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BANGALORE – KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT
FOR DISSERTATION
NAOREM SANGEETA
1St year M.Sc (Nursing)
OBSTETRICS AND GYNAECOLOGICAL
NURSING
YEAR 2009-2010
CAUVERY COLLEGE OF NURSING
# 42/2B, 2C, TERESIAN CIRCLE
SIDDARTHA LAYOUT
MYSORE.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,
BANGALORE- KARNATAKA.
ANNEXURE – 1
PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
1.
NAME AND
ADDRESS OF
THECANDIDATE
MS. NAOREM SANGEETA
I YEAR M. SC. NURSING ,
CAUVERY COLLEGE OF
NURSING , MYSORE.
2.
NAME OF THE
INSTITUTION
CAUVERY COLLEGE OF
NURSING , MYSORE
3.
COURSE OF STUDY
AND SUBJECT
MASTER IN NURSING
OBSTETRIC &
GYNAECOLOGICAL NURSING
4.
DATE OF
ADMISSION TO THE
COURSE
15 - 06 - 2009
5.
TITLE OF THE
STUDY
EFFECTIVENESS OF VEDIO
ASSISSTED TEACHING
REGARDING KNOWLEDGE
ABOUT HOME REMEDIES ON
MINOR AILMENTS AMONG
THE ANTENATAL MOTHERS IN
HANCHAYA PHC AT MYSORE.
5.1
STATEMENT OF
THE PROBLEM
A STUDY TO ASSESS THE
EFFECTIVENESS OF VIDEO
ASSISTED TEACHING
REGARDING KNOWLEDGE
ABOUT HOME REMEDIES ON
MINOR AILMENTS AMONG
THE ANTENATAL MOTHERS IN
HANCHAYA PHC AT MYSORE.
6.BRIEF RESUME OF THE INTENDED WORK
6.1 INTRODUCTION:
Pregnancy is a wonderful time in most women’s life, whether expected or
unexpected there is certain amount of joy that comes out bringing a new life in the
world.1
Every pregnancy is a unique experience for that women and each pregnancy
the women experience will be new and uniquely different. Although such disorder
are often term as minor disorders, they are far from minor for the women who is
experiencing them. This minor disorder if left untreated become medical disorder of
pregnancy for which the women must be referred to the appropriate medical
practitioner. Davis(1996) has stated that the majority of the discomforts experience
during pregnancy can be related to either hormonal changes or the physical changes
related to the growing uterus.2
The minor problems problems which are related to pregnancy can cause lot of
discomfort and interfere with the nutrition of the pregnant women.3
The maternal mortality ratio or MMR is a major risk of the health once the
women become pregnant; more than 80% of maternal deaths world wide due to
haemorrhage (34%), and infection(21%). Every 5minutes a women dies from
complications related to pregnancy; 50% within 24hours of child birth; 20% within 7
days of delivery; and 55 from 2 to 6 weeks of child birth. This complication can be
due to neglected minor ailments during pregnancy.4
According to 3 years collaborative studies estimating maternal mortality rate
from 41 hospitals affiliated with teaching centers in India, maternal mortality was 721
per 100,000 live births, India has 1 out of 4 of the world’s maternal death or 1 every 6
minutes. Risk is low in Kerala compared to Uttar Pradesh or Madhya Pradesh.
Societal factors such as illiteracy and malnutrition, poorly supervised pregnancies, are
other determinant of mortality and morbidity.5
As the adage goes, “An ounce of prevention is worth a pound of care”. That is
the same of pregnancy if not more important. Prevention comes in many shapes and
sizes. The best thing is to eat a well balance diet, drink plenty of fluids, salt the food
to taste and get regular exercise. These help the pregnant body fend of viruses’ and
maintain order.6
Some of the common ailment which most of the women are facing can be
include, morning sickness, heart burn, constipation, pica, leg cramp, rhinitis,
backache, pelvic pain and skin changes.
Regular exercise can strengthen muscles, gives more energy and help to feel
better, as well as reduce most of the minor ailments. It also help to sleep better at
night. Generally, low impact aerobic or strength-training work out are best for getting
heart pumping and blood flowing.7
Many of these minor ailments will get worse if not treated earlier. The
midwife has a very important role to play in triaging patients, educating patients and
managing minor conditions, therefore preventing many hospital admissions.
