Download bangalore, karnataka. - Rajiv Gandhi University of Health Sciences

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION.
Mrs. Vijaya Prajula. S ,
1st Year M.Sc. Nursing,
Roohi College of Nursing,
Kadusonapanahalli cross,
Bagalore Main Road,
Kannure Village,
Banglore-562 149.
1.
Name of the candidate and Address
2.
Name of institution
Roohi College of Nursing, Bangalore
3.
Course of study and subject
M .Sc. Nursing,
OBG Nursing.
4.
Date of admission to the course
“A study to assess the effectiveness of
5.
Title of the topic
Self
Instructional
knowledge
Module
regarding
on
maternal
reflexology in reducing labour pain and
labour duration among staff Nurse
working
in
Bangalore”
1
selected
hospital
at
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
Pregnancy, childbirth and motherhood are times where a woman undergoes a vast
change in her body and it can be termed as an entirely new birth for the woman or as a
time of rebirth. The wait to bring a new life surfacing out of our own body is the one that
all of us aspire to experience at least once in our lifetime. This period is called Pregnancy.
Responsibilities and growing concern for the new life now plays a significant role as we
set foot on the path that transmutes one from a woman into a mother. Among these is our
duty to the life that is yet to be and how we can give of ourselves, in body and spirit, to
form and nurture the new life that we seek to bring into existence.1
Giving life is powerful. It is vital, therefore, that we prepare our body to become a
suitable environment for the baby to grow in while staying happy and healthy
emotionally and mentally as well. Each week of pregnancy brings with it new changes
and feelings that may require some explanations and support. This study touches on those
aspects you need to be aware of in the time before, during and after your pregnancy.1
After becoming pregnant, labor is the next event that a woman eagerly awaits.
There is also an apprehension among many women that they may fail to notice the initial
signs or symptoms of labor and in the process may not be adequately ready for childbirth
to occur. However, there is no reason to fear, as your body will display early signs that
labor is fast approaching.2
The final stage of pregnancy, third trimester, ends with labor and the birth of your
baby and is a period of excitement. Large size of your growing baby may bring in
physical discomforts and you may experience heartburn, increased fatigue, hemorrhoids,
2
swelling on the ankles and fingers and Braxton Hicks contractions (mild contractions)
that last for about 30–60 s. Do not hesitate to contact your doctor if you observe sudden
swelling on your ankles and if you experience a rapid and sudden weight gain. Do
continue to keep looking for signs of pre term labor like contractions accompanied by
vaginal discharge, sever back pain and if you experience more than 8 contractions/h,
occurring at regular intervals.1
You may have experienced contractions during your period of pregnancy.
Contractions (uterine muscle spasms) occurring at intervals of less than 10 min are
usually a warning that labor has begun. These contractions become more repeated, severe
and painful as labor progresses. Your labor pain may sometimes turn out to be a false
alarm. There is no need to be embarrassed if you rush to the hospital only to find that
your labor pain was not real, since it is not always easy to determine labor pain
accurately. Signs of false labor such as, Pain and contraction reduce with walking.
Irregular contractions, Pain decreases with a change of position, Contractions do not
increase in frequency or severity and Discomfort is felt in the abdomen only.2
Although each labor is different and unique in its own way, labor is generally
divided into three main stages, with the first stage, (latent stage) subdivided into three
phases.3
Labour is accompanied by intense and prolonged pain. Pain levels reported by
labouring women vary widely. Pain levels seem to be influenced by fear and anxiety
levels, experience with prior childbirth, cultural ideas of childbirth and pain, mobility
during labour and the support given during labour. One study found that middle-eastern
3
women, especially those with a low educational background, had more painful
experiences during childbirth.3
Pain is only one factor of many influencing women's experience with the process
of childbirth. A systematic review of 137 studies found that personal expectations, the
amount of support from caregivers, quality of the caregiver-patient relationship, and
involvement in decision-making are more important in women's overall satisfaction with
the experience of childbirth than are other factors such as age, socioeconomic status,
ethnicity, preparation, physical environment, pain, immobility, or medical interventions.3
Pain in contractions has been described as feeling like a very strong menstrual
cramp. Midwives often encourage refraining from screaming but recommend moaning
and grunting to relieve some pain. Crowning will feel like intense stretching and burning.
Even women who show little reaction to labor pains often show a reaction to crowning.
Childbirth can be an intense event and strong emotions, both positive and negative, can
be brought to the surface. Between 70% and 80% of mothers in the United States report
some feelings of sadness or "baby blues" after childbirth. Postpartum depression may
develop in some women; about 10% of mothers in the United States are diagnosed with
this condition. Abnormal and persistent fear of childbirth is known as tokophobia.
