Download 6.2.1 Studies related to home based post natal care

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGLORE KARNATAKA
ANNEXURE II
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DISSERTATION
1
NAME OF THE
Mrs. JINCY JOHN P
CANDIDATE AND
1ST YEAR MSC NURSING
ADDRESS
RATHNA COLLEGE OF NURSING
B.M.ROAD HASSAN KARNATAKA
2
3
4
NAME OF THE
RATHNA COLLEGE OF NURSING
INSTITUTION
B.M ROAD HASSAN KARNATAKA
COURSE OF STUDY
MASTER OF SCIENCE IN NURSING
AND SUBJECT
(OBSTETRICS AND GYNAECOLOGY)
DATE OF
13/07/11
ADMISSION
TO COURSE
“EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON
5
TITLE OF THE
KNOWLEDGE REGARDING SELECTED HOME BASED POST
TOPIC
NATAL CARE AMONG PRIMI POST NATAL MOTHERS
UNDERWENT CAESAREAN SECTION.”
“A STUDY TO EVALUATE THE EFFECTIVENESS OF STUCTURED
5.1
STATEMENT OF
TEACHING PROGRAMME ON KNOWLEDGE REGARDING
THE PROBLEM
SELECTED HOME BASED POST NATAL CARE AMONG PRIMI
POST NATAL MOTHERS UNDERWENT CAESAREAN SECTION IN
SELECTED HOSPITALS AT HASSAN.”
1
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“When you are a mother you are never alone in your thoughts. A mother always has to
think twice one for herself and one for her child.”
- Sophia Loren
Throughout pregnancy, mother was center stage. The partner, family, doctor and mother
herself were concentrating on various aspects of her health and care in pregnancy and labour.
The fetus growing inside was a secondary patient. Now that she has delivered, the focus of
everybody’s attention, seems to have shifted suddenly from mother to baby. However, there are
many things about mother’s body that are still going to change. This post delivery period is
extremely important, and to recover to her pre-pregnancy health.1
Postnatal period is the time just after the delivery and through the first six weeks of life.
And this period is called puerperium. This period is usually considered to be six weeks in
duration.2 By six weeks after delivery, most of the changes of pregnancy, labor, and delivery
have resolved and the body has reverted to the non pregnant state.The immediate postpartum
period most often occurs in the hospital setting, where the majority of women remain for
approximately 2 days after a vaginal delivery and 3-5 days after a cesarean delivery. During this
time, women are recovering from their delivery and are beginning to care for the newborn. This
period is used to make sure the mother is stable and to educate her in the care of her baby
especially the first-time mother. 3
An essential care during this period is necessary for mother and child for their healthy
outcome. Care in the period following birth is critical not only for survival but also to the future
of mothers and newborn babies. Major changes occur during this period that determines their
well-being and potential for a healthy future. Postnatal care is pre-eminently about the provision
of a supportive environment in which a woman, her baby and the wider family can begin their
new life together.4
2
Lack of knowledge regarding post natal care may lead the mother to wide range of
postpartum problems. Common problems experienced by the mothers include postpartum
infections, including uterine, bladder, or kidney infections, excessive bleeding after delivery,
pain in the incision area, vaginal discharge, breast problems such as swollen breasts, infection
and clogged ducts, marks, hemorrhoids and constipation, urinary or fecal incontinence,
depression, discomfort during sex etc.5
In order to prevent all these problems, prompt post natal care is very essential after the
delivery of the baby till the sixth week. During this period the care is essential not only for the
mother but also for the child. The general post natal home based care include provision of
adequate rest and ambulance, diet, sleep, care of the breast, importance of postnatal exercise,
family planning advice and guidance, importance of post natal check up for the mother, and
adequate breast feeding and newborn care.6
Post natal care is necessary to ensure that no complications have developed in the
woman after childbirth. It is important that mothers and their partners are informed of what
normally happens during this period, and that make sure there are no danger signs which can
compromise the health of the mother or the newborn. Post partum maternal health care
influences the health of both mothers and their children. Recommendations to promote maternal
health include establishing polices regarding post partum maternal health, re evaluating and
reforming the program of routine post partum health care, encouraging family support, offering
support groups, designing long term educational programs and conducting research focused on
post partum maternal health.7
6.1 NEED FOR THE STUDY
“If new mothers thrive, it means that the healthcare system is working, and the opposite is also
true…”
LaurieGarrett
During the period of pregnancy and child birth, the body of a mother undergoes several
changes, which takes time to get back to the pre- pregnancy stage. After a child birth it is
essential for the mother to take care of herself so that she can enjoy with her new baby and rest
of the family. Taking care of the baby and feeding the baby is very tiring and requires energy. So
the post natal care of the mother is very important especially those who underwent cesarean
section8
3
Maternal morbidity and mortality rates remain unacceptably high across the developing
world. Every minute, a woman dies from complications related to childbirth or pregnancy.