Treatment must be individualized and serious conditions must be excluded and
referred without delay.8
6.2 NEED FOR THE STUDY:
According to census 1991, adolescent girls constitute 20.7% of total female
population in India. More than 31% of women aged 15 - 19year are married. The
married adolescent girls are more prone to expose to minor ailments of pregnancy.9
The majority of pregnant women will experience the symptoms of morning
sickness, heart burn, pica, common cold, lower backache, lower abdominal pain,
constipation oedema and various skin changes during the course of their pregnancy.10
Review of pregnancy complication in developing countries observe that
teenage were of increased risk of minor ailments which when complicated may leads
to maternal anemia, pre-term birth and caesarean section delivery.9
Nausea and vomiting are said to be affect over 50% of pregnancies. In this
0.3% - 2% will develop a more serious condition known as hyperemesis
gravidarum.11
The incidence rate of constipation in pregnancy is 11 - 38%. A two centre
study by Anderson(1984) that included pregnant women from Israel and England
demonstrated that 11% and 38% respectively of women in these countries identified
themselves as being constipated. If constipation persists then haemorrhoid may
develop, caused by straining at defecation, which can subsequently cause particular
difficulties during the birth process.2
Gastro esophageal reflux disease is common in pregnancy, affecting 30% 50% of all pregnant patients.12
About 30% of pregnant women experience significant rhinitis symptoms.13
Up until the 1970s, back pain/ discomfort in pregnancy was not investigated. The first
report of estimated incidence of 48% in 1977 is only underlined by the published
increase to 54.8% in 1994. Now this analysis revealed that approximately 50% of
pregnant women experience back pain in world wide14.
In a study by Valbo and Bohmer (1999), 129 pregnant women were sent a
questionnaire to assess the extent to which they had suffered leg cramp during
pregnancy. The results revealed that 45% had suffered leg cramps during pregnancy.2
Fischer-Rasmussen et al conducted a randomized trial of ginger for the
treatment of morning sickness. This study have shown that ginger is effective in
relieving symptoms of nausea and vomiting. After 4days, there was a significant
reduction in both nausea and vomiting in patient receiving 125mg of ginger, 6
hourly.15
Effort must be made to inform all the health professional that home remedies
for minor disorders is effective. Until there are opportunities to obtain quality
antenatal care services and education to the mother about the importance of home
remedies for minor ailments , this service may continue to be regardless by many,
having little values. So proper guideline and knowledge should be given that home
remedies on minor ailments is effective and essential for improving the health free
from side effect by drugs.16
It is she who with her own knowledge and perceptions influence the well
being of herself. Therefore improving mother’s knowledge and modifying her beliefs
regarding home remedies on minor ailments can positively influence the maternal
health. This indicates the need to study the perception of mothers regarding home
remedies on minor ailments of pregnancy.17
Thus most of the minor ailment in pregnancy do not require drug treatment.
The aim of these articles is to provide a simple approach to manage the common
minor ailments of pregnancy.18
6.3 STATEMENT OF THE PROBLEM:
A study to assess the effectiveness of video assisted teaching regarding
knowledge about home remedies on minor ailments among the antenatal mother in
Hanchaya PHC at Mysore.
6.4 OBJECTIVES OF THE STUDY:
1) To assess the knowledge level about home remedies on minor ailments in
experimental and control group.
2) To assess the post-test knowledge level regarding home remedies on minor
ailments in experimental and control group.
3) To compare the post-test knowledge regarding home remedies on minor ailments
in experimental and control group.
4) To associate the level of knowledge in both the group with their demographic
variables.
6.5 HYPOTHESES:
H1: There is a significant increase in level of knowledge on experimental group than
the control group.
H2: There is an association between experimental group and selected demographic
variables than the control group.
6.6 OPERATIONAL DEFINITIONS:
1) Assess - It is a method to evaluate the level of knowledge among the
antenatal mothers regarding home remedies on minor ailments of pregnancy.
2) Knowledge - It refers to the awareness gained by the antenatal mother
regarding home remedies on minor ailments of pregnancy.
3) Effectiveness - The change in the knowledge level of antenatal mothers on
home remedies on minor ailments of pregnancy as a result of video assisted teaching
program which is measured through questionnaire.
4) Antenatal mother - A mother who is pregnant and going to give delivery.
5) Video assisted teaching - It is a systematically organized teaching
regarding home remedies on selected minor ailments of pregnancy to a group of
antenatal mothers on antenatal care for 30-40 minutes by using recorded audio and
video clips through projector.
6) Minor ailment of pregnancy - The minor disorders of pregnancy due to
metabolic and physiologic changes of pregnancy occurring in the first trimester.
6.7 ASSUMPTION:
1) Home remedies prevent the further complications of minor disorders if
practice in early time.
2) Video assisted teaching will enhance each participants for active learning.
3) Knowledge of mother has a strong influence in adaptation of healthy
behaviours.
