“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE AND

PRACTICE REGARDING MANAGEMENT OF MINOR DISORDERS OF PREGNANCY AMONG PRIMIGRAVIDA MOTHERS IN DISTRICT HOPSPITAL TUMKUR”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MAGI THOMASOBSTETRICS AND GYNECOLOGICAL NURSING

Aruna College of NursingRing Road, Maralur,

Tumkur.2009-10

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of The Candidate : MAGI THOMAS

and Address First year M.sc .Nursing

Ring road,Maralur

Tumkur.

2. Name of The Institute : Aruna College Of Nursing

Ring Road, Maralur,

Tumkur-572105

3. Course of Study And Subject : 1ST Year, M.SC Nursing

Obstetrics and Gynecological

Nursing

4. Date of Admission : 10-06-2009

5. Title of The Topic : “A study to assess the effectiveness

of structured teaching programme

on knowledge and practice regarding

management of minor disorders of

pregnancy among primigravida

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mothers in district hospital,

Tumkur.”

6. BRIEF RESUME OF THE INTENDED WORK

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

effective”

“Dr.Lee Jong Wook”

Pregnancy is the vital event in the life of a women, it need special attention

from the time of conception to the postnatal stage, every pregnancy is a unique

experience for that women and each pregnancy the women experience will be new and

adequately different. This is why it is so important that the midwife has knowledge and

understanding of the common disorders of pregnancy in order to advice the women on

strategies that will help her to hope with the condition and minimize the effect she

experiences1.

The prenatal period is a time of physical and psychological preparation of birth

and parent hood. Prenatal health supervision permit the diagnosis and treatment of pre-

existing maternal disorder or disorder that may develop during pregnancy in India most

of the mothers have poor knowledge about antenatal and intranatal care available to them.

Illiteracy, poverty and lack of communication and transportation facility make them

vulnerable to serious consequences, even though they are prominent care providers with

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the family the fundamental right health is denied to them in most part of the world . The

death of the mother increase the risk to the survival of her young child and family can’t

substitute a maternal role.2

Minor disorders are common in pregnant mothers like, nausea, vomiting, back

ache, leg cramps and constipation and also the pregnancy is a period of drastic change in

the women’s body these minor disorders are the signs that the body is naturally preparing

itself for new life.3

Women pregnant for the first time are confronted with symptom that would be

considered abnormal in the non pregnant state, much of the prenatal care requested by

such women is prompted by the need for explanation of the causes of minor disorders and

for advice on ways to relieve the discomfort Nurses can do much to allay a first time

mother’s anxiety about such symptom by telling her about them in advance using

terminology that the woman can understood such women who understood physical

discomforts of pregnancy are less able to become very anxious about their health in

addition to understanding the rationale for treatment promotes their participation in their

care.4

In India the morbidity among women may also increase with the decreasing

consumption of food and increasing work burden, Chezhumen has remarked that

women’s minor disorders ahead with or without medication. Good understanding of both

traditional and modern medical view will go along the way in minimizing the disorders

associated with pregnancy.5

One of the important strategies in the care of pregnant women is impairing

knowledge. It is essential to give advice to specific problem which the women is

experiencing .Minor disorders which are related to pregnancy can cause sleeplessness,

interfere with good nutrition, and results in much discomforts and the response of the

disorders depending upon the severity of symptoms.6

Promoting health behaviors in women and increasing knowledge about

pregnancy and its complication among women, their family are always important they

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become life saving mothers can be encouraged to begin antenatal care early in pregnancy

and should be aware of the available services like Folic acid therapy, and tetanus toxoid.8