Childbirth is stressful for the infant. In addition to the normal stress of leaving the
protected uterine environment, additional stresses associated with breech birth, such as
asphyxiation, may affect the infant's brain.3
Pain during labor is caused by contractions of the muscles of the uterus and by
pressure on the cervix. This pain may be felt as strong cramping in the abdomen, groin,
and back, as well as an achy feeling. Some women experience pain in their sides or thighs
4
as well. Other causes of pain during labor include pressure on the bladder and bowels by
the baby's head and the stretching of the birth canal and vagina. Pain during labor is
different for every woman. Although labor is often thought of as one of the more painful
events in human experience, it ranges widely from woman to woman and even from
pregnancy to pregnancy. Women experience labor pain differently — for some, it
resembles menstrual cramps; for others, severe pressure; and for others, extremely strong
waves that feel like diarrheal cramps.4
A variety of pain medications can be used during labor and delivery, depending
on the situation. Talk to your health care provider about the risks and benefits of each.
Pain medications can be given many ways. If they are given intravenously (into
an IV) or through a shot into a muscle, the medications can affect the whole body. These
medicines can cause side effects in the mother, including drowsiness and nausea. They
can also have effects on the baby. This is what most women think of when they consider
pain medication during labor. By blocking the feeling from specific regions of the body,
these methods can be used for pain relief in both vaginal and cesarean section deliveries.5
Epidurals, a form of local anesthesia, relieve most of the pain from the entire body
below the belly button, including the vaginal walls, during labor and delivery. An
epidural involves medication given by an anesthesiologist through a thin, tube-like
catheter that's inserted in the woman's lower back. The amount of medication can be
increased or decreased according to a woman's needs. Very little medication reaches the
baby, so there are usually no effects on the baby from this method of pain relief.
Epidurals do have some drawbacks — they can cause a woman's blood pressure to drop
and can make it difficult to urinate. They can also cause itching, nausea, and headaches in
5
the mother. The risks to the baby are minimal, but include problems caused by low blood
pressure in the mother.4
Tranquilizers, These drugs don't relieve pain, but they may help to calm and relax
women who are very anxious. Sometimes they are used along with analgesics. These
drugs can have effects on both the mother and baby, and are not often used.
The amount of pain experienced during childbirth differs from mother to mother
and may even be different each time you give birth. For a first time mother, the fear of
the unknown may add to her anxiety. For many expectant moms, knowing ways to cope
with pain not only with medication, but using alternative and natural methods, is a source
of comfort. If you and your partner attend childbirth classes, you'll learn different
techniques for handling pain. 4
Women all over the world can benefit from massage, relaxation and hydrotherapy
in times of distress and pain during labour. Though you may find relief in one, or all, of
the methods, it’s a good idea to speak to your doctor before trying therapies such as
reflexology or acupuncture.5
Reflexology – Another ancient practice in which pressure is applied to specific
body parts, specifically the soles of the feet, to relax other body parts. During labour, a
reflexologist can help women cope with pain, and speed the process of childbirth by
applying pressure and stroking specific ankle points, which are said to stimulate the
pituitary glands to release pain killing hormones.6
6
6.1. NEED FOR THE STUDY
The mother is the panacea for all kinds of calamities. The act of giving birth is the
only moment when both pain and pleasure converge in a moment of time. This is a
miracle. Before the childbirth, the lady was a woman. After the childbirth, the woman is
transformed into a mother. This is a revolutionary act; an evolutionary happening; in the
manner of the silkworm getting transformed into some winged angel; this is also a
miracle1
This experience of transformation into motherhood is a privilege reserved
exclusively for women. Men do not undergo such miraculous transformation. Birth is the
renewal of life. Birth is as ancient as itself and as natural as process of breathing.
