• Abstract and Figures
• Public Full-text

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON SELECTED ASPECTS OF POST OPERATIVE CARE AMONG PRIMIMOTHERS UNDERGOING ELECTIVE CAESAREAN SECTION IN SELECTED HOSPITALS AT KOLAR DISTRICT.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms.POONGODI.V AE & CS PAVAN COLLEGE OF NURSING KOLAR - 563101 (KARNATAKA) RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE Ms. POONGODI. V 1ST YEAR MS.c NURSING AND ADDRESS AE & CS PAVAN COLLEGE OF NURSING, KOLAR - 563101 KARNATAKA. 2. NAME OF INSTITUTION AE & CS PAVAN COLLEGE OF NURSING, KOLAR - 563101 KARNATAKA.

3. COURSE OF STUDY AND THE M.Sc. (NURSING) SUBJECT OBSTETRICS& GYNACOLOGICAL NURSING.

4. DATE OF ADMISSION TO 03-06-2008 COURSE

5. TITLE OF THE TOPIC: A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON SELECTED ASPECTS OF POST OPERATIVE CARE AMONG PRIMIMOTHERS UNDERGOING ELECTIVE CAESAREAN SECTION IN SELECTED HOSPITALS AT KOLAR DISTRICT.

2 6. BRIEF RESUME OF INTENDED WORK

Introduction: ‘The most successful man in life is the man who has the best information the only thing more expensive than education is ignorance”. - K. Park

The word "Caesarean" is derived from the Latin word "Caedore" which means "to cut". French obstetrician, Francois Mauriceau first reported casearean section in 1668. It was Max Sanger in 1882, first sutured the uterine wall.1 Caesarean section is described as being an operative procedure that is carried out under anesthesia where by the fetus, placenta and membranes are delivered through an incision in the abdominal wall and the uterus. This is usually carried out after viability has been reached (24 weeks of gestation onwards). 2 There are two types of caesarean section. Elective and emergency. In elective caesarean section when the operation is done at a pre arranged time during pregnancy to ensure the best quality of obstetrics, an aesthesia, neonatal resuscitation and nursing services.1 The world health organization estimates that the rate of caesarean section between 10% and 15% of all births in developed countries. In 2004, the caesarean section rate was 20% in the United Kingdom, while the Canadian rate was 22.5% in 2001-2002. In the United States the caesarean section rate has risen to 46%. Since 1996, reaching level of 30.2% in 2005.3 A study was conducted to estimate the population caesarean section rate in urban India. Total population caesarean section rate was 32.6% (95% CI 27-38) and primary caesarean section rate was 25 %( 95%CI 20-30). Total caesarean section rate in the public, charitable and private sector were 20%, 38% and 47%. Private sector deliveries had an odds ratio of 2.4 (95%CI 1.5,3.8) of a primary caesarean section delivery in comparison with the public sector after adjustment for parity, age at delivery of mothers and educational status.4

3 In Jordan, caesarean sections increased consistently from 8.5% in 1990, to 12.9% in 1997 to 17.8% in 2002. The rate of increase in cesarean section delivery was slightly higher in private hospitals than in public one.5 Currently the incidence is nearly 18% for first time mothers, over 70% for repeat procedures (DHHS 2000). This rates results from the combination of the increased safety of caesarean birth and the use of fetal monitors, which provide for early detection of fetal problems (Grumble and Greedy 2000) . Caesarean section rate increase may also be related to the phenomenon that physicians skilled in doing caesarean sections have less experience with other methods.6 Over the last 20 Years there has been increasing in the rate of caesarean section in India. A collaborative study done by the Indian council of medical research (ICMR), in 1980’s showed a caesareans section rate was 13.8% in teaching hospitals. This has risen significantly. The overall rate showed to increase from 21.8% in 1993- 94 to 25.4% in 1998-1999. In that 42.4% were primigravidas and 31% had come from rural areas.7 Caesarean section delivery related complications have been increasing worldwide. Specially in 18 selected states. In India According to National Family Health Survey in 1992-93 Goa (15.3%) and Kerala (13.7%) were the two states with relatively higher caesarean section rates. There is reason to believe that current rates are Part of a rising trend. In Andhra Pradesh, Bihar, Gujarat, Karnataka, Punjab and Uttar Pradesh the risk of undergoing caesarean section in private sector institutions is four or more times that in the public sector.8 Caesarean births are not without complications both for mother and fetus. Maternal complications occur in 25% of births. Proper post operative care will reduce the incidence.9 A retrospective analysis of maternal deaths following caesarean section, sepsis was the single most important cause of maternal death (81.5%).10 Currently, caesarean section delivery as a prophylactic measure, to alleviate problems of birth conditions such as cephalopelvic disproportion, failed induction or failure to progress in labour and obstructive, benign or malignant tumor.6

