RAJIV GANDHI UNIVERSITY OF HEALTH
SCIENCES, BANGALORE,KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
MS.V.JEYANTHI I YEAR M. Sc NURSING, OBSTETRIC AND GYNAECOLOGICAL NURSING (2008 –10 BATCH)
VARALAKSHMI COLLEGE OF NURSING , # 19, KIADB ROAD, CHOKKASANDRA, T. DASARAHALLI, BANGALORE -560057 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR
DISSERTATION
MS.V.JAYANTHI I YEAR M.Sc NURSING NAME OF THE VARALAKSHMI COLLEGE OF NURSING 1 CANDIDATE AND NO19,KIADB ROAD,CHOKKASANDRA ADDRESS T.DASARAHALLI BANGALORE -560057
VARALAKSHMI COLLEGE OF NURSING NAME OF THE NO19,KIADB ROAD,CHOKKASANDRA 2 INSTITUTION T.DASARAHALLI BANGALORE -560057
MASTER DEGREE OF NURSING, 3 COURSE OF STUDY AND OBSTETRIC AND GYNAECOLOGICAL SUBJECT NURSING
DATE OF ADMISSION 4 TO COURSE 30-06-2008
ASSESS THE EFFECTIVENESS OF NEEM EXTRACT SITZ BATH VERSUS 5 TITLE OF THE TOPIC BETADINE SITZ BATH ON EPISIOTOMY WOUND HEALING. 6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
An episiotomy is a surgical cut in the perineum, the muscular area between the vagina and the back passage. A local anaesthetic to numb the perineum is given before the episiotomy is carried out. Having an episiotomy is no longer a routine part of labour.
Your midwife might suggest one if your baby is becoming distressed and needs to be born quickly, or if she thinks that you may tear very badly unless the opening from the vagina is carefully enlarged.1 Some health professionals believe that an episiotomy heals better than a tear, although the research doesn't bear out this assumption. Spontaneous tears are less painful or at least no more painful for women in the days after the birth than episiotomies. Various studies have concluded that women who have an episiotomy, women who tear, and women who have no damage to the perineum during childbirth have equally strong pelvic floor muscles three months after giving birth.2
Puerperium is the period following childbirth during which the body tissues, specially the pelvic organs revert back approximately to the pre-pregnant state both anatomically and physiologically. The retrogressive changes are mostly confined to the reproductive organs with the exception of the mammary gland which in fact shows features of activity. Involution the process whereby the genital organs revert back approximately to the state as they were before pregnancy. The woman is termed as a puerpera. The period is arbitrarily divided into a) immediate-within 24 hours; b)early- up to 7 days and c)remote- up to 6 weeks.3 6.1 NEED FOR STUDY
The Sanskrit name of neem tree is arishtha meaning 'reliever of sickness' and hence is considered as sarbaroganibarini. The tree is still regarded as 'village dispensary' in India. The importance of the neem tree has been recognized by US National Academy of Sciences, which published a report in 1992 entitled 'Neem – a tree for solving global problems.For thousands of years the beneficial properties of Neem (A Azadirachta indica. Juss) have been recognized in the Indian tradition. Each part of the neem tree has some medicinal property.4 Neem is regarded the holy plant of India. One of its vast uses in medicine is for skin conditions. It is very rich in nutritients that preserve skin elasticity like omega 3-6-9. All parts of the herb exhibit properties as, antiviral, anti-inflammatory, immuno-modulatory, antibacterial, and antifungal. More than 140 compounds were isolated from different parts of the herb.
Neem or Azadirachta Indica, popularly known as margosa is a large, evergreen tree. Neem has been used as a tonic and astringent that heartens wound healing. Neem or
Azadirachta Indica traditionally being used because of its detoxifying benefits that help protects healthy circulatory, digestive, respiratory and urinary systems of the body. It is widely used for external applications in skin related problems. Neem or Azadirachta
Indica extracts have wonderful effects like anti-diabetic, anti-bacterial, and anti-viral properties.
A wound affects the first line, of our body’s defense system, the skin. When such takes place, a plethora of symptoms may appear like, bleeding, swelling, redness, pain and tenderness, fever with infection, heat, stiffness, discoloration, scabbing, itching and scar formation.Wounds on skin and other soft tissues, trigger a self-healing process of our body which is summarizes to the scientific term “inflammation”. This process increases collagen production below the skin (dermis). Then, follows the regeneration of the outer skin layer.5
The postnatal mothers who had undergone episiotomy, they are more prone to get puerperal infection during early postnatal period. So the researcher felt that by providing medicated sitz bath can minimize the puerperal infection and promote episiotomy wound healing.