6.1 NEED FOR THE STUDY

Problems of pregnancy range from the mildly irritating to life threatening

condition regular antenatal checks beginning early in the pregnancy are undoubtedly

valuable they help to prevent many complication and their ensuring problems, contribute

t timely diagnosis and treatment.1

The practical nurse can play a significant role in the process of providing

patient education during pregnancy. The prenatal patient especially the first time mother,

may have many questions and concerns about this period in her life, much of the

information she may have is probably inaccurate and complete information about self

care concerns, diet need, management of common disorders and the dangers with in the

environment which may effect the health of the unborn infant.7

The goal of the maternity care is a healthy pregnancy with a physically

safe and emotionally satisfying out come for the mother, infant and family. How ever

may maternal adaptations are unfamiliar to pregnant women and their families, helping

the pregnant women to recognize the relationship between her physical status and the

plan for her care, assist her in making decisions and encourages her to participate in her

own care.2

Minor disorders are common during pregnancy may lead to serious

complication like morning sickness that develop into the hyper emesis gravidarum a

condition that begins as a minor disorder and become life threatening abnormality. So

make the mother as alert as possible to any complication and referral is important, For

that she must always educate when the changes of pregnancy are understood and it is

easier to tolerate and avoid unnecessary anxiety.2

4

There is a close relationship between the physical and psychological

reactions to pregnancy although it is a physiological process. It must also be accepted that

some women undergo profound psychological changes during pregnancy. To understand

what is happening during pregnancy is half way towards enjoying a happy successful

pregnancy, but it is important that the husband or family members need to appreciate the

pregnant women. The importance of information is paramount. If the women understand

about her pregnancy and what is happening to her body and mind, she will have more

confident in herself and in her pregnancy.9

The cost of educating management of minor disorders is minimal, and the

results are great. It enhances the mother to progress on health status health education of

management of minor disorders is also with in the scope of nursing practice so it is

mandatory for the mother to gain the knowledge to equip herself to cope with the

experience of pregnancy and also gain specific knowledge, when she presents with a

worrying symptom or discomfort. 6

Health education is one of the helping roles of the nursing care, one of the

first responsibility of personnel involved in the care of the pregnant women is to alert

them on the signs and symptoms that indicate a potential complication of pregnancy.

WHO (1994) reported that antenatal mother need to know why and how report such

warning signs, for the specific problem immediate medical help is required.4

Today nurses and midwives have an important role in health promotion,

being the health care manufactures, the mid wife is passed to a unique function of

identifying and providing high standard of antenatal care that contribute to the

maintenance of good health and minimize the severity of disease one of the factor that

contribute maternal mortality and morbidity is lack of recognition of danger signals by

women.7

The researcher during her clinical experience found that primigravida

mothers had poor knowledge regarding management of minor disorders, personal

interview with the mothers in various hospital found that there was lack of knowledge

5

regarding management of minor disorders of pregnancy so the investigator felt that there

is a need to give sufficient health education regarding management of minor disorders of

pregnancy.

6.2 REVIEW OF LITERATURE

A Review of literature is a body of text that aims to review the critical points of

current knowledge and methodological approaches on a particular topic, the role of the

literature review is to formulate and clarify the research problems, to ascertain what is

already known in relation to problem of interest, for developing a broad conceptual

context, facilitate cumulating of scientific knowledge for interpreting the result of the

study.

Review of literature is the reading and organizing of previously written

materials relevant to specific problem to be investigated frame work and methods

appropriate to perform the study10

A study was conducted to assess the women’s 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 minor

disorders of pregnancy. 11

A study was conducted to assess the practice of pregnant women

regarding directory intake of fibre in Southern Brazil(2009). A cross sectional cohort

study was conducted in eighteen general practices in among 578 pregnant women. The

mean energy intake was 2776 kcal/d. The mean fibre intake is 30.2 g/d, was slightly

above the recommended. Yet 50% of the women failed to meet the recommendation. The

study concluded that practices regarding dietary fibre intake of pregnant women is in

adequate.12

6

A study was conducted to determine the effect of ginger in nausea and

vomiting of pregnancy in Isfahan (2009). It was a single blind clinical trial study. The

subject included sixty seven pregnant women who complained of nausea and vomiting

from Isfahan city hospital. The participants were randomly assigned to two groups an

experimental group and a control group. The experimental group received ginger 250 mg

capsules for four days and the control group received placebo with the same prescription

form. The gingers was demonstrated a high rate of improvement than the placebo users