4 There are two types of indications for elective caesarean section, namely definite indications such as cephalopelvic disproportion, major degree of placenta praevia and high order multiple pregnancy and possible indications such as breech presentation, moderate to severe pre-eclampsia, a medical condition that warrants the exclusion of maternal effort, diabetes mellitus, intrauterine growth restriction, antepartum haemorrhage and certain fetal abnormalities (hydrocephalus).2 Child birth is considered a multidimensional experience. Labour and child birth includes intense physical, emotional, social, cultural and spiritual elements that may be critical to an individual women experience of this major life events11. Post operative caesarean section complications are postpartum hemorrhage, Shock, an aesthetic hazards, infections, intestinal obstruction, thromboembolic disorders, wound complications, (wound sepsis, frank pus, haematoma, and dehiscence) secondary postpartum hemorrhage.1 Before beginning teaching, assess how much the woman already knows about the caesarean section surgery. Answer all specific questions and fill in gaps in knowledge. Explain preoperative measures that will be necessary such as surgical skin preparations, eating nothing before the time of surgery, premeditations and method of transport, throughout teaching, use visual aids as necessary.6 The post-operative period extends from the time the Patient leaves the operating room until the follow-up visit with the surgeon. This period may be as short as one week or as long as several months. During the post-operative period, nursing care is directed at re-establishing the patients physiological equilibrium, alleviating pain, preventing complications and teaching the patients self care.12

6.1 NEED FOR THE STUDY:-

5 A 2008, United States report found that fully one third of babies born in Massachesetts in 2006 were delivered by caesarean section. Among developing countries, Brazil has one of the highest rates of caesarean section in the world. In public health network, the rate reaches 35% while in private hospitals the rate approaches 80%.3 Rates of caesarean section are of concern in both developed and developing countries. They estimate the proportion of births by caesarean section at national, regional and global levels. The analysed nationally representative data available from surveys or vital registration systems on the proportion of births by caesarean section. They used local non-parametric regression techniques to correlate caesarean section with maternal mortality ration, infant and neonatal mortality rates, and the proportion of births attended by skilled health personnel. 15% of births world wide occurs by caesarean section. Latin America and the caesarean section shows the highest rate (29.2%) and Africa shows the lowest (3.5%).13 A study was conducted to examine etiology and preventability of maternal death and the causal relationship of caesarean delivery. Ninety Five maternal deaths occurred in 1,461,270 pregnancies (6.5 per 1.00,000 pregnancies). The rate of maternal death causally related to mode of delivery was 0.2 per 1,00,000 for vaginal birth and 2.2 per 1,00,000 for caesarean delivery.14 A study was conducted to determine the prevalence and correlates of caesarean deliveries. The rate of caesarean section was 26.4% and correlated with socio-demographic, obstetrical and provider related variables. This study showed an increased caesarean section rate in a middle income country and identifies the correlates of women delivering by the abdominal route.15 A study was conducted on the voice of patients for improving caesarean delivery care methods the women who had received caesarean section filled out questionnaire survey few days after caesarean section. This study results showed that all pregnant women and family, the medical staff should offer correct information concerning caesarean section at the early stage.16