Motherhood is the only act that manifests in human form the cosmic wonder of creation
of life. The story begins with a birth and like all beginnings, a positive childbirth is not
only spiritually more fulfilling, but can also strengthen the mother –child bond.2
Pregnancy and childbirth are wonderful and remarkable moments of life, Giving
birth to a child can be one of the most joyful experiences of a woman's life, but it is
undeniably one of the most painful. Human Body can Bear Only Up to 45 Del (Unit) of
Pain. But.. At the Time of Giving Birth, a Woman Feels Up to 57 Del of Pain.5
The management of labour pain consists of pharmacological management and non
pharmacological management. The pharmacological management includes narcotics,
parental opiates, epidural analgesia, nitrous oxide, tranquilizers, Para cervical block,
spinal block, pudendal block The non-pharmacological management includes massage,
guided imagery, meditation, breathing techniques, positions, hot or cold therapy, music
7
and audio analgesia, sterile water injections, calm birth, water birth, hypnosis,
acupuncture, acupressure aromatherapy, reflexology and machine operated, such as
TENS or transcutaneous electronic nerve stimulation.4
Among all the non pharmacological methods for labour pain reflexology is one
of the best methods... because in reflexology the treatment is safe, free from side effects,
giving lasting cure, economical, and it is compatible with other forms of treatment; after
getting little training from the reflexologies’ everyone can apply this method for safe
delivery of baby in a less pain. It’s needed to propagate to the public the availability of
this kind of alternative therapy in the field of medicine is the role of each Nurses.4
Reflexology was rediscovered by Dr William Fitzgerald (born in 1872 in the
USA). In his book on zone therapy (his term for Reflexology) he says: "A form of
treatment by means of pressure points was known in India and China 5000 year ago. This
knowledge, however, appears to be lost or forgotten.” If we look back in history, we can
find further evidence of this technique being used. Cellini (1500-1571), the great
Florentine sculptor, is reported to have used strong pressure on his fingers and toes in
order to relieve pain in his body. Moreover, North American Indian tribes knew of the
relationship between the reflex points and the internal organs of the body and used this
knowledge to treat disease.4
Reflexology massage is a type of massage that uses the thumb and the forefinger
to stimulate some focal points on the foot. It is said that the foot has more than 7000
nerve endings, which are linked to various organs in the body. Stimulating and applying
pressure on these nerve endings rids the body of a number of physical problems.6
8
The corresponding area heals and benefits in several ways. One of the most
important benefits of a reflexology massage is that it induces calm and relaxation and
helps to reduce stress levels. Let us now study some of the benefits of a reflexology
massage.6
Reflexology involves massage, and the application of pressure, to points on the
feet, which correspond to various organs and systems in the body. Some women (and
caregivers) will use certain reflexology points for labour pain throughout the woman's
labour. Each time the contraction starts, the person administering the reflexology takes
one foot (or both) and applies pressure during the contractions. Some women will ask for
different points on the feet to be tried, to see which one she prefers.7
A point that lies between the fleshy pads under the big toe and next toe. The
partner, support person or caregiver holds one of the woman's feet firmly in their hands
and applies strong pressure at the beginning of a contraction with their finger or thumb,
easing the pressure off as the contraction finishes.8
A point that lies just below the centre of the ball of the foot. Again, the partner,
support person or caregiver holds one of the woman's feet firmly in their hands and
applies strong pressure at the beginning of a contraction with their finger or thumb,
easing the pressure off as the contraction finishes.8
This point is probably the most effective one for inducing labor. It affects the
pituitary gland, which releases oxytocin, the natural hormone in your body which is
responsible for uterine contractions. Press firmly on the center of the thumb for at least
three minutes. Then, switch to your other thumb.8
9
Reflexology has been shown to help induce labor and reduce pain during
childbirth. In fact, more and more nurses are beginning to learn this specialized type of
foot massage and are using it in delivery rooms around the world to ease their patients’
discomfort and reduce the length of labor. While reflexology is best known as a
specialized type of foot massage, it is performed on the hands as well. Reflexology is
similar to acupressure because it applies pressure to specific points on the body, but
reflexology doesn’t work with the body’s energy flow in the same way as acupressure.
Reflexology is based on certain reflex areas on the feet and hands that directly affect the
organs and muscles of the rest of the body.10
Little is more relaxing than a foot massage, but reflexology is even more effective
because it pinpoints the specific areas that will help move you toward a faster delivery
date. Try these points on yourself, and if a contraction begins, stop the pressure. When
the contraction stops, apply pressure again. Of course, avoid all of these reflexology
points until you are past your due date – at least your 41st week. You certainly don’t want
to rush the baby before its time.6
Reflexology is also great during childbirth, and your partner will feel more
helpful in the delivery room if he has learned these techniques. Applying pressure to any
of these points will help to reduce your pain while keeping your contractions frequent and
successful. If you use both reflexology and acupressure points to speed your labor after
your due date has passed you by, you are almost guaranteed to reach the delivery room
more quickly and definitely more naturally.7
10
A Study was conducted to investigate the association of antenatal reflexology
with different outcomes in labour period. The study design was retrospective cohort
study. The objective of this study was to investigate the association of antenatal
reflexology with different outcomes in the intranatal period. The findings showed that the
group who had four or more reflexology treatments had a reduced length of labour so it
can be concluded that reflexology can be used as non pharmacological method for
reducing labour duration.8
A study was done to assess the effectiveness of Reflexology therapy and its
labour outcome, it was offered free of cost to 64 pregnant women from 20 weeks of
pregnancy to term. Thirty-seven completed the set course of 10 treatments. The
remaining group found that Reflexology helped with the following presenting problems:
It was discovered that the effects of Reflexology on labour outcomes were outstanding.