6.8 DELIMITATION:
1) Study is limited to antenatal mother who are in first trimester.
2) Study is limited to antenatal mother without any complications.
3) Sample size is limited to 60.
4) Prescribed data collection period is 4-6 weeks.
6.9 CONCEPTUAL FRAMEWORK:
Conceptual model of this study is based on Rosenstoct’s Becker and
Mainman’s belief model as cited in Potter and Perry. It was modified to suit the
present study.
6.10 REVIEW OF LITERATURE:
The review of literature is a broad comprehensive, in depth systemic and
critical review of scholarly publication, unpublished scholarly print materials, AV
material and personal communications.
A literature review is a written summary of the existing knowledge on a
research problem. The task of reviewing research literature involve the identification,
selection, critical analysis and written description of existing information.
(Polit and Hugler 2003)
Literature related to home remedies on selected minor ailments of pregnancy.
A study was conducted on urinary in continence and constipation during
pregnancy. A total of 2,062 women (858 primi gravidae, 1,057 multi gravidae (2-4)
and 147 multi gravidae (5+) participated. A questionnaire was administered on the
maternity wards of the Rotunda Hospital, Dublin. Of the total number of women
questioned initially, 59% experienced some degree of leaking the incidence of which
significantly increased with parity(x2=56.26; P=0.0001). The incidence of
incontinence 31% in the multi parous and 11% in precipitous group of the total
women questioned, 355 suffered from constipation, the incidence of which also
significantly increased in parity(x2=6.034, P=0.049).19
A study conducted on interventions for leg cramps in pregnancy in UK. Five
trail involving 352 women were included. The trials were of moderate quality. The
evidence that calcium reduces cramp in weak and seems to depend on placebo effect.
The evidence for sodium chloride is stronger. If a women fine cramp troublesome in
pregnancy, the best evidence is magnesium lactate(or) citrate taken as 5mmol in
morning and evening.20
A study conducted to assess the safety and efficacy of a novel reflux
suppressant in the treatment of heart burn during pregnancy. In university of Hull,
UK, the study was an open label multi centre phase IV study in general practice and
antenatal clinic in UK. Pregnant women aged 18-40 years suffering from heart burn
instructed to take gaviscon 5-10 ml, after 4 weeks 88%- 90% of women
reported(57%n=83) symptom relief within 10 minutes.21
A study was done to assess the effectiveness of ginger in relieving the
symptom of nausea and vomiting in pregnancy. The result compared with placebo
ginger group had significantly lower nausea score on day 3(P=.031) and day 4(P=.05)
and for the entire treatment period(P=.014). The number of vomiting episodes
decreased significantly over the 4day treatment period of ginger group compared with
the placebo group(P<.001). The study conclude that ginger is effective in relieving
morning sickness,22
A study conducted pica behaviour concluded that, the prevalence of pica
during pregnancy was 44%(n=33) in the Ensenada group and 31%(n=46) in Southern
California. The high reported rate of pica in this sample indicates that pregnant
Maxican born women should be screened for pica and educated about the potentially
serious effects on fetus and mother.23
A prospective study was conducted to assess the minor disorders of pregnancy
in India. Antenatal mothers were suffered from non-pathological nausea, vomiting,
anemia, pyuria and frequency of micturation, restless leg and leg cramps at night,
abdominal pain and heart burn etc. The study was concluded that, this can be
managed effectively by regular treatment with home remedies, rather than
symptomatic .24
A study was conducted to assess the drug intake regarding minor ailments
like headache, fever and backache. The study was done in southern Indian Hospital.
The awareness of the inherent risks attached to medication use during pregnancy is
increasing. The result shows that the drug used by the mother are analgesics 9%, anti
inflammatory agents49%, and anti biotics 38%. The majority of the women were
unaware of the potential side effects of medication during breast feeding. Thus the
study conclude that home remedies have minimal side effect compared to medical
treatment.25
A comparative study was conducted regarding dietary factors in the aetiology
and treatment of constipation during pregnancy in India. Using a 7 days weighed
intake method a comparison between 9 women who had constipation in 3rd trimester
not altered their diet, 9 women who had not suffered constipation at any time during
the pregnancy. In the result both were well below the level of dietary fibre intake
known to be successful in treating constipation.26
A study stated that there was a statistically significant increased in magnesium
excretion in magnesium treatment group(P<0.01). Thus no significant effect on
intensity of leg cramps in pregnant women treatment with 360mg daily could be
detected in this trial.27
A study investigated the effect of exercise on low back pain by randomly
assigning pregnant women(N=212) to a supervised exercise programme 3times per
week(or)control group. The exercise group reported reduced back pain intensity and
greater flexibility of the spine relative to the control group.28
A study was conducted in selected prenatal care clinic of Isfahan City hospital
on the effect of ginger on reducing morning sickness. The ginger users demonstrated
a higher rate of improvement than the placebo user did(85% versus 50%; P,0.01). The
decrease in vomiting time among ginger user was also significantly greater than
among the women who receive placebo(50%versus9%;P,0.05).29
In rural area women are able to understand the causes of diseases, do
symptomatic diagnosis of common ailments, and treat minor ailments after attending
teaching programme in PHC. In the survey, 84% women said that they gained
knowledge regarding antenatal care and nutrition. So it appears that the community
has accepted the referral services provided by government and ready utilize the
services.30
7. MATERIALS AND METHODS OF STUDY
7.1 SIGNIFICANCE OF THE STUDY:
The study implies the importance of increasing the knowledge regarding the
home remedies on minor ailment for the ante-natal mother in Hanchaya PHC at
Mysore.