6 A study was conducted to analyze the frequency of post operative complications following elective and emergency caesarean delivery. In 574 planned caesarean section case post operative complication was 1.4% while in 292 emergency caesarean section it was 2.05% (P>0.05). It is a major surgical procedure characterized with morbidity even if performed as a planned procedure. The risk of complications seems to be higher in cases of repeated caesarean section.17 A study was conducted to estimate the relative risk of post-partum complication by type of delivery. The results indicate that the incidence of major puerperal infection, thromboembolic events, anesthetic complications and obstetrical surgical wound infection was higher among women undergoing a caesarean section as compared to those with vaginal delivery. These findings are of particular relevance in light of the substantial proportion of repeat caesarean sections performed on an elective basis.18 Maternal deaths from caesarean sections was exceptionally high and result from avoidable causes such as hemorrhagic shock, sepsis and hypertensive disorders in pregnancy. Increased involvement of specialists in the care and improved intra and post-operative management of cases was advocated to reduce the higher maternal mortality rate.19 A study was conducted to examine the annual incidence and secular trend of caesarean births. The results from 1987 to 1999 the over all annual caesarean section rate rise steadily from 16.6 to 27.4 per 100 hospital deliveries, resulting in a 65% increase over 12 years. The mean difference in rates of surgical delivery between public (mean (public) = 16.0%) and private (mean (private) =43.4%) institutions was 27.4% (95% confidence interval (CI) = 24.1, 30.7, P<0.001). 20 The national sentinel caesarean section Audit 2001 show that caesarean section rates in 2000 were highest in Wales, at 24.2% in 2000 and in Northern Ireland, at 23.9% in 2000-1.2 There are many reasons for the increase in caesarean section rates. These may be attributed to both technological and social changes. The expectation is perhaps that every pregnancy should have a healthy outcome (silverton 1993), perhaps the more, so because many women work full time and are choosing to delay and

7 restrict the number of pregnancies they have. (Call Wood and Thomas 2008). Fear of litigation may be a reason for early recourse to caesarean birth.2 Women who deliver by caesarean birth have an additional care concern in the immediate post partal period, because they are not only post partal patients but post surgical ones as well. Due to the strain of the unexpected procedure, they may have increased difficulty bonding with their new infant. There is little time for teaching because of shortened hospital stays.6 Preoperative teaching is a vital part of nursing care. Studies have shown that preoperative teaching reduces clients anxiety and postoperative complications and increases their satisfaction with the surgical experience. Good preoperative teaching also facilitates the client's return to work and other activities of daily living.21 Based on the review of literatures and personal experience of the investigator during practice in the field of nursing service found that primimothers undergoing elective caesarean section they are not having adequate knowledge regarding post operative care. This gap of knowledge on one side and the growing risks on the other side necessitates to need to systematically educated the mother's to adopt healthy life style pattern. So the investigator felt to impart that the structured teaching programme will facilitate them to know about the selected aspects of post operative care after caesarean section.

8 6.2. REVIEW OF LITERATURE:

According to Polit and Beck (2006) a broad, comprehensive, in depth, systematic and critical review of scollerly publications, unpublished materials, audio visual materials and personal communications is called review of literature.22 An extensive search of literature was done by the investigator to elicit factual information about selected aspects of post operative care after caesarean section. The related literatures is organized and presented under the following headings. 1. Literatures related to caesarean section 2. Literatures related to selected aspects of post operative care after caesarean section.  Related to pain management  Related to prevention of wound complications  Related to maternal nutrition  Related to initiation of breast feeding. 3. Literatures related to effectiveness of structured teaching program on selected aspects of post operative care after caesarean section. 1. Literatures related to caesarean section. The caesarean section rate continues with routine access to medical services, yet this increase is not associated with improvement in prenatal mortality or morbidity. The women preference for caesarean section varied from 0.3% - 14%. Caesarean section related to psychological factors, perceptions of safety, or in some countries was influenced by cultural or social factors.23

2. Literatures related to selected aspects of post operative care after caesarean section.  Related to pain management. A study was conducted to assess the analgesic effect of transcutaneous nerve stimulation (TENS) on caesarean 54 subjects randomly selected. The result of this study showed that intensity of pain and usage of sedative drug remarkably reduced after use of transautaneous nerve stimulation (TENS) (P<0.001, P<0.05).

9 Patient satisfaction was significantly before than the control group (P<0.001) This might lead to better out comes in pain control and facilitating development of bonding between mother and baby.24 A study was conducted to assess post operative pain and pain relief after caesarean birth. 60 women underwent caesarean birth. Descriptive patient survey was carried out and data are collected through a questionnaire and assessment of pain by visual analog scale (VAS) and women birth experience measured on a seven-point Likert scale. The results showed that the women experienced high level pain during the first 24 hours and 78% of the women scored greater than or equal to 4 on the visual Analog Scale. There was no difference between elective and emergency caesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. Postoperative pain negatively affected breastfeeding and infant care. The study concluded that, there is a need for individual with adequate pain treatment for women undergoing caesarean birth, as high levels of pain interfere with early infant care and breastfeeding.25 A study was conducted to evaluate the effectiveness of acupressure for controlling post-caesarean section symptoms such as nausea, vomiting, anxiety perception and pain perception. A total of 104 eligible participants were recruited by convenience sampling techniques. The experimental group received three acupressure treatments before caesarean section and within the first 24 hours after caesarean section. The results indicated that the experimental group had significantly lower anxiety and pain perception of caesarean experiences than the control group. The study concluded that the utilization of acupressure treatment to promote the comfort of women during caesarean delivery is strongly recommended.26 A quality improvement study of pain management after caesarean delivery was conducted. The patient subjective report of satification with pain management was not related to the method or drug used for pain control (P=0.13) fewer women assigned to morphine thereby stopped breastfeeding (P=0.02) and more roomed in with their infants (p<0.01). The pain relief was superior with the morphine regimens used and was positively associated with breast feeding and infant rooming in.27