Some had labour times of only 2 hours, some 3 hours. The 20-25 year olds had an
average time of first stage labour of 5 or 6 hours, as did the first time mothers (text book
average is 16-24 hours). Second time mothers, 26-30 year olds, seemed to have longer
labours (and may have fallen into the group experiencing more social stress). The second
stage of labour lasted an average of 16 minutes (compared to the text book expectancy of
1-2 hours). In this small study it was found that there was very little difference between
the labour times of 30 year olds and 40 year olds, even though many of the 40-year-olds
were first time mothers – (who had 2-3 hour labours). Outcomes for mothers receiving
reflexology in the study the normal Deliveries percentage is 89.0.11
A study was done to assess the right time to start the reflexology in pregnancy.
Despite the fact that we have found Reflexology to be safe during pregnancy,
11
occasionally there have been reports that Midwives have told expectant mothers not to
have reflexology during pregnancy as it might provoke miscarriage or bring on early
labour. Dr Laurence Wood, Obstetric Consultant at Walsgrave Hospital, Coventry asked
us to research this. Dr Motha then presented our findings at the “Clinical Governance in
Maternity Services Meeting's at the Royal College of Obstetrics and Gynaecologists on
16th November 2001. For this study we established the gestation of the baby born to all
mothers (who we were able to contact) who had had any reflexology in pregnancy with a
Jeyarani practitioner between the years of 1997 and 2001. As can be seen from the graph
below the majority (45.5%) of babies were born at 40 weeks gestation. Only 1.7% of
babies were born at 36 weeks, these babies were twins.13
A study was done to examine the effects of complementary and alternative
therapies for pain management in labour on maternal and perinatal morbidity. The study
shows that the fourteen trials were included in the review with data reporting on 1537
women using different modalities of pain management; 1448 women were included in the
meta-analysis. Three trials involved reflexology (n = 496), one audio-analgesia (n = 24),
two trials acupressure (n = 172), one aromatherapy (n = 22), five trials hypnosis (n =
729), one trial of massage (n = 60), and relaxation (n = 34). The trials of acupuncture
showed a decreased need for pain relief (relative risk (RR) 0.70, 95% confidence interval
(CI) 0.49 to 1.00, two trials 288 women). Women taught self-hypnosis had decreased
requirements for pharmacological analgesia (RR 0.53, 95% CI 0.36 to 0.79, five trials
749 women) including epidural analgesia (RR 0.30, 95% CI 0.22 to 0.40) and were more
satisfied with their pain management in labour compared with controls (RR 2.33, 95% CI
1.15 to 4.71, one trial). No differences were seen for women receiving aromatherapy, or
12
audio analgesia. The study result concluded that Reflexology and hypnosis may be
beneficial for the management of pain during labour.13
Complementary therapies have been a part of nursing practice for centuries and
are supported today as a part of nursing practice by many state boards of nursing. Some
of these modalities can be used by nurses as a part of their comprehensive plan of labor
support for women during the childbirth experience.
6.2. REVIEW OF LITERATURE
Review of literature is a broad comprehensive in depth systematic and critical
review of scholarly publication, unpublished scholarly print materials, audio visual
material and personal communications. 12
A study was done to explore the prevalence and motivation for use of
complementary and alternative medicine by pregnant women. The study result shows that
although the estimates vary widely from 1% to 87%, the general trend indicates that a
significant number of pregnant women use complementary and alternative medicine.