Complications of pregnancy and childbirth are a leading cause of death and disability among
women of reproductive age (ages 15 to 44) in developing countries. While most maternal deaths
are preventable, poor health services and scarce resources limit women’s access to life-saving,
high-quality care. Although there have been some notable advances, efforts to adequately
address maternal health remain fragmented.9
Problems women can experience during the postnatal period include: tiredness, breast
problems, backache, hemorrhoids, constipation, depression, anemia, headache and urinary
symptoms. Postpartum care and recovery length varies widely from woman to woman. It can
take weeks, even months for mother’s body to heal and return to its pre-pregnancy state. Women
who have had surgery (C-section) usually need a longer recovery period than those who had
vaginal birth.
The quality of Home based postnatal care provided to women and families in the first
days and weeks after birth can have a significant impact on their experience of the transition to
parenthood. First time parents often have very limited experience of the physical and emotional
demands of their new roles and responsibilities which can be quite a challenge. Research
repeatedly shows more negative comments from service users in relation to hospital postnatal
services than about any other aspect of maternity care. It shows that all mothers should be able to
access good quality postnatal support in their home.10
During the post natal period mother requires education regarding rest, diet, exercises, breast
feeding, hygiene,family planning and new born care. Postpartum care can be categorized to
different categories such as external, internal and mental care. For a new mother, she has to make
sure she takes good care of herself in these three aspects in order to prevent the post natal
complications.11
A study was conducted to assess the effectiveness of home-based postnatal care. The aim
of the study was to explore home based post natal care in terms of what is currently provided;
what women expect; and how prepared midwives are to provide home-based postnatal care. The
study comprises three components. Component one is a web-based survey of all managers of
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public maternity hospitals in Victoria exploring the guidelines, procedures, and practice of homebased postnatal care. Component two involves interviews with new mothers whose babies are
approximately four to five months of age, and who received home-based postnatal care.
Component three comprises focus groups with Victorian midwives who provide home-based
postnatal care. Study concluded that urgently needed information concerning the structure and
content of home-based post natal care. 12
A study to assess the information needed to parents after being discharged directly
from the hospital. The purpose of this study was to examine the parents' need of information
after early discharge after delivery and to compare their needs with the information given
according to the checklist for home-visits. Forty-two couples completed the study. They were
asked to formulate five questions to the midwife at the home-visit. After the questions were
gathered, a content-analysis was done. Three different main groups were identified: questions
concerning 1) the child (68%) such as hygiene, bowel movements, burping, vomiting, eating,
sleeping and sneezing 2) breast-feeding (21%) questions were asked about position while breastfeeding, nipples and amount of milk 3) the mother (11%) questions concerned after pains,
stitches, eating and drinking. The results show that the checklist worked sufficiently well as a
work tool, but can be adjusted further according to the parents' need. This study shows that they
needed more information about the care of the infant, primarily concerning hygiene.13
The World Health Organization in Postpartum care of the mother and newborn recognizes
the benefits of postnatal care.“Psychological problems in the postpartum period are not
uncommon. These problems can be lessened by adequate social support and support from trained
care-givers during pregnancy, labour and the postpartum period”. The WHO in Postpartum care
of the mother and newborn recommends that the establishment and maintenance of breastfeeding
should be one of the major goals of postpartum care.14
Every minute of every day, somewhere in the world and most often in a developing
country, a woman dies from complications related to pregnancy or childbirth. That is 515,000
women a minimum, dying every year. Nearly all maternal deaths (99 percent) occur in the
developing world--making maternal mortality the health statistic with the largest disparity
between developed and developing countries.15
5
Post natal complications are major health problems in developing country like India.