10  Related to Prevention of wound complications A study was conducted on risk factors for surgical site infection after low transverse caesarean section. Retrospective cast-control study design. Surgical site infections (5.0%) independent risk factors for surgical site infections 95%. It should be incorporated into approaches for the prevention and surveillance of surgical site infection after surgery.28 A study was conducted on caesarean section, surgical site infection and wound management. Surgical site infections are a common cause of morbidity. The risk factors for surgical site infections following caesarean section including prophylaxis antibiotics, type of dressing, approach to wound closure, obesity and general health.29 A study was conducted to assess the post partum uterine wound dehiscence is a case for late postpartum hemorrhage following caesarean section. A partial or complete dehiscence of the lower segment caesarean section is a rare, but possible cause. Emergency laparotomy revealed a complete dehiscence of the lower uterine segment incision. A subtotal hysterectomy was performed to control the bleeding.30 A study was conducted to assess the occurrence of abdominal wall scar endometroma after caesarean section. A study was undertaken of six patient's in general surgical clinic, each of whom had presented with a painful mass at a previous caesarean section site. It is strongly recommended that, at the conclusion of the procedure of caesarean section, the abdominal wall wound be cleaned thoroughly and irrigated vigorously with high jet saline solution before closure.31 A study was conducted to assess the risk factors associated with surgical site infections following caesarean section. 765 samples selected by randomized sampling techniques. Multiple logistic regression analysis identified four factors: absence of prophylactics antibiotiic (P=0.001), Surgery time (P=0.04), < 7 prenatal visits (P=0.001) and hours of ruptured membranes (P=0.04). women's health care professionals also must continue to encourage pregnant women to start prenatal visits early in the pregnancy and to maintain scheduled visits throughout the pregnancy to prevent perinatal complications, including post operative infection. 32

11 A study was conducted to assess the role of prophylaxis antibiotic in caesarean section for prevention of infections complications during puerperium. Not a single case with endometritis and only one case with suppuration (13.99%). All these parturient were with low risk of puerperal infections.33

 Related to maternal nutrition: A study was conducted on the effect of early versus delayed post caesarean feeding on woman's satisfaction. Women's satisfaction measured with a visual analogue scale (VAS). The woman's satisfaction was similar in both groups. A statistically significant difference was observed in mean postoperative pain 29+/- 13mm in the delayed feeding group versus 24+/-11mm in the early feeding group (P=0.008). Early feeding after uncomplicated caesarean in low risk women is equivalent in terms of the woman's satisfaction and the reduced perceived pain.34 A study was conducted on early maternal feeding following caesarean delivery. A prospective, randomized study was design including 179 women underwent first or repeated caesarean delivery. The received clear fluids and solid food within 8 hours of surgery maternal satisfaction was significantly higher among the early fed women. It is not associated with higher rates of post operative complications.35 A randomized controlled trial study was conducted on beneficial effects of early feeding post caesarean delivery. Bowel sounds were present immediately postoperatively in 90.8% (early group) versus 95.5% (control). Maternal satisfaction rate higher in the early fed group (90 versus 60, on visual analogue scale score 0-100, P.Value is less than 0.001). Early feeding post-caesarean delivery with added benefits of earlier intravenous cannula removal, ambulation, breast feeding initiation and potential for shorter hospitalization.36 A comparative study was conducted on early post operative feeding versus conventional feeding for patients undergoing caesarean section. The rate of mild ileus symptoms in the early feeding groups was significantly less than the conventional group (19.6%) versus 31.1% P =0.03). The early feeding after uncomplicated caesarean section had reduced the rate of ileus symptoms and offer