Common modalities used include massage, vitamin and mineral supplements, herbal
medicine, relaxation therapies and aromatherapy. Reasons for use are varied and include
the belief that these therapies offer safe alternatives to pharmaceuticals, they allow
greater choice and control over the childbearing experiences, and they are congruent with
their holistic health beliefs. The influence of traditional cultural practices on the use of
these therapies is unclear. Most expectant women rely on advice from family and friends,
and many do not disclose their use to their pregnancy care providers. The study result
concluded that many women use complementary and alternative medicine when they are
13
pregnant. Further research is needed to gain a greater understanding of the true
prevalence and expectant women's motivation for the use of complementary and
alternative medicine. Health-care professionals are encouraged to ask women about their
use of these treatments and seek out relevant information. The use of complementary and
alternative medicine (CAM) has become increasingly prevalent in industrialized
countries, with women being the most prolific users. Some women continue to consume
these therapies when they become pregnant.14
A study at the Gentofte Hospital in Copenhagen revealed that reflexology is
beneficial to women during the labour of childbirth. 58 out of 60 women giving birth
experienced "outstanding pain relief using reflexology treatment", and 11 out of 14
women were able to avoid surgery under general anaesthesia. Dr Carsten Lenstrup was so
impressed by the results that he said:"Taken as a whole, the results are so good that am
not in any doubt that reflexology can give many women a better, easier and less painful
delivery than they would have had otherwise." The findings of the Gentofte study were
supported by a further study carried out by Dr Gowri Motva at the Jeyrani Birth Centre
on the effects of reflexology on pregnant women. 37 pregnant women completed a course
of 10 reflexology treatments with remarkable effect. The average length of the first stage
of labour was 5 hours whereas the text book average is 16 - 24 hours; the second stage of
labour lasted an average of 16 minutes compared to the text book expectancy of 1 - 2
hours, and only 5.4% of the women who had reflexology treatment required emergency
caesarian section compared to an average of 13% in Newham district which was the
district where the study was conducted.15
14
A study was done to examine the scientific evidence for the use of
complementary and alternative medicine to stimulate labour. Induction of labour is a
common obstetric procedure. Some women are likely to turn to complementary and
alternative medicine in order to avoid medical intervention. Most complementary and
alternative medicines used for induction of labour are recommended on the basis of
traditional knowledge, rather than scientific research. Currently, the clinical evidence is
sparse and it is not possible to make firm conclusions regarding the effectiveness of these
therapies. There is however some data to support the use of reflexology and breast
stimulation for induction of labour. Acupuncture and raspberry leaf may also be
beneficial. Castor oil and evening primrose oil might not be effective and possibly
increase the incidence of complications. There is no evidence from clinical trails to
support homeopathy however, some women have found these remedies helpful. Blue
cohosh may be harmful during pregnancy and should not be recommended for induction.
Other complementary and alternative medicine (CAM) therapies may be useful but
further investigation is needed. The study result concluded that more research is needed
to establish the safety and efficacy of CAM modalities. Midwives should develop a good
understanding of these therapies, including both the benefits and risks, so they can assist
women to make appropriate decisions.16
A quasi-experimental study was done to review the effect of reflexology on the
pain and outcomes of the labor. In this quasi-experimental study, 88 primiparous mothers
referred to selected hospitals. The intervention was general and specific reflexology in
the active phase of labor. PRI was assessed before the intervention and four times after
the intervention (3-5 cm, 6-8 cm and 9-10 cm dilatations and second stage of labor. The
15
study result shows that the reflexology group, there was a significant difference between
the PRI before and after the 4 stages intervention (p < 0.001). PRI was different
significantly between studied groups after intervention (p < 0.001). The length of active
phase of labor was different significantly between the two groups; but this difference was
not significant during the second (p = 0.29), and the third (p = 0.27) stages. The
difference between the 1(st) minute and the 5(th) minute Apgar score (p < 0.001) and rate
of hemorrhage between the two groups were different significantly (p = 0.02). The study
result concluded that the Reflexology can lead to decrease in the labor pain. Therefore,
regarding to the safety of this technique, it can be replaced as an alternative for
pharmacological methods. Reflexology is one of the non-pharmacological pain relief
methods, and since it is a non-invasive, inexpensive and applicable technique, it can be
used by a skilled and trained midwife.17
A randomized clinical trial study was done to determine the effect of reflexology
on pain intensity as well as to determine the duration of labor in primiparas. The study
included 120 parturient women with low risk pregnancy into three groups. The first group
received 40 minutes of reflexology at the beginning of active phase (4-5 cm cervical
dilatation). Emotional support was offered for the second group in the same stage of
pregnancy and with the same duration. The third group received only routine care during
labor. Pain severity was evaluated with visual analogue scale (0 to 10 cm). In all groups,
pregnant women were asked to evaluate the severity of pain experienced before and after
intervention and also at cervical dilatations of 6-7 cm and 8-10 cm respectively. Data
were collected through the numerical pain scale. Pain intensity at all the three stages of
cervical dilatation was significantly lower in the reflexology group. During the 4-5 cm
16
dilatation stage, women in the supported group reported less severe pain compared to
those receiving routine care, but no significant differences at the later stages of labor.
