Proforma for Registration of Subject for Dissertation s2

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

DISSERTATION PROPOSAL

“A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING

KNOWLEDGE ON UTERINE PROLAPSE AMONG

MULTIPAROUS WOMEN IN SELECTED RURAL AREA,

TUMKUR”.

SUBMITTED BY :- Miss. SANTY JOHN I YEAR M.Sc (NURSING) OBSTERICS AND GYNAECOLOGICAL NURSING SHRIDEVI COLLEGE OF NURSING SIRA ROAD, LINGAPURA , TUMKUR- 572106. 2007 - 2008 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA ANNEXURE II

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE : MISS. SANTY JOHN I YEAR M.Sc NURSING, SHRIDEVI COLLEGE OF NURSING, LINGAPURA, SIRA ROAD, TUMKUR.

2. NAME OF THE INSTITUTION : SHRIDEVI COLLEGE OF NURSING

3. COURSE OF STUDY AND SUBJECT : I YEAR M.Sc NURSING, OBSTETRICS AND GYNAECOLOGICAL NURSING 4. DATE OF ADMISSION TO COURSE : 22-05-2007

5. TITILE OF THE TOPIC : “ A STUDY TO ASSESS THE EFFCETIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING KNOWLEDGE ON UTERINE PROLAPSE AMONG MULTIPAROUS WOMAN IN SELECTED RURAL AREA, TUMKUR.”

INTRODUCTION :

The reproductive system is inter-related with other systems including the neurologic, endocrine and urinary system and also with general physiologic function. The reproductive system is also directly related to sexual function and is therefore, intricately interwoven into the complex, sensitive and frequently stress-laden area of psychosocial mores and cultural values regarding sex 1.

Some problems related to “related” pelvic muscles like cystocele, rectocele and uterine prolapse may be prevented. During pregnancy early visit to the health care provider permit early detection of potential problems. During the post partum period, the women can be taught to perform kegel exercises to strengthen the muscles that support the uterus 2.

Delays in obtaining evaluation and treatment may result in complications such as Infection, cervical ulceration, cystitis and hemorrhoids. The nurse, therefore, encourages the patient to obtain prompt treatment for these structural disorders 2.

Uterine prolapse is falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal.

Better than treatment, is prevention, particularly through proper education and improved obstetric care. The nurse can assist in preventing uterine prolapse by (a) encouraging pregnant to seek qualified obstetric care. (b) teaching patients after delivery to alternatively tense and relax their gluteal muscles and the muscles of the pelvic floor. In some instances prolapse is treated with pessaries. The third method of treatment is surgical 3.

The nurses has a responsibility to assist in the general health education to refer patients for appropriate health care and to understand the treatment available as the nursing care needed when disease develops 1. The women especially multiparous, who is more prone for uterine prolapse should have an idea regarding uterine prolapse for its prevention, early detection and specific treatment modalities to improve their reproductive health status.

6.1 NEED FOR THE STUDY :

The significance of uterine prolapse as a women’s health care issue can be guided by the fact that it was the 3rd most frequently reported case for hysterectomy in the United states from 1993-1998, accounting for 548 657 during the same time 4. It is estimated that the life time risk of requiring atleast one operation to correct incontinence or prolapse is approximately 11% 5.

A study conducted regarding the prevalence of uterine prolapse proved that the uterine prolapse rate is 15/1000 women/years 6. In another study state that uterine prolapse was the most common reason for hysterectomy in women older than 55 years in a second large scale survey 7.

Pelvic floor defects are created as a result of childbirth and are caused by the stretching and tearing of the endopelvic fascia and the levator muscles and perineal body. Partial pudendal and perineal neuropathies are also associated with labor. Impaired nerve transmission to the muscles of the pelvic floor may predispose them to decreased tone, leading to further sagging and stretching. Therefore, multiparous women are at particular risk for uterine prolapse 8.

Genital prolapse is one of the commonest reproductive morbidity in developing country. Common predisposing factors are multiparity, early post partum sternous activity, advanced age and menopause 9.

Thus overall aim of this study to provide information about uterine prolapse and to prevent complications of uterine prolapse, to the multiparous women. 6.2 REVIEW OF LITERATURE :

Review of literature is defined as broad comprehensive in depth systematic and critical review of scholarly publications, unpublished scholarly print materials, audio visual material and personal communication.

The purpose of this study is to identify the effectiveness of structured teaching programme on uterine prolapse among multiparous women through structured questionnaires. Also the purpose of review of literature is to obtain comprehensive knowledge base and indepth of information from previous studies.

1. Rortveit et al (June 2007) conducted a study to estimate the prevalence of and identify risk factors associated with symptomatic pelvic organ prolapse and level of distress in racially diverse women aged older than 40 years. Symptomatic prolapse was reported by 6% women and 35% reported that the symptoms affected at least one physical, social or sexual activity. In multivariable analysis, the risk of prolapse was significantly increased in women with one (2.8, 95% confidence interval) vaginal deliveries compared with nulliparous women. They concluded that symptomatic prolapse is more common among women with a prior vaginal delivery, poor health status, constipation. Nearly one half of women with symptomatic prolapse are substantially bothered by their symptoms 10.