12 potential benefits associated with shorter interval to bowel movement, IV fluid administration and length of hospital stays.37 A study was conducted on early oral hydration and its impact on bowel activity after caesarean section. Bowel sounds appeared in a significantly shorter duration of time in study group the mean being 7.4h as compared to 11.5h in the control group. The mean oral fluid intake was much more and return to soft and the full diet was faster in the study group. The early oral hydration in the post operative period helps in the faster recovery of the patient by means of quicker return to normal feeding habits and early ambulation.38 A study was conducted on early compared with delayed oral fluids and food after caesarean section. The results showed that early oral fluids or food were associated with reduced time to first food intake (weighted mean difference - 7.20 hours 95% confidence interval 13.26 to 1.14). No complication of withholding oral fluids after uncomplicated caesarean section.39 A study was conducted on attitudes to oral feeding following caesarean section. Only 21.5% of units had a departmental policy concerning feeding after caesarean section. The women could eat or drink in the majority of obstetric units (78.5%) after without help of guidelines. The period of postoperative starvation was found to very greatly, from <1hr in some units to >24 hrs in others. They suggest that all obstetric units should produce guidelines in order to rationalize postoperative feeding for women following caesarean section.40 A study was conducted to assess on safety and efficacy of early postoperative solid food consumption after caesarean section. Early solid food consumption would reduce the need for analgesia. Women will eat solid food very soon after caesarean section (mean + /-SD 10.2+/-5.2 hours from surgery to onset of solid food consumption) as compared to women on a traditional dietary expansive regimen (mean+/-SD 41.5+/-16.0 hours P<.001). There is no evidence of complications. Early postoperative feeding after caesarean section is a safe and effective alternative for most women.41

13  Related to initiation of breast feeding A study was conducted on caesarean section and breastfeeding initiation. With established determinants for breastfeeding duration, including feeding exclusively with breast milk in maternity wards, early initiation of breast feeding, rooming-in and pacifier use, varied according to nationality. The rate in the mothers country of origin (P<0.001, P=0.04). The study concluded that these differences are dependant on educational level and on the mothers nationality. The large variation suggests that different trans-national experiences play some role in health-related decision-making and access to health care.42 A study was conducted to assess the effects of caesarean section on breast feeding. There was a significantly lower postpartum prolactin (PRL) level in the caesarean section group (8.48 nmol/<, 95% CI: 7.80 - 9.21 nmol/L). Caesarean section was an important hazard for a shorter duration of breastfeeding (RR=1.21; 95% CI; 1.10 - 1.33) with in one year after childbirth. Measures including promoting the secretion of postpartum prolactin (PRL) such as early contact, early sucking and analgesic method should be taken to improve the successful breastfeeding rate.43 A study was conducted to assess the policies and practices for maternal support options during childbirth and breastfeeding initiation after caesarean delivery. Convenience sample of 154 obstetric nurse manager and nurse representatives 89% permitted only one support person during non emergent caesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mothers request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room. The study concluded that breastfeeding initiation after caesarean birth was encouraging, support person options during non emergent caesarean births and related rationales warrant further examinations.44 3. Literatures related to effectiveness of structured teaching programme related to post operative care after caesarean section. A study was conducted on caesarean section and maternal education. Studies on the association between caesarean section and maternal social background. This study result showed that the lowest educated had the highest risk of caesarean

14 section. In all deliveries the adjusted relative risk of caesarean section for the lowest versus the highest educated increased from 1.16 in the 1967-76 period to 1.34 in the 1996-2004 period.45 A study was conducted to evaluate individual or group antenatal education for childbirth or parenthood, or both. To assess the effects of this education on knowledge acquisition, anxiety, sense of control, pain, labour and birth support, breastfeeding, infant-care abilities, and psychological and social adjustment. Randomized controlled trials of any structured educational programme provided during pregnancy by an educator to either parent that included information related to pregnancy, birth or parenthood. No consistent results were found. Sample sizes were very small to moderate, ranging from 10 to 318. No data were reported concerning anxiety, breastfeeding success, or general social support. The study concluded that the effects of general antenatal education for childbirth or parenthood, or both, remain largely unknown. Individualized prenatal education directed toward avoidance of a repeat caesarean birth.46

15 PROBLEM STATEMENT

A study to evaluate the effectiveness of structured teaching programme on selected aspects of post operative care among primimothers undergoing elective caesarean section in selected hospitals at Kolar district.