This indicates that reflexology could decrease the duration of first, second and third
stages of labor. The study result concluded that reflexology can be useful to decrease the
pain intensity as well as duration of labor. Reflexology is an ancient, mild and noninvasive technique, used widely as one of the non-pharmacological methods for pain
relief.18
The study was to evaluate the effectiveness of non-pharmacological strategies to
relieve pain in parturients in labor. This is a before and after therapeutic intervention
clinical trial, performed at a public maternity in the city of Natal, in the state of Rio
Grande do Norte, Brazil, with 100 parturients applying breathing exercises, muscle
relaxation, lumbosacral massage, and showers. A visual analogue scale was used for data
collection. Most parturients were between 20- and 30-years-old (60%), had incomplete
primary-level education (85%), family income of up to 2 minimum salaries (74%), and
78% had a companion with them at the hospital. Oxytocine was administered in 81% of
cases, but 15% did not receive any medication. A significant difference was observed in
pain relief after using non-pharmacological strategies, showing reduced pain as cervix
dilation increased. It was concluded that the strategies were effective in reducing the
intensity of pain in the studied parturients in labor.19
A study was done to examine the effects of manual healing methods including
massage and reflexology for pain management in labour on maternal and perinatal
morbidity. The study included six trials, with data reporting on five trials and 326 women
17
in the meta-analysis. We found trials for massage only. Less pain during labour was
reported from Reflexology and massage compared with usual care during the first stage
of labour (standardised mean difference (SMD) -0.82, 95% confidence interval (CI) -1.17
to -0.47), four trials, 225 women), and labour pain was reduced in one trial of massage
compared with music (risk ratio (RR) 0.40, 95% CI 0.18 to 0.89, 101 women). One trial
of massage compared with usual care found reduced anxiety during the first stage of
labour (MD -16.27, 95% CI -27.03 to -5.51, 60 women). No trial was assessed as being at
a low risk of bias for all quality domains. The study result concluded that the Reflexology
and Massage may have a role in reducing pain, and improving women's emotional
experience of labour.20
A study was done to investigate the association of antenatal reflexology with
different outcomes in the intranatal period. The key variables of interest were onset of
labour, duration of labour, analgesia used and mode of delivery. The findings showed
there was no significant difference in the onset of labour or duration of labour between
the two groups. The group who had four or more reflexology treatments had a reduced
length of labour but this was not statistically significant. There was a significant
difference in the use of Entonox between the two groups with the reflexology group
having a lower uptake. Fewer women in the reflexology group had a normal labour with a
higher percentage of women having a forceps delivery. In conclusion the only
statistically significant difference between groups was less use of Entonox in the
reflexology group. The integration of reflexology into midwifery care has become more
common in recent years as a result of a developing interest in alternative and
18
complementary therapies and also due to the integration of new skills into midwifery
practice.21
A systematic review of five nonpharmacologic measures and it’s effectiveness to
reduce labor pain. Despite reports that some of these methods reduce pain, increase
maternal satisfaction, and improve other obstetric outcomes. The controlled studies of
nonpharmacologic methods are limited in number and sometimes provide conflicting
results. This systematic review was conducted to assess the safety and efficacy of the best
studied techniques, as well as to highlight areas in need of further research. Five comfort
measures were selected for review, based on these criteria: they have been evaluated with
prospective controlled studies and they require institutional support (eg, skills, policies,
equipment). These 5 methods included continuous labor support, baths, reflexology and
massage, maternal movement and positioning, and intradermal water blocks for back pain
relief. An extensive search of electronic databases and other sources identified studies for
consideration. Critical evaluation of controlled studies of these 5 methods suggests that
all 5 may be effective in reducing labor pain and improving other obstetric outcomes, and
they are safe when used appropriately. Additional well-designed studies are warranted to
further clarify their effect and to evaluate their cost effectiveness.22
19
6.3 STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of Self Instructional Module on knowledge regarding
maternal reflexology in reducing labour pain and labour duration among staff Nurse
working in selected hospital at Bangalore”
6.4 OBJECTIVES OF THE STUDY
The objectives of the study are to

To assess the knowledge of staff nurse regarding maternal reflexology in reducing
labour pain and labour duration

To determine the effectiveness of self instructional module regarding maternal
reflexology in reducing labour pain and labour duration.

To find out the association between the knowledge score of staff nurse and their
selected socio-demographic variables.
6.5 HYPOTHESIS
H1 :
There will be the significant difference in pre test and post test knowledge score
of staff nurse regarding maternal reflexology in reducing labour pain and labour
duration.
H2 :
There will be significant association between the mean post test knowledge score
and their selected socio-demographic variables regarding maternal reflexology in
reducing labour pain and labour duration.
6.6 OPERATIONAL DEFINITION OF TERMS
ASSESSMENT: It is the method of describing or the critical analysis and valuation or
judgment of the status or quality.