2. Tegerstdt G (January 2006) conducted a study to identify obstetric risk factors for symptomatic prolapse. The study design was a population–base case – control study of prolapse prevalence. In this study the response rate was 76%. Among parous women the odds for symptomatic pelvic organ prolapse increased with number of childbirths and were 3.3 – fold higher among mothers of 4 than among mothers of one. Indices of excessive stretching and tearing during labour were associated with increased risk for symptomatic pelvic organ prolapse 11.

3. Deeb Me et al (November 2003) conducted a study to determine the prevalence of reproduction –related illness in a rural community in Lebanon. A total of 557 ever-married women aged 15-60 years were selected randomly. In result, genital prolapse and gynecological morbidity is more. 49.6% had genital prolapse. It concluded that, the study showed an unexpectedly high prevalence of genital prolapse and obesity a finding that has clear implications for primary health care priorities in such rural communities 12.

4. Deval B et al (September 2002) conducted a study to determine the risk factors for genital prolapse in a group of 37 young women less than 45 years old. The data support the suggestion that multiparity, babies, weight and congenital factors are responsible for a higher rate of genital prolapse in young women 13.

5. Hendrix SL et al (June 2002). The purpose of this study was to describe the prevalence of and correlates for pelvic organ prolapse. In this cross-sectional study they selected 27,342 women and the rate of uterine prolapse was 14.2%. It concluded that, pelvic organ prolapse is a common condition in older women. The risk for prolapse differs between ethnic groups, which suggests that the approaches to risk factor modification and prevention may also differ. These data will help address the gynecologic needs of diverse populations 14.

6. A study conducted that to analyse determinants/risk factors for uterine prolapse in a population of women around menopause. This study increase with the number of vaginal births and was higher in overweight women, offering some quantitative estimates of these factors on the risk of condition 15.

7. Kumari S et al (July-August 2000) conducted a study to estimate the prevalence of self-reported uterine prolapse and to determine the treatment –seeking behaviour of the respondents. A house to house

screening of the women was done by a nursing student utilizing a checklist of indicator symptoms of uterine prolapse. The result showed that the prevalence of prolapse was significantly higher in women with higher parity. More than 7% of the women reported symptoms of uterine prolapse 16.

Statement of the problem :- “ A study to assess the effectiveness of structured teaching programme regarding knowledge on uterine prolapse among multiparous women in selected rural area, Tumkur”.

6.3 OBJECTIVES OF THE STUDY :

6.3.1 To assess the existing knowledge of multiparous women regarding the uterine prolapse. 6.3.2 To administer planned teaching programme on uterine prolapse among multiparous women. 6.3.3 To assess the effectiveness of planned teaching programme on uterine prolapse among multiparous women by comparing pre and post test knowledge. 6.3.4 To findout the association between selected demographic variables with knowledge of multiparous women.

6.4 OPERATIONAL DEFINITIONS :

 Assessment :- Refers to the organized systematic variables process of collecting inform about pretest and post test knowledge from multiparous women regarding the uterine prolapse.

 Effectiveness :- Refers to the extent to which the planned teaching programme on uterine prolapse achieves desired effect in improving the knowledge of multiparous women as evident from gain knowledge scores.

 Structured Teaching Programme :- Refers to the systematically developed institutional method and teaching aids designed for multiparous women to provide information on uterine prolapse.

 Knowledge :- It refers to correct responses of the multiparous women to knowledge items on uterine prolapse as achieved by knowledge scores.

 Uterine Prolapse :- Uterine prolapse is falling or sliding of the uternus from its its position in the pelvic cavity into the vaginal canal which can be diagnosed by gynecology

 Multiparous women :- Women who has delivered 2 or more children.

6.5 HYPOTHESIS OF THE STUDY :

Research Hypothesis H1:- There will be significant difference between the pre and post test knowledge scores of multiparous women regarding uterine prolapse.

6.6 ASSUMPTIONS : Multiparous women may not have adequate knowledge on uterine prolapse. Enhancement of the knowledge regarding uterine prolapse, a way to prevent the uterine prolapse.

6.7 DELIMITATIONS : 1. This study is limited to the multiparous women in selected rural area. 2. Sample size in limited to 50 multiparous women.

6.8 PILOT STUDY : Pilot study will be conducted with 5 samples. The purpose of pilot of study is to find out the feasibility of conducting study and design on plan of statistical analysis. 6.9 VARIABLES : Research variables are the concepts at various levels of abstract that are entered manipulated and collected in a study.

 Independent variable - Structured Teaching Programme.  Dependent variable - knowledge.

7.0 MATERIALS AND METHODS (Methodology) : The study is designed to determine the effectiveness of structured teaching programme on uterine prolapse among multiparous women of selected rural area in Tumur.