6.3 OBJECTIVES:

 To assess the existing knowledge of primimothers undergoing elective caesarean section regarding selected aspects of post operative care.  To evaluate the effectiveness of structured teaching programme on selected aspects of post operative care among primimothers undergoing elective caesarean section.  To find the association between post test knowledge level with their selected demographic variables.

6.4 OPERATIONAL DEFINITIONS:

Evaluate: It refers to determine the effectiveness of preoperative teaching on selected aspects of post operative care among primimothers undergoing elective caesarean section.

Effectiveness: It refers to a significant increase in the level of knowledge of primimothers after structured teaching programme regarding selected aspects of post operative care. Structured teaching Programme: Refers to a system of planned instructional design to impart information in order to bring the changes in knowledge regarding selected aspects of post operative care of primimothers undergoing elective caesarean section.

16 Selected aspects of Post operative care: It refers to selected aspects of care after operation in terms of pain management, prevention of wound complications, maternal nutrition and initiation of breast feeding.

Caesarean section (CS): It refers to an operative procedure helps to deliver the fetus after viability has been reached (24 weeks of gestation onwards).

Primimothers: It refers to mothers who are pregnant for the first time.

6.5 HYPOTHESIS: Ho: There will be no relationship between pretest and post test scores of primi mothers undergoing elective caesarean section.

6.6 VARIABLES:

6.6.1 Dependent Variables: Knowledge of Primi mothers regarding selected aspects of post operative care.

6.6.2 Independent Variables: Structured teaching programme.

6.6.3 Attributed Variables: Age, education, occupation, income, religion, type of family, place of residence and source of information .

17 7. MATERIAL AND METHOD : 7.1 Source of data: Primi mothers admitted for elective caesarean section in selected hospitals at Kolar.

7.2 Method of data collection: 7.2.1 Research design: Pre- experimental design (One group Pre test - post test) 7.2.2 Setting: The study will be conducted in two hospitals namely, Sri Narasimha Raja (SNR) hospital Kolar, the incidence rate of caesarean section in 2007 was 986, it is having 500 bed strength which is 2km away from pavan college of nursing and R.L. Jalappa hospital and Research center Tamaka, Kolar, the incidence rate of caesarean section in 2007 was 792, it is having 850 bed strength which is 5km away from Pavan College of nursing. 7.2.3 Population: The population for the present study comprises of primimothers who are undergoing elective caesarean section. 7.2.4 Sample: Primimothers who are undergoing elective caesearean section, age group between 20-40 years. 7.2.5 Sample size: 60 Primimothers. 7.2.6 Sampling technique: Convenient sampling technique will be used to select the sample for the study. 7.2.7 Sampling Criteria: Inclusion Criteria:  Primimothers who are admitted for elective caesarean section in Sri Narasimha Raja (SNR) hospital and R.L. Jalappa hospital and Research center at Kolar.

18  Primimothers age group between 20-40 years.  Primimothers who can communicate in Kannada or English.  Primimothers who are willing to participate in the study.

Exclusive Criteria:  Mothers who are below 20 years and above 40 years.  Mothers who are admitted for normal vaginal delivery.  Mothers who are undergoing emergency caesarean section.  Mothers who can not communicate Kannada or English.  Mothers who are not willing to participate in the study.

7.2.8 Tool of data collection: Structured interview schedule will be used for data collection. The tool consists of two sections. Section A Consists of demographic data of the subject which includes age, education, occupation, income, religion, type of family, place of residence, and source of information. Section B Consists of knowledge questions regarding selected aspects of post operative care. (Knowledge regarding pain management, prevention of wound complications, maternal nutrition and initiation of breast feeding). 7.2.9 Method of data collection: Structured interview schedule will be used to collect the data from the primimothers who are undergoing elective caesarean section. The purpose of the study will be explained and consent from the participant will be obtained to involve in the study. The tentative period of data collection will be 6 weeks, before that tool will be developed and after validation by the experts, the further refinement of the tool will be done. Before the main study the pilot study will be conducted.

19 7.2.10 Data analysis and interpretation: Data will be analysed on the basis of objectives and hypothesis by using descriptive and inferential statistics. In descriptive statistics the frequency, percentage, mean and standard deviation will be used for the data analysis. In inferential statistics the chi-square test will be used to find the association between post test knowledge level with their selected demographic variables and paired ‘t’ test will be used to know the effectiveness of structured teaching programme on selected aspects of post operative care. The results will be presented in the form of tables, graphs and diagrams.