Based on much literatures and investigators experience, it is felt that it is essential to give
adequate knowledge regarding home based post natal care to primi para mothers. The knowledge
will help them to improve their awareness regarding home based post natal care and help them to
promote longer-term physiological and emotional wellbeing.
6.2REVIEW OF LITERATURE
Review of literature is a key step in research process. Review of literature is the
reading and organizing of previously written materials relevant to the specific problems to be
investigated: Framework and methods appropriate to perform the study.
The literature reviewed under following headings:6.2.1 Studies related to home based post natal care.
6.2.2 Studies related to post natal care.
6.2.1 Studies related to home based post natal care
A study was conducted to enhance the postnatal education for first-time mothers
investigated through an action research cycle. This study sought to benefit women in the
transition to motherhood by enhancing the postnatal teaching offered to first-time mothers in
hospital following childbirth. The study followed an action research cycle to design, implement
and evaluate an educational resource for first-time mothers during the immediate postnatal
period. The result of the study showed that first-time mothers considered lack of time as a
significant factor in giving and receiving postnatal education. It was also found that the provision
of relevant information was important. The study identified that specific information relating to
baby-care and self-care are primary educational needs for first-time mothers.16
A study was conducted to assess the effectiveness of postpartum home visits extending
the continuum of care from hospital to home. Crucial maternal, newborn, and family healthcare
needs arise during the early postpartum period, providing the opportunity for home care nurses to
extend the continuum of care from hospital to home. This study identifies common early
postpartum problems discovered on home health visits and describes the related interventions
6
of home health nurses. Co relational analysis revealed that young mothers, first-time mothers,
breastfeeding mothers, and single mothers are priority candidates for follow-up homecare.17
A study was conducted to assess the effectiveness of postpartum support to improve
maternal parenting, mental health, quality of life, and physical health. This review examined the
published evidence of the effectiveness of postpartum support programs to improve maternal
knowledge, attitudes, and skills related to parenting, maternal mental health, maternal quality of
life, and maternal physical health. Randomized controlled trial evidence was found to endorse
universal provision of postpartum support to improve parenting, maternal mental health,
maternal quality of life, or maternal physical health. There is some evidence that high-risk
populations may benefit from postpartum support.18
A study was conducted regarding postnatal care in the community: report of an
evaluation of birthing women's assessments of a postnatal home-careprogramme.The aim of the
study was to evaluate a new postnatal home support worker introduced into a geographically
defined catchment area of a metropolitan hospital in South Australia. The research methods used
included interviews with antenatal women about their knowledge of and attitudes to the
programe, and interviews with postnatal women about their transition home experience and
assessment
of
the
program.
The
results
demonstrate
the
importance
of
well-
structured home support services to maternal satisfaction and maternal well-being through the
provision of physical, social and emotional care and support in the home.19
A study to gain a deeper understanding of first-time parents experiences of early discharge
from hospital after delivery and home based post natal care. Twenty one parents participated.
Three themes emerged: the family strategy, which describes the families expectation of post
natal care and their experience of the real situation. Some are flexible concerning going home
early, and others have decided in advance. Professional support in the home summarizes the
parents experience of the midwife is seen as a support and adviser to the parents.This study
shows that parents welcome home-based postnatal care with suits healthy families. We think it
will be more important in the future to discriminate between healthy families and those in need
of hospital care than to focus on the moment when they leave the hospital, early or late.20
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6.2.2 Studies related to post natal care
A study was conducted to assess the maternal health after childbirth. The women who
participate gave birth in a two-week period. One or more health problems in the first
six postnatal months were reported by 94% of the women. The research conclude that physical
and emotional health problems are common after childbirth, and are frequently not reported to
health professionals despite the fact that many women would like more advice and assistance in
dealing with them.21
A study was conducted to assess the women's experience of their postnatal care. This
paper examines women's experience of their postnatal care in hospital and at home. It found that
over a third of women surveyed had problems caring for themselves and the baby.