7.2 SOURCE OF DATA COLLECTION:
The data will be collected from the antenatal mothers who are attending the
PHC.
7.3 RESEARCH DESIGN:
Quasi-experimental design. Two group pre and post-test design, with manipulation,
control group and no randomnization.
Group
Pre-test
Intervention
Post-test
Experimental
O1
X
O2
O1
-
O2
group
Control group
Key:O1- Pre-test on ante-natal mother on knowledge regarding home remedies on
minor ailment of pregnancy.
X- Video assisted teaching regarding home remedies on minor ailment of
pregnancy.
O2- Post-test of ante-natal mother on knowledge regarding home remedies on
minor ailment of pregnancy.
7.4 METHOD OF DATA COLLECTION:
Data will be collected obtaining consent from the subject and authority. The
background information will be collected through socio demographic schedule
and level of knowledge will be assessed by structured Questionaire.
7.5 SAMPLING PROCEDURE:
7.5.1 SELECTION OF SAMPLING CRITERIA:
INCLUSION CRITERIA
1) Ante-natal mothers, those who are willing to participate and available
during the time of study.
2) Can understand Kannada.
3) Ante-natal mothers those who are attending PHC.
EXCLUSION CRITERIA
1) Ante-natal mothers with complications.
2) Ante-natal mothers who are beyond 1st trimester.
7.5.2 POPULATION
Ante-natal mothers who are attending PHC.
7.5.3 SAMPLES
Ante-natal mothers who fulfilled the inclusion and exclusion criteria.
7.5.4 SAMPLE SIZE
Sample size for the study is 60. 30 experimental 30 control groups
7.5.5 SAMPLE TECNIQUE
Non-probability convenient sampling technique.
7.5.6 SETTING
The present study will be conducted in Hanchaya PHC.
7.5.7 PILOT STUDY
10% of the population is select for the pilot study.
7.6 VARIABLE:
Independent Variables - Video assisted teaching about home remedies
on minor ailments among the anti-natal mothers.
Dependent Variables - Knowledge about home remedies on minor
ailment among the ante-natal mothers.
7.7 PLAN FOR DATA ANALYSIS:
DESCRIPTIVE STATISTICS
The descriptive statistical analysis includes percentage, frequency,
mean, median and standard deviation for the ante-natal mothers who are
attending PHC.
INFERENTIAL STATISTICS
Pre-test and post-test differences will be analyzed using student paired t-test.
Difference between experimental and control group will be analyzed
using student dependent t-test
Association between level of knowledge and demographic variables will
be analyzed using pearson Chi-square test.
7.8 PROJECTED OUTCOME:
The study result will reveal the knowledge of ante-natal mothers regarding
home remedies. After post-test the investigator is going to provide phamplets on
application of home remedies for minor disorders of pregnancy, through which the
samples are going to learn the usage.
7.9 ETHICAL CONSIDERATIONS:
1) Does the study require any interventions to be conducted on ante-natal mother who
are attending PHC?
YES… The study require interventions.
2) Has ethical clearance being obtained from your institution?
YES… Ethical information has been obtained from the institution.
3) Has the consent being taken from the PHC?
YES… Consent has been taken from the PHC.
8. LIST OF REFERRENCE:
1. www.megavista-health.com treatment for nausea and vomiting in pregnancy
2. Myles.Text Book for Midwives.14 Edition,Churchill Livingstone,London; 217221.
3. C Rajeshwari. treatment for minor ailment of pregnancy. Nightingle Nursing Times
Feb2.11. 2006. 38
4. http://www.flonnet.com/f12209/stories/2005.