20
EFFECTIVENESS: Refers to gained level of knowledge as determined by significant
difference between pre test and post test regarding maternal reflexology in reducing
labour pain and labour duration among staff nurses.
SELF INSTRUCTIONAL MODULE (SIM): If refers to a pre-prepared study
material in english it includes different aspects of maternal reflexology in reducing labour
pain and labour duration.
KNOWLEDGE: It is the ability to understand about the maternal reflexology in
reducing labour pain and labour duration which is gained through experiences or
education.
MATERNAL REFELXOLOGY: Another ancient practice in which pressure is applied
to specific body parts, specifically the soles of the feet, to relax other body parts. During
labour, a reflexologist can help women cope with pain, and speed the process of
childbirth by applying pressure and stroking specific ankle points.
LABOUR PAIN: Labour pain is referred as painful uterine contractions at regular
intervals with increasing intensity and duration during labour process. Pain during labor
is caused by contractions of the muscles of the uterus and by pressure on the cervix.
LABOUR DURATION: It is the length of time the state of labour lasts from 3 cm
dilatation to the delivery of placenta expressed as the number of completed hours.
STAFF NURSE’S: In this the study it refers to registered staff nurses who are working
in maternity settings.
6.7 ASSUMPTIONS
The study is based on the following assumptions.
21
1.
The knowledge of the staff nurse regarding maternal reflexology in reducing
labour pain and labour duration will be assessed by structured knowledge
questionnaires.
2.
The staff nurses will have little knowledge about the maternal reflexology in
reducing labour pain and labour duration.
3.
SIM will provide an opportunity to the staff nurses for their learning and better
understanding regarding maternal reflexology in reducing labour pain and labour
duration.
6.8 DELIMITATIONS
The study is delimited to
1.
The study is delimited to staff nurses working in selected hospital, Bangalore.
2.
The total period of data collection is delimited to 4 weeks.
3.
The sample size is delimited to 60.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Data will be collected from staff nurse working in selected hospital, Bangalore.
7.2 METHOD OF DATA COLLECTION
Research approach
: Pre-experimental
Research design
: One group pre-test/post-test design.
Sampling Technique
: Non-probability convenient Sampling.
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Sample Size
: The sample size was 60.
Setting of the Study
: The study was conducted in the selected maternity
hospital, Bangalore.
7.2.1 SAMPLING CRITERIA
INCLUSION CRITERIA
The study includes staff nurses who are
1.
The working in the selected hospital, Bangalore.
2.
Can understand and communicate in English.
3.
Willing to participate in the study.
4.
Available at the time of data collection.
EXCLUSION CRITERIA.
The study excludes staff nurses who
1.
Are not willing to participate in the study.
2.
Can’t understand English.
3.
Are not present at the time of data collection.
7.2.2 DATA COLLECTION TOOL
The research tool is developed by doing extensive literature review from various
sources. The primary and secondary sources of literature review have aided in developing
the appropriate tool. Expert from the OBG department have given their valuable opinion
and suggestion in developing research tool.
Description of the Tool
23
Section – A
:
Demographic Data
Section – B
:
Questionnaires to assess the knowledge of the participants
Section-A
:
Section A consists of demographic data such as Age, Sex,
Educational status, Experience and source of information.
Section-B
:
Section B consists of 30 questionnaire to assess the
knowledge of staff nurse regarding maternal reflexology in
reducing labour pain and labour duration.
Scoring Procedure of Knowledge
The scoring of the knowledge question is given in such a way that each right
response is awarded 1 mark. There is no negative mark for negative response. The
maximum possible score is “30” and minimum is “0”.
Interpretation of Score:
To interpret level of knowledge the scores were distributed as follows.
1. Inadequate knowledge
<50%
2. Moderate knowledge
51-75%
3. Adequate knowledge
>75%
7.2.3 DATA ANALYSIS METHOD.
Data analysis will be done by using descriptive and inferential statistics.
Frequency and percentage distribution will be done to analyze demographic variables.
It will also be described descriptively. Mean and standard deviation will be done to
assess the knowledge regarding maternal reflexology in reducing labour pain and
labour duration. A‘t’ test will be done to compare the mean pretest and post test
knowledge scores of
staff nurse regarding knowledge on maternal reflexology in
24
reducing labour pain and labour duration. A Chi square test will be done to determine
association between the mean pretest knowledge scores and selected sociodemographic variables.
7.3. DOES THE STUDY REQUIRES ANY INVESTIGATION OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR
OTHER HUMANS OR ANIMALS
Yes.