(85% versus 56% :P<0.01). The result shows that ginger is an effective herbal remedy for

decreasing nausea and vomiting during pregnancy.13

A study was conducted regarding Gastro esophageal reflux disease and

management in advanced pregnancy in Germany (2009). A prospective study was

conducted to determine the prevalence of Gastro esophageal reflux disease, the frequency

and severity of typical gastro esophageal reflux disease symptom,and their impact on

quality of life and therapeutic management in advanced pregnancy. 135 consecutive

pregnant women in the third trimester were included in the study. Result reveals that the

prevalence for gastro esophageal reflux disease in this unselected population was 56.3%.

Among symptom regurgitation was the most frequent with 47.3%, where as heart burn

was graded as the most severe symptom. The impact of Gastro esophageal reflux disease

on the quality of life of the pregnant women was significant (P<0.001). 22.9% of the

gastro esophageal reflux disease population required medication. It shows that, gastro

esophageal reflux is common in late pregnancy with an important negative impact on the

quality of life. Gastro esophageal reflux disease in advance pregnancy requires more

attention and better therapeutic management. 14

A study was conducted to determine whether decreasing iron exposure can

mitigate nausea and vomiting symptom in pregnancy in Tornato (2009). Data collected

from a prospective cohort at the mother sick programme in Tornato, 97 women seeking

advice on managing severe nausea and vomiting were advised to discontinue prenatal

multivitamin administration and switch to folic acid. Two thirds (63 out of 97)(P<0.001)

of those women qualitatively reported an improvement in nausea and vomiting symptom

after discontinuation of iron-containing prenatal multivitamins. These data suggest that

7

avoiding iron-containing prenatal multivitamins in the first trimester is effective in

improving morning sickness. 15

A study was conducted to explore knowledge of primigravida mothers

regarding minor disorders of pregnancy and obstetric complication in pregnancy in an

urban health centre in Malawi (2007). A descriptive study was conducted participants

were selected by means of purposive sampling, 45 primigravida from the urban settings

were interviewed. The findings showed that 60% of the participants were knowledgeable

about minor disorders and obstetrics complication in pregnancy, but participants had

limited knowledge of complication that may need immediate treatment during pregnancy.

The findings suggest there is a critical need for giving sufficient information to the

mothers, regarding obstetric complication and minor disorders.16

A study was conducted to assess the effect of treatment to relieve the

symptom associated with varicosity in pregnancy and to reduce leg edema in South

Africa (2006). Four trails of three different treatments were included. In one trail, women

give rutoside capsules in the last 3 months of pregnancy noted an improvement in

symptoms compared with placebo (relative risk 0.54%, 95%, CI 0.32, 0.89). In other trail

women were treated with external pneumatic intermittent compression for 30 minutes to

reduce leg edema in another trail compression stocking prophylatically reduced the

emergencies of leg symptoms (relative risk 0.74 95% CI 0.59, 0.93). Thus the result

shows rutosides appear to relieve symptoms of venous insufficiency in late pregnancy,

external pneumatic compression appears to reduce ankle swelling and compression

stocking reduce leg symptoms. 17

A study was conducted to assess the preventive intervention and treatment

for back pain in pregnancy (2001), randomized trials of any treatment to reduce the

incidence and severity of back pain in pregnancy was selected. Trail quality was assessed

and data were extracted independently by two reviewers. On trails of 109 women was

included. This cross over trail compared the use of a special shaped pillow to fit under the

women’s abdomen (ozzlo pillow) with a standard pillow, women experienced less pain in

the week when they used the ozzlo pillow than in the week with the standard pillow (odds