Breastfeeding mothers were more likely to have problems than bottle-feeding mothers. There
was no relationship between having such problems and parity. Women were particularly
dissatisfied with postnatal services at home, 45% describing them as inadequate. Satisfaction
with services was significantly associated with having sufficient advice from health professionals
in hospital and at home. In view of the findings of this paper, it is clear that a strategy is required
to identify those most in need of postnatal care and target services accordingly.22
A Study was conducted to assess the Stressful events, social support and coping strategies
of primiparous women during the postpartum period: 60 women interviewed six weeks after the
birth at term of their first child. During the early postpartum period, interaction with caregivers
was an important source of perceived stress. Upon returning home, the partner was considered as
the primary source of social support, but the first need expressed was for material support.
Educational information dispensed by medical staff during the prenatal period was not put into
practice during the postpartum period. Mothers expressed the need to be accompanied and
counseled when problems arose and regretted the lack of long-term postpartum support. Both the
prenatal education and postpartum social support seem to mismatch women's needs and
expectations. Concerted efforts are required by health professionals at the maternity unit and in
the community to provide mothers with more adequate postpartum assistance.23
A
study
was
conducted
to
assess
the
Women's
views
and
experiences
of postnatal hospital care. The participants were 1616 women who gave birth in Victoria in a 2week period. The research shows that women rate early postnatal care in hospital far less
8
favorable than care in pregnancy, labor and birth. The findings indicate that interactions with
caregivers are a major influence on women's overall rating of postnatal hospital care. Acting on
these findings requires a greater focus on communication and listening skills, attention to staffing
levels, and leadership promoting more women-centered care in postnatal wards.24
A study was conducted to assess the comparison of breast feeding after
traditional postnatal hospital care and earlydischarge.304 women were participate with babies of
six months of age. Division was made for breast feeding at 2, 4 and 6 months of age. The four
main groups were examined for demographic differences. A difference was found in education
level; early discharge mothers had a lower level of education than THC mothers. No significant
difference was found for the frequency or duration of breast feeding between the early discharge
and the traditional hospital care groups, despite the higher education level in the traditional
hospital care group. A possible explanation for this finding is that a care plan aimed at
supporting the individual's responsibility and participation, providing relevant knowledge and a
subliminal communication of trust in the competence of parent and child, is of particular
significance for women with less education. The presence and participation of the baby's father
at an early stage may also be a factor.25
STATEMENT OF THE PROBLEM
“A study to evaluate the effectiveness of structured teaching program (STP) on
knowledge regarding selected home based post natal care among primi post natal mothers
underwent caesarean section in selected hospitals at Hassan.”
6.3 OBJECTIVES
1. To assess the knowledge level of primi post natal mothers on selected home based post
natal care before structured teaching program.
2. To evaluate the effectiveness of structured teaching program on selected home based post
natal care in terms of knowledge scores as measured by post test.
9
3. To find out the association between the knowledge score with selected socio demographic
variables.
6.3.1 HYPOTHESIS
H1:- There will be a significant difference between pretest and post test knowledge scores of
primi post natal mothers before and after the structured teaching program.
H2:- There will be a significant association between the knowledge scores of primi post natal
mothers with their selected socio demographic variables.
6.3.2 ASSUMPTIONS
The study assumes that
1. The primi post natal mothers may have some knowledge regarding selected home based
post natal care.
2. Structured teaching program will enhance the knowledge of primi post natal mother’s
regarding selected home based post natal care.
6.3.3 OPERATIONAL DEFINITIONS
1. Evaluate: It refers to the statistical estimation of knowledge regarding selected home
based post natal care.
2. Effectiveness: Effectiveness refers to the significant gain in the knowledge of primi
post natal mothers regarding selected home based post natal care.
10
3. Structured teaching program: It is the systematically developed teaching program to
provide adequate and relevant information on selected home based post natal care to the
primi post natal mothers.