7.3 Does the studies require any investigation or intervention to be conducted on patient/sample population or other humans or animals? Yes. The study will be conducted on the primi mothers undergoing elective caesarean section. Since it is pre- experimental study, it requires interventions in the form of teaching regarding pain management, prevention of wound complications, maternal nutrition and initiation of breast feeding; it will not have any harm to the mothers.

7.4 Has ethical clearance been obtained from your institutes? Yes, prior permission will be obtained from the concerned authorities of SNR hospital and R.L Jallapa hospital in Kolar to conduct a study and also from research committee of AE & CS Pavan College of nursing at Kolar. The purpose of the study will be explained to the primi mothers who are undergoing elective caesarean section in selected hospitals and the scientific objectivity of the study will be maintained with honesty.

20 8. List of referances:-

1) D.C Dutta. Text book of obstetrics. 6th edition. New central book agency (p) Ltd. 2004; 588-89,596-97. 2) Myles. Text book for midwives. 14th edition. Published by Elsevier Ltd. 2003; 581, 583-85. 3) Statistics report on World Health Organization, regarding caesarean section. Wttp: //does google.com. 4) Sreevidya.S. Sathiyasekaran BW. Population –based cross sectional study on high caesarean rates in Madras (India). 2003 Feb; 110(2):106-11. 5) M.Khawaja and M.Al-Nsour. Trends in the prevalence and determinats of caesarean section delivery in Jordan. 2002, 17(1):90-98. 6) Adele Pillitteri. Maternal and child health Nursing. Care of the child bearing and child rearing family.4th edition. Williams Lippincott publication. 2003, 540,549. 7) Gita Arjun. Caesarean section. Evaluation, guidelines and recommendations. 8) US Mishra and Mala Ramanathan. Delivery-related complications and determinants of caesarean section rates in India. 9) Bobak. Maternity and gynecologic care. 5th edition. Mosby publications. 1066. 10) Ojo VA. Adetoro OO. Okwerekwn FE. Characteristics of maternal deaths following caesarean section in a developing country. 1988; PMID: 290308. 11) The Nursing Journal of India. LXXXIX, 3 1998; 53. 12) Brunner and Suddhardh. Medical surgical Nursing. 9th edition. WB.Sounders company. 2001: 347 13) Betran. Ana P etal. Rates of caesarean section analysis of global, regional and national estimates. 10.111/j.1365-3016.2007.00786.x. 14) Clark SL. Belfort MA. Dildy GA. Herbst MA. Dildy GA. Herbst MA. Mevers JA. Hankins GD. Maternal deaths in the 21st century: causes, Prevention and relationship to caesarean delivery. 2008 July: 199(1):36.el-5 15) Tamim H etal. Incidence and correlates of caesarean section in a capital city of middle-income country. 2007; 35(4):282-8.

21 16)Masui. The voice of patients for improving caesarean delivery care. 2006 July: 55(7):914-9 17) Dimitrova V. Pandeva I. Tsankova M. Pranchev N. Post- operative complications following elective and emergency caesarean delivery. 2005; 44(7):15-21. 18)Koroukian SM. Relative risk of postpartum complications in the ohio medical population: vaginal versus caesarean delivery. 2004 June; 61(2):203-24 19) Ozumba BC. Anya SE. Maternal deaths associated with caesarean section in Enugu, Nigeria. 2002 March; 76(3):307-9. 20) Leung GM. Lam TH. Thach TO. Wan s. Ho LM. Rates of caesarean births in Hong Kong. 2001 September; 28(3):166-72. 21)Barbara Kozier. Text book of fundamentals of nursing. 7th edition. Published by Dorling Kindersely (India) Pvt. Ltd. 940. 22) Basavanthappa BT. Nursing Research. 1st edition. Jaypee brothers. New Delhi. 1998: 93. 23) Mc Court C. Weaver J. Statham H. Beake S. Gamble J. Creedy DK. Elective caesarean section and decision making, a critical review of the literature. 2007 March; 34(1); 65-79. 24) Jaafarpor M. Khani A Javadifar N. Taghinejad H. Mahmoudi R. Saadipour KH. The analgesic effect of Transcutaneous Elective Nerve Stimulation (TENS) on caesarean under spinal anaesthesia. 2008 June. Email. [email protected]. 25) Karlstrom A. Engstrom-Olofasson R. Norbergh KG. Sjoling M. Hildingsson I. Postoperative pain after caesarean birth affects breast feeding and infant care. 2007 September; 36(5); 430-40. 26) Chen HM. Chang FY. Hsu CT. Effect of acupressure on nausea, Vomiting, anxiety and pain among post-caesarean section women in Taiwan. 2005 August; 21(8); 341-50. 27)Yost NP. Bloom SL. Sibley MK. Lo Jy. Mdntire DD. Leveno KJ. A hospital- sponsored quality imptovement study of pain management after caesarean delivery. 2004 May; 190(5):1341-6. PMID: 15167840.