8

ratio 0.32%, 9.5% confidence interval 0.18 to 0.58 ). This shows that specially shaped

pillow appear to help reduce back pain in late pregnancy and improve sleep.18

A study was conducted to assess the effect of different methods for

treating consumption in pregnancy in United Kingdom (2000). Randomized trail of any

treatment for constipation in pregnancy was selected. Trail quality assessment and data

extraction were done independently by two reviewers one trial of 40 women was

included fibre supplements increased the frequency of defecation (odds ratio 0.18, 95%

confidence interval 0.05 to 0.67) and lead to suffer stools. Thus the dietary supplements

of fibre in the form of bran or wheat fibre are likely to help women experiencing

constipation in pregnancy.19

6.3 STATEMENT OF PROBLEM

9

“A study to assess the effectiveness of structured teaching programme on

knowledge and practice regarding management of minor disorders of pregnancy

among primigravida mothers in District Hospital Tumkur.”

6.4 OBJECTIVES OF THE STUDY

To assess the knowledge of primigravida mothers regarding

management of minor disorders of pregnancy.

To identify the practice of primigravida mothers regarding management of

minor disorders of pregnancy.

To educate the primigravida mothers with a structured teaching

programme regarding management of minor disorders of pregnancy.

To evaluate the effectiveness of structured teaching programme regarding

management of minor disorders of pregnancy among primigravida

mothers.

To associate the knowledge and practice of prmigravida mothers regarding

management of minor disorders of pregnancy with selected demographic

variables.

6.5 OPERATIONAL DEFINITIONS

10

Assess : It is the organized and continous process of

collecting data.

Effectiveness : it refers to the extent to which the structured

Teaching programme on management of

Minor disorders of pregnancy has achieved

the desired effect in improving the

knowledge, changing practice of primigravida

mothers ,evident from gain in knowledge

score and change in practice score .

Structured teaching : it refers to the Systematically developed

Programme information designed to teach the primigravida

mothers regarding management of minor

disorders of pregnancy.

Knowledge : It denotes the awareness or

information that the

primigravida mothers posses regarding

management of minor disorders of pregnancy .

11

Practice : It refers to the actual activities done by the

primigravida mothers .

Management : Measures taken to relieve the minor disorders of

Pregnancy.

Minor Disorders : The anatomical and physiological changes in

Pregnancy which disturb the normal functioning

of the body is called as minor diorders of .

pregnancy.

Pregnancy : The condition from conception to the expulsion

Of the fetus.

Primigravida : A women who is pregnant for the first time.

Mothers

6.6 ASSUMPTION

Primigravida mothers may have some knowledge regarding management

of minor disorders of pregnancy.

Structured teaching programme will help to improve the knowledge and

practice of Primigravida mothers regarding management of minor

disorders of pregnancy .

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6.7 HYPOTHESIS

H1 : There will be significant difference between pre-test and post test

knowledge of primigravida mothers regarding management of

minor disorders of pregnancy after implementation of structured

teaching programme.

H2 : There will be significant relationship between structured

teaching programme and change in knowledge and practice

of management of minor disorders of pregnancy among

Primigravida mothers.

H3 : There will be significant association between the knowledge

and practice with the selected demographic variables of

Primigravida mothers.

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7. MATERIALS AND METHODS

The purpose of this study is to determine the effectiveness of structured

teaching programme on knowledge and practice regarding management of minor

disorders of pregnancy among primigravida mothers in district hospital Tumkur.

7.1 SOURCES OF DATA

Research approach : pre experimental approach is used for

study

Research design : one group pretest and post test

Pre experimental Design.

Setting of the study : District Hospital Tumkur

Sample Size : 60 Subjects

Sampling technique : Simple Random Sampling

Selected Variables

Independent Variable : structured teaching programme

Dependent Variable : Knowledge and practice of primigravida

mothers with selected demographic

variables such as age, Sex, Education,

Religion.

Sampling Criteria

Inclusion Criteria : Mother who were pregnant for the first time : Mother who are willing to participate in

the study.

: Mother who can understand English and

Kannada.

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Exclusion Criteria : Mothers who are multigravida.

: Mother who are not available at the time

of data collection .