4. Knowledge: It is the response given by the primi post natal mothers to the knowledge
questionnaire on selected home based post natal care, measured as knowledge scores.
5. Home based post natal care: Home based post natal care is a care which is followed
at home after the caesarean section.
6. Primi post natal mothers: who delivered a child for first time.
7.Caesarean section:It is a surgical procedure in which incisions are made through a
woman's abdomen and uterus to deliver her baby.
6.3.4 CONCEPTUAL FRAME WORK
It is based on “general system theory-ludwig von bertalanffy’s ”.
6.3.5 DELIMITATION OF THE STUDY
The study is delimited to
1. primi post natal mothers underwent caesarean section in selected hospitals at Hassan
2. The study period is limited to 4-6 weeks of duration.
3. Sample size is limited to 60 .
7. MATERIALS AND METHODS
7.1 SOURCE OF DATA
The data will be collected from primi post natal mothers underwent caesarean section in
selected hospitals at Hassan.
7.1.1 SIGNIFICANCE OF STUDY
The study signifies the importance of the structured teaching program on selected home based
post natal care and it will enhance the knowledge of primi post natal mothers and they can
apply this knowledge in practice in future .
11
7.1.2 RESEARCH DESIGN
One group pretest- post test design
subjects
primi post natal
pretest
o1
intervention
Post test
x
o2
mothers
underwent
caesarean section
Key Words
O1- pretest
X – Structured teaching program on selected home based post natal care.
O2- post test
7.2 METHODS OF DATA COLLECTION
Data is intended to collect by using structured knowledge questionnaire regarding
selected home based post natal care. The tool has two sections:
Section I: socio demographic variables.
Section II: structured knowledge questionnaire on selected home based post natal care.
7.2.1 SAMPLING PROCESS
CRITERIA FOR SAMPLE SELECTION
Inclusion criteria:
1. Primi post natal mothers underwent caesarean section in selected hospitals at Hassan.
2. Primi post natal mothers who can read and write kannada.
3. Primi post natal mothers who are willing to participate and present at the time of study.
12
Exclusion criteria:
1. Primi post natal mothers who are not willing to participate.
2. Primi post natal mothers who are not present at the time of study.
3. Primi post natal mothers who cannot read and write kannada.
7.2.2 SAMPLING PROCEDURE
7.2.2.1 POPULATION
In this study, population comprises of primi post natal mothers underwent caesarean section in
selected hospitals at Hassan.
7.2.2.2 SAMPLE
Primi post natal mothers who fulfill the inclusion criteria
7.2.2.3 SAMPLE SIZE
Sample size is 60.
7.2.2.4 SAMPLE TECHNIQUE
Non probability convenient sampling techniques
7.2.2.5 SETTING
The study will be planned to conduct in selected hospitals at Hassan.
7.2.2.6 PILOT STUDY
It is planned with 10% of total sample in selected hospitals that will be excluded from the main
study.
7.2.2.7 VARIABLES
Independent variable- In this study independent variable refers to Structured teaching
program on selected home based post natal care.
Dependent variable- In this study dependent variable is knowledge of primi post natal
mothers on selected home based post natal care.
13
Extraneous variable – Age, Sex, Religion, Type of family, Education of husband ,
Education of wife, Family income, Source of information, Residence, previous
knowledge about home based post natal care .
7.2.2.8 METHOD OF DATA ANALYSIS
It includes descriptive and inferential statistics.
Descriptive statistics
To describe the statistical analysis includes frequency, percentage, mean, median and
standard deviation.
Inferential statistics
1. The Chi square test will be used to calculate and analyze the association between
knowledge scores with selected demographic variables.
2. Paired‘t’ test is used to find out the significant difference between pretest and post
test scores.
7.3. DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE
CONDUCTED ON PATIENTS OR OTHER HUMANS?
Yes, structured teaching program will be used as an intervention among primi post natal
mothers underwent caesarean section.
7.4. HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR
INSTITUTION?
Yes, permission will be obtained from the research committee of Rathna college of
Nursing and authorities of selected hospitals at Hassan.
14
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