7.1 Source of data :- Multiparous women at selected rural area, Tumkur.

7.1.1 Research Design : - One group pretest –post test design.

7.1.2 Research Approach :- An evaluative research approach.

7.1.3 Setting of the Study :- This study will be conducted in selected rural area in Tumkur.

7.1.4 Population :- The population of present study comprises of multiparous women in selected rural area at Tumkur.

7.2. Method of collection of Data :- (including sampling procedure) Structured interview guide on uterine prolapse.

7.2.1. Sampling Technique :- Non-probability convenient sampling technique.

7.2.2. Sampling Size :- The sample of the study consists of 50 multiparous women in selected rural area.

SAMPLING CRITERIA

7.2.3. Inclusion Criteria :- 1. Multiparous women, who are willing to participate in the study. 2. Multiparous women, who are available during the period of data collection.

7.2.4. Exclusion Criteria :- 1. Multiparous women, who are not willing to participate in the study. 2. Multiparous women, who are not available during the study.

7.2.5. Tool for data collection :- Structured knowledge questionnaire. It consists of two parts Part I and Part II.

Part - I :- Items on demographic variable like age, educational status, parity.

Part - II :- Knowledge items on uterine prolapse.

Procedure for data collection :-

The data will be collected with the prescribed time period some selected rural area will be taken for study. The objective of a study will be explained to the responsible person of each area before starting the data collection. 7.2.6. Data Analyasis Method :-

The data analysis through descriptive and inferential statistics.

 Descriptive Statistics :- Frequency, mean, mean percentage and standard deviation of described demographic valuables.  Inferential Statistics :- Paired ‘t’ test to compare pre and post test knowledge scores. X 2 test will be used to find out the association between selected variable with knowledge scores.

7.3. Does the study require any interventions to be conducted on patients or other Humans or Animals? :-

Yes, the planned teaching programme will be administered to multiparous women regarding uterine prolapse.

7.4. Ethical clearence :-

The main study will be conducted after the approval of research committee. Permission will be obtained from the concerned head of the institution. The purpose & details of the study will be explained to the study subjects and an informed consent will be obtained from them. Assurance will be given to the study subjects on the confidentially of the data collected from them.

Information consent will also be taken from the multiparous women who are willing to participate in the study. 8. LIST OF REFERENCES ( VANCOUVER STYLE FOLLOWED)

1. Basavanthappa B.T. Medical Surgical Nursing. 1st Edition, New Delhi : Jaypee Brothers Publication. 756-774.

2. Brunner and Suddarth. Medical Surgical Nursing. 9th Edition, Lippincott. 1238-1239.

3. Luckmann and Sorensen. Medical Surgical Nursing, W. B. Saunders company. 1423-1248.

4. CDC Morbidity and Mortality weekly report special focus. Surveillance for Reproductive health. Clinical Obstetric & Gynecology. 1977 ; 89 (4) : 1-47. 5. Olsen AL. Epidemiology of Surgically managed Pelvic Organ Prolapse and urinary in continence. Obstetric & Gynecology. April 1997; 89 (4) , 501-6. 6. Mant J. Epidemiology of genital prolapse – Observation from the Oxford Family Planning Association study. British Journal of Obstetric & Gynecology. 1997 ; 57-85. 7. Brown JS et al. Pelvic organ Prolapse Survey in the United states – 1997. American Journal of Obstetric & Gynecology. 2002 ; 186 : 712 – 716. 8. Smith AR. The role of partial denervation of the pelvic of the pelvic floor in the actiology of genitourinary prolapse and stress incontinence of urine–A neurophysiological study. January 1989 ; 96 (1) : 24-28. 9. Marahatta R.K. Shah A ., Genital prolapse in women of Bkaletapur. Nepal Medical College Journal. June 2003 ; 5 (1) : 31-3. 10. Rortveit G, Brown JS, Thom DH, Van Den Eedan SK, Creasman JM, Subak LL., Symptomatic Pelvic Organ Prolapse : Prevalence and risk factors in a population–based, racially diverse cohort. Obstetric & Gynecology, June 2007 ; 109 (6) : 1396 – 403. 11. Tegerstedt G, Miedel A, Maehle – Schmidt M, Nyren O, Hammarstrom M., Obstetric risk factors symptomatic prolapse : a population based approach. American Journal of Obstetric & Gynecology. January 2006 ; 194 (1) : 75-81.

12. Deeb ME , Awwad J, Yeretzian JS, Kaspar HG., Prevalence of reproductive tract infections, genital prolapse and obesity in a rural community in London Bulletin of World Health Organization. November 2003 ; 81 (9) : 639-45. 13. Deval B, Rafil A, Poilpots S, Aflack N, Levardon M., Prolapse in the young woman : study of risk factors. Gynecology & Obstetric Fertilization. March 2003 ; 31 (3) : 320-321. 14. Hendrix SL, Clark A, Nygaard I, Aragaki A, Barnabberi V, Mc Tiernan A., Pelvic Organ Prolapse in the women’s Health initiative : gravity and gravidity. American Journal of Obstetric & Gynecology. June 2002 ; 186 (6) : 1160-1162. 15. Progetto Menopausa in non-hysterectomized women around menopause. European Jouranl of Obstetric & Gynecology Reproductive Biology. December 2000 ; 93 (2) : 135-40. 16. Kumari S, Walia I, Singh A., Self –reported uterine prolapse in a resettlement colony of north India. Journal of Midwifery Womens Health. 2000 July –August ; 45 (4) : 343-50.