEN OBTAINED ? Permission will be obtained from the institutional ethical research committee of Columbia College of nursing at Bangalore. Permission will be obtained from the concerned authorities in the selected maternity hospital at Bangalore.

Informed consent will be obtained from primigravida mothers those who are willing to participate in the study. Confidentiality and anonymity of the subject will be maintained.

8. LIST OF REFERENCES

1. Jayne Klossner N & Nancy Hatfield. Introductory maternity and Pediatric Nursing. Philadelphia; Lippincott Williams & Wilkins; 2006: 278.

2. Ruth V. Bennett, Linda K. Brown. Myles Textbook for midwives. 13th ed. Philadelphia; Churchill Livingstone company; 2001:224-241.

3. Krishna Kumari Gulani. Community Health Nursing.

a. 1st ed. New Delhi: Kumar Publishing house; 2006:348-50.

4. WHO. Why do so many women still die in pregnancy or child birth. NNT, Jan 2006;10(1): 65.

5. Ministry of Health and Family Welfare Govt. of India. Activities In North-East Region.NNT, july 2007 ;(3)28-32.

6. Dutta DC. Textbook of obstetrics. 5th ed. Calcutta; new central book agency ltd;2001:212-231.

7. Park. Park`s Textbook of Preventive and Social Medicine. 16th ed. Jabalpur: Banarsidas bhanot company; 2000:380-81

8. Ministry of Health and Family Welfare Govt. of India. Maternal Health Programme. NNT,Sept 2006:(3) 28-32.

9. Lesley Ann Page, Rona Mc Candlish. The new midwife. 2nd ed. Philadelphia: Churchill Livingstone company; 2006:66-67.

10. George L. Lack of preparedness: experiences of first-time mothers. MCN Am J Matern Child Nurs. 2005 Jul-Aug;30(4):251-5. Available from george@rmu.edu11. Morse C, Durkin S, Buist A, Milgrom J.Improving the postnatal outcomes of new mothers. J Adv Nurs. 2004 Mar;45(5):465-74.

12. Lof M, Svalenius EC, Persson EK. Factors that influence first-time mothers choice and experience of early discharge. Scand J Caring Sci. 2006 Sep;20(3):323-3.

13. Maunders H, et al.Perceptions of community health professional support. Community Pract. 2007 Apr;80(4):24-9.

14. Giarratano G.Woman-centered maternity nursing education and practice. J Perinatal Educ. 2003 Winter;12(1):18-28.

15. Heins H.C.,et al, social support in importing perinital outcome: Text book of Obstetrical and Gynaecology, 3rd edition, Pp 263-66.

16. Ferguson.J.E, et al., perinatal resource programme, Pp no.268-70.

17. Abo academic university department of Perinatal science and women experience vol (2) 2008; Pp370-80.

18. Sherbini.A.F. et al., assessment of knowledge of mothers in antenatal carePp 111-30.

19. Khoia.T.et al., portion of antenatal visits in gestational age 1194(3); Pp 116-18.

20. Ekwempu.CC. et al., the influence of antenatal care on pregnancy outcome: 1988(5); Pp 67-71.

21. Park Pernatal mortality patterns in korea 1980Pp 56- 60

22. Molays Maternal age and Primiparity1989Pp 27-40.

23. Thebald C.E. et al., Factors influencing pregnancy outcomes 1986; Pp 60-68.24. Nargis Danish et al., Assessment of Pregnancy outcome in primigravida 2004 Pp 70-80. 25. www.google.com26. www.pubmed.com27. 31.www.askMedline.com28. 32.www.elseivierhealth.com29. www.medscane.com9. Signature of the Candidates

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