The study requires intervention in the form of a SIM only. No other intervention
which causes any physical harm will be done for the subjects.
7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED?
Yes.
A.
Confidentiality and anonymity of subjects will be maintained.
B.
A written permission from institutional authority will be obtained.
C.
A written consent will be obtained from the samples regarding their willingness
to participate in the study.
25
8. LIST OF REFERANCES:
1.
The Columbia Encyclopedia, Sixth Edition. Copyright 2006 Columbia University
Press.
2.
Hodnett, ED. "Pain and women's satisfaction with the experience of childbirth: A
systematic review". American journal of obstetrics and gynecology 186 (5 Suppl
Nature): 2001, S160–72.
3.
Callister, LC; Khalaf, I; Semenic, S; Kartchner, R; Vehvilainen-Julkunen, K.
"The pain of childbirth: perceptions of culturally diverse women". Pain
management nursing : official journal of the American Society of Pain
Management Nurses2003, 4 (4): 145–54.
4.
Weisenberg, M; Caspi, Z (1989). "Cultural and educational influences on pain of
childbirth". Journal of pain and symptom management 4 (1): 13–9.
5.
Weber, SE (1996). "Cultural Aspects of Pain in Childbearing Women". Journal of
obstetric, gynecologic, and neonatal nursing : Jognn / naacog 25 (1): 67–72.
6.
Prasertcharoensuk W, Thinkhamrop J. Non-pharmacologic labour pain relief. J
Med Assoc Thai. 2004 Oct;87 Suppl 3:S203-6.
7.
Smith CA, Collins CT. Complementary and alternative therapies for pain
management in labour. MCN Am J Matern Child Nurs, 2006 Nov-Dec;31(6):36470.
8.
Hall HG, Griffiths DL, McKenna LG. The use of complementary and alternative
medicine by pregnant women: a literature review. Midwifery Journal. 2011
Dec;27(6):817-24.
26
9.
Hall HG, McKenna LG, Griffiths DL. Complementary and alternative medicine
for induction of labour. Women Birth. 2011 Apr 25.
10.
Valiani M, Shiran E. Reviewing the effect of reflexology on the pain and certain
features and outcomes of the labor on the primiparous women. Indian J Nurs
Midwifery Res. 2010 Dec;15(Suppl 1):302-10.
11.
Dolatian1 M, Hasanpour A. The Effect of Reflexology on Pain Intensity and
Duration of Labor on Primiparas. Iran Red Crescent Med J. 2011 Jul;13(7):475479.
12.
Pollit Hungler, “Importance of review of literature, text book of nursing
research”; 2003; page no. 38-40.
13.
Zhang Changlang, “The application of foot reflexology in relieving labour
pains,”China reflexology,Registre des essays on publies en 2000-2001,march 1
14.
Motha G,Mc Grath J,The effect of reflexology on labour outcome.Journal of
association of reflexologists 2003, 3;4:2-4
15.
Barrault,M.E,How
does
reflexology
enrich
nursing?
Krankenptl-soins-
infirmiers,86(7),july 2003, 3,20-24
16.
Dr Gowri Motha and Dr Jane Mc Grath, “The effects of reflexology on labour
outcome,”Forest gate,London,England. Nursing times oct,2008.
17.
Hasanpour A,Heshmat R,Alavi Majd H,and Dolatian M “The effect of
reflexology on pain intensity of labour” 2010 18(72):52-61]
18.
Davim RM, Torres Gde V, Dantas Jda C. Effectiveness of non-pharmacological
strategies in relieving labor pain. Rev Esc Enferm USP. 2009 Jun;43(2):438-45.
27
19.
Smith CA, Levett KM, Collins CT. Massage, reflexology and other manual
methods for pain management in labour. Cochrane Database Syst Rev. 2012 Feb
15;2:CD009290.
20.
McNeill JA, Alderdice FA, McMurray F. A retrospective cohort study exploring
the relationship between antenatal reflexology and intranatal outcomes.
Complement Ther Clin Pract. 2006 May;12(2):119-25.
21.
Simkin PP, O'hara M. Nonpharmacologic relief of pain during labor: systematic
reviews of five methods. Am J Obstet Gynecol. 2002 May;186.
22.
Tiran.D. “The use of complementary therapies in midwifery practice, a focus in
reflexology, 2:32-37
28
9
SIGNATURE OF
CANDIDATE
10
REMARKS OF THE GUIDE
NAME AND DESIGNATION
11
11 .1 GUIDE/HOD
11.2 SIGNATURE
12
12.1 REMARKS BY
PRINCIPAL
12 .2 SIGNATURE
29