22 28) Olsen MA. Butler AM. Willers DM. Devkota P. Cross GA .Fraser VJ. Risk factors for surgical site infection after low transverse caesarean Section.2008 June; 29(6); 477-84.PMID:18510455. 29) Gould D. Caesarean section, surgical site infection and wound management. 2007 April .PMID 17479790. 30) Wagner MS. Bedard MJ. Postpartum uterine wound dehiscence, a case report. 2006 Aug; 28(8); 713-5.PMID 17022911. 31) Wasfie T. Gome ZE. Seon S. Zado B. Abdominal wall endometrioma after caesarean section, a preventable complication. 2002 July; 87(3):175-7. 32) Killian CA. Graffunder EM. Vinciguerra TJ. Venezia RA. Risk factors for surgical-site infections following caesarean section. 2001 Oct; 22(10); 613-7. 33) Bozhinova S. Ignatov P. Bogdanova A. the role of antibiotic Prophylaxis in caesarean section. 1998. 34) Izbizky GH. Minig L. Sebastiani MA. Otano L. The effect of early versus delayed post caesarean feeding on women’s satisfaction: a randomized controlled trial. 2008 Feb; 115(3):332-8.PMID 18190369. 35) Bar G. Sheiner E. Lezerovizt A. Lazer T. Hallak M. Early maternal feeding following caesarean delivery; a prospective randomized study. 2008; 87(1); 68-71. 36) Teoh WH. Shah MK. Mah CL. A randomized controlled trial on beneficial effects of early feeding post-caesarean delivery under regional anesthesia. 2007 February; 48(2); 152-7. Teohwendy @yahoo.com. 37) Chantarasorn V. Tannirandorn Y. A comparative study of early post-operative feeding versus conventional feeding for patents undergoing ceasarean section; a randomized controlled trial. 2006 October; 89suppl 4; s 11-6. [email protected]. 38) Malhotra N. Khannas. pasrija S . Jain M. Agarwala RB. Early oral hydration and its impact on bowel activity after elective caesarean section. 2005 may; 120(1); 53-6. 39) Mangesi L. Hofmevr GJ. Early compared with delayed oral fluids and food after caesarean section . 2002 ;( 3); CD003516.

23 40) Worthington L M . Mulcaby AJ. White S . Flvnn P J. Attitudes to oral feeding following caesarean section. 1999 July; 54(7); 719-20. 41) Burrows W R etal. Safety and efficacy of early postoperative solid food Consumption after caesarean section. 1995 June; 40(6); 463-7. 42) Merten S. Wyss C. Ackermann – Liebrich U. Caesarean sections and Breast feeding initiation among migrants in Switzerland 2007; 52(4):210-22. 43) Wang BS . Zhou LF . zhu LP . Gao XL . Gao ES . Prospective Observational study on the effects of caesarean section on breastfeeding. 2006 April; 41(4); 246-8. 44) Spear H. Policies and practices for maternal support options during childbirth and breast feeding initiation after caesarean in Southeaster Hospitals. 2006 September; 35(5):634-43. 45) Tollanes MC. Thompson JM. Daltveit AK. Irgens LM. Caesarean section and maternal education. 2007; 86(7); 840-8. 46) Gagnon AJ. Sandall J. Individual or group antenatal education for childbirth or parenthood, or for both. 2007 July 18 ;( 3)-CD002869.

24 9. SIGNATURE OF THE CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

1. GUIDE

2. SIGNATURE

3. CO-GUIDE

4. SIGNATURE

5. HEAD OF THE DEPARTMENT

6. SIGNATURE

12. REMARKS OF CHAIRMAN OR PRINCIPAL 1. SIGNATURE

25

Load more

  25

Copy Link