7.2 METHOD OF DATA COLLECTION

Tool for data collection : Structured Questionnaire

Tool 1

Part A : Porforma for collecting demographic Data

Part B : Structured Questionnaire to assess

knowledge and Practice on Management

of minor disorders of pregnancy

Tool 2 : Structured teaching Programme regarding

Management of minor disorders of

Pregnancy.

Method of data analysis. : Data will be analyzed according to the

and interpretation objectives of the study and by using

appropriate statistical techniques

and will be present in the form of tables,

graphs and diagrams.

Duration of the study : 6 weeks

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7.3 :Does the study the require any investigation or intervention to be conducted

on the patient or human beings or animal? so please describe briefly

No

7.4 : Has ethical clearance been obtained from your institution?

Yes, Ethical clearance been obtained from the institutions ethical committee

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8.LIST OF REFERENCES

1. Myles. Textbook For midwives.14th edition .London ;Churchill Livingstone P.13,217.

2. B.T Basavantappa .Midwifery And Reproductive Health Nursing. Ist edition.Jaypee

brothers; P. 171,232,254.

3. Richard Sea. Problem Pregnancies; health action September 1993.

4. Bobak and Jenson.Maternity And Gynecologic Care. 5th edition. 1993. p.118,120-122.

5. Francis C.M . Antenatal care ,The Guide line of health worker and Expectant

mothers; Health action 1994, 13-17.

6. Katharine, A May, Lavrar, Mahimeister. Maternal And Neonatal Nursing. 3rd edition.

p. 270-1994.

7. Women’s health Care Topics: http://www.womenshealthcaretopic.com .

8. Message from the Director General of WHO ,Health Action 1998 ,71(4): 41.

9. Markatz .Thomson and Kesingston. Prenatal care. Journal of obstetric Gynecologic

and neonatal Nursing, 1993 June; 22(3): 242.

10. Polit D.F and B.F Hungler .Text book of Nursing Research Principles and

methods ,Lipping Cott Publication, p:57.

11. Pembe A.B ,Urassa D.P ,Carlsted .A . Women’s awareness of Minor Disorders and

obstetric complication. BMC Pregnancy child birth, 2009; 9-12.

12. Bussc, Nunes MA, Cameys, Manzolli P. Dietary Fibre Intake of the Pregnant Women

,Public health Nutr .2009 Sep. 12(9) : 1392-8.

13. Ozgoli G, Goli m, Simbar M. Effects of Ginger capsules on pregnancy nausea and

vomiting, J.Altern.complement Med 2009 mar; 15(3): 243-6.

17

14. Fill Malfertheiners, Monice Muller K, Rohi FW . Gastro Esophageal Reflux disease

and management in advanced pregnancy .Digestion, 2009; 79(2):115-20.

15. Gill SK Maltepc, Koren G. The Effectivness of Discontinuing iron Containing

prenatal multivitamins on reducing the severity of nausea and vomiting of Pregnancy.

J.obstet Gynaecol, 2009 Jan; 29(1):13-6.

16. Kumbani LC, Mclnerney. Knowledge of minor disorder and Obstetric complication

among primigravida. Curations, 2007 August ; 29(3) :41-93.

17. Bamigboy. AA, Hotmegr G.J . Intervention for leg oedema and varicosities in

pregnancy ,European Journal of obstetrics and Gyneacology ,2006 November 129 (1)

: 3-8.

18. Young G, Jewell D. Intervention for preventing and treating back ache in pregnancy,

Cochrane data base systematic review ,2001 April; (2).

19. Jewell D, Young G. Intervention for treating constipation in pregnancy ,2000 January

; (2).

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9. Signature of the Candidates :

10. Remarks of the Guide

11. Name of the Designation Of :

11.1. Guide :

11.2. Signature :

11.3. Co-Guide(if Any) :

11.4. Signature :

11.5. Head of Department :

11.6. Signature :

12.

12.1. Remarks of the Principal :

12.2. Signature :

19

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