5. Rao KB.How safe motherhood in India is.J Indian Med Assoc.1995 Feb;93(2):412.
6. Robin Elise Weiss. Natural Remedies During Pregnancy FAQ, 1994-98
7. Walker. Lorraine.o.Managing Excessive weight gain during pregnancy.Journal of
Obstetric.gynecologic and neonatal nursing.36(5).490-500.September/October 2007.
8. Conover E A. Over-the-counter products: Non prescription medications.
Neutraceuticals and herbal agents. Clinical Obstetrics and Gynaecology 2
02. 45; 1: 89 – 98.
9. http// Medind. Nic. In/ibl/to3;1p240.PDF, pregnancy in adolescent a Community
Base study.
10. Biko J.MB, Bch, Mmed, O&G, FCOG. Gynaecologist. Pretoria University and
Kalafong Hospital. Professional Nursing Today. March / April 2007. 11; 2: 16
11. Jewell. DJ. Young. G. Interventions for treating constipation in pregnancy. Rov.
2001. CDooll42[Medline].
12. Richter J E. Gastro-oesophageal reflux disease in pregnancy. Gastroenterol
clinicNorth Am. 32: 235-261.
13. Talati AJ. Salim MA and Koroness SB. Persistent pulmonary hypertension after
maternal Naproxen ingestion in a term newborn: a case report.
American J Perinatol 2000; 17: 69 – 71
14. Connie. J. Green wood, RN, CM, M Mid &M Colleen Stainton, RN DNSC, Back
pain/ Discomfort in pregnancy: Invisible& Forgotten, A Lamaze International
publication 2001.
15. Fischer-Rasmussen W. Kjaer SK. Dahl C et al: Ginger treatment of hyperemesis
gravidarum. European J obstetr and gynecol Reprod Biol. 1990; 38:19.
16. www.save the children org.
17. Inge Hutter. Tropical Medicine and International Health vol 1 Issue3. Page 399405
18. Sannerstedt R, Lundborg P, Danielsson BR et al. Drugs during pregnancy: An
issue of classification and information to prescribers. Drug saf 1996. 14; 2: 69 – 77.
19. Lingkinghub.Elsevier.com/retrieve/piig/soo31940605669593 by K. Marshall1996 cited by 9.
20. [email protected]:11869565[pubmed-index for medline]
21. Lindow sw. Regnellp. Littles. multicoated study to assess the safety and efficacy
of a noveal reflux suppressant treatment of heart burn during pregnancy,
PMID:12723718[pubmed-index from medline].
22. Jellin JM. Gregory P. Batz F. Hitchens K. Ginger monograph. In: Jellin JM.
Gregory P. Batz F. Hitchens K. eds. Natural medicines comprehensive database.
Stockton. Calif: Therapeutic Research Faculty; 2000:475-77.
23. Ellen Simpson. “Pica during Pregnancy htm”. west J med 2000; 173:20-24.
24. Barnie-ad shead AM. Jagger C; study to assess the minor disorder of pregnancy;
Br. J Gen pract 1993. 26 Sep 2006.
25. www.springerlink.com/index/woopo4651231RK5J.polf-1994
26. Jogger CA. a comparative study to assess the dietary factor in the etiology and
treatment of constipation during pregnancy. Elsevier 1996 cited by 9
27. Nygaaed IH. Valbo A. Pethi CK SV. dose oral magnesium substitution relieve
pregnancy-induced leg cramps. hf. Norway.
28. www.madscope.com/viewarticle/5804666 Kubrick et al- 2005 the effect of
exercise during pregnancy on maternal outcomes.
29. Kathy Abascal. Eric Yarnell Clinical Uses of Zingiber officinale (Ginger)
Alternative and Complementary Therapies. Oct 2009, Vol. 15, No. 5: 231-237.
30. Mahtab S Bamji. M Vishnu Vardhan Rao. Devyani Dangoria. Women’s health of
women health and nutrition. www.sero.who.int/in/section1243.
9. SIGNATURE OF THE
CANDIDATE
10. REMARKS OF THE GUIDE
11. NAME AND DESIGNATION OF
(IN BLOCK LETTERS)
11.1 GUIDE
G. AMSAVENI
11.2 SIGNATURE
11.3 CO-GUIDE (IF ANY)
MS KAVIMANI
11.4 SIGNATURE
11.5 HEAD OF THE DEPARTMENT
G. AMSAVENI
11.6 SIGNATURE
12.1 REMARKS OF THE
CHAIRMAN AND PRINCIPAL
12.2 SIGNATURE
RECOMMENDED AND
FORWARDED