6.2 REVIEW OF LITERATUR
Hur et al. conducted a study to verify the effect of aroma-sitz bath with aroma- soap application on perineal healing on 100 postpartum mothers. The effectiveness was assessed by REEDA scale and smear of episiotomy wound. The data were analyzed by repeated measures of ANOVA,ANCOVA and chi (2) test. The study related that REEDA scale was significantly low in the experimental group at postpartum
5th and 7th day(P=.0009,P=.003) and few bacteria were observed in the smears of episiotomy wound. In the study they concluded that aroma-sitz bath is more effective in healing episiotomy.6
Anupama conducted a study to assess the effectiveness of moist and dry heat application on healing of episiotomy wound on 30 postnatal mothers by using REEDA scale. The subjects were randomly allocated to experimental and control group. The study concluded that rate of wound healing with of moist heat and dry heat application was similar.7 Molkizadeh et al (1382-83) conducted a study to verify the evaluation of lavender cream effect on perineal pain and episiotomy wound healing in 100 primiparous women with term pregnancies requiring surgical repair of episiotomy fiiowing a normal and spontaneous delivery at Moderre’s hospital in Kashmar. The effectiveness was assessed for perineal pain by VAS and wound healing by REEDA scale at first 24hrs,3rd ,
5th and 7th day postpartum. The data was analyzed with chi- square, mann-withny u and t-test and analysis in spss software.There was no significant differences in perineal pain at first 24hrs postpartum between two group(P=0.78), but perineal pain at :3rd(P=0.035),
5th (p=0.0)and 10th ( P=0.04) days postpartum was less in experimental group.In wound healing there was no significant difference between two groups at 3rd day postpartum
(P=0.170) but at 5th day (0.002), and 10th day (P=0.0) there was significant difference between two group.The study concluded that the topical application of lavender creem was effective in reliving perineal pain and episiotomy wound healing.8
Tejirian et al. conducted astudy to justify and support the recommendation of sitz bath in the management of ano-rectal disorders. Thirty six articles were found which highlighted the physiology,benefits,risks,complications and techniques of sitz bath. This study conducted that sitz bath induces relaxation of the internal sphincter muscle and cold sitz bath was reported to decrease perineal edema. This study also recommended additional studies are needed to investigate the benefits of sitz bath.9 STATEMENT OF THE PROBLEM
A COMPARITIVE STUDY TO ASSESS THE EFFECTIVENESS OF NEEM EXTRACT
SITZ BATH VERSUS BETADINE SITZ BATH ON EPISIOTOMY WOUND HEALING
AMONG POST NATAL MOTHERS AT SELECTED HOSPITAL, BANGALORE.
6.3 OBJECTIVES
6.3.1 To assess the rate of wound healing in episiotomy after providing neem
tract sitz bath among postnatal mothers in experimental group.
6.3.2 To assess the rate of wound healing in episiotomy after providing betadine
sitz bath among postnatal mothers in control group.
6.3.3 To compare the effectiveness of neem extract sitz bath versus betadine sitz
bath on episiotomy wound healing among postnatal mothers in experimental
and control group.
6.3.4 To study the association between effectiveness of neem extract sitz bath
versus betadine sitz bath on episiotomy wound healing with selected
demographic variables of postnatal mothers in experimental and control
group.
6.4 HYPOTHESIS
H1:
There will be significant difference between neem extract sitz bath versus betadine sitz bath on episiotomy wound healing.
H2:
There will be significant correlation between neem extract sitz bath versus betadine sitz bath on episiotomy wound healing. H3
There will be significant association between the episiotomy wound healing with the selected demographic variables.
6.5 OPERATIONAL DEFINITIONS
Effectiveness:
In this study it refers to the wound healing produced in the vaginal introitus by
providing neem extract sitz bath vs betadine sitz bath.
Betadine Solution:
It is the pharmacologically available 10% povidone iodine , topical antiseptics in
readymade form.
Neem extract:
It is a solution in which 20gm of neem paste is added in one litter of boiled water
then the boiled solution is filtered and called as neem extract.
Sitz Bath:
It is a type of bath in which the episiotomy wound is soaked in some
recommended solutions about 15 to 20 minutes.
Episiotomy wound:
An incision made medially or medio-laterally to the vaginal introitus during labor
process to facilitate delivery of the fetus.
Healing:
It refers to the process of returning back towards normal apposition of muscles
and skin. Post natal mothers:
In this study, it refers to all prime mothers within 24 hours of delivery with
episiotomy.
6.6 ASSUMPTIONS
1. Post- natal mothers in experimental group will accept the neem extract sitz bath.
2. The rate of episiotomy wound healing will be higher in neem extract sitz bath
compared to betadine sitz bath.
3. Post-natal mothers in experimental group will have more satisfaction
than postnatal mothers in control group.
6.7 DELIMITATION:-
1. Mothers who had undergone episiotomy during study period.
2. Mothers who have the willing to participate in this study.
3.The study was delimited to four week period.
6.8 VARIABLES
Independent Variable: Providing neem extract sitz bath versus betadine sitz bath.
Dependent Variable: Episiotomy wound healing.
Demographic Variable: Age, Parity, Education, Occupation and Religion, source of
information, previous experience. 7.0. MATERIALS AND METHODS
This study is designed to compare the effectiveness of neem extract sitz bath versus betadine sitz bath on episiotomy wound healing among postnatal mother in a selected hospital, Bangalore.
7.1. SOURCE OF DATA
Data will be collected from the postnatal mothers with episiotomy wound at
selected hospital, Bangalore.
7.2 METHODS OF COLLECTION OF DATA
Structured questionnaire will be collecting the data regarding effectiveness of
neem extract sitz bath versus betadine sitz bath on episiotomy wound healing.
7.2.1 RESEARCH DESIGN:
Quasi Experimental research design.
7.2.2 RESEARCH APPROACH:
An evaluative descriptive approach will be used to assess the effectiveness
neem extract sitz bath versus bedatine sitz bath through comparing the outcome of
experimental and control group.
7.2.3 SETTING OF THE STUDY
The study will be conducted at a selected hospital, Bangalore.
7.2.4 POPULATION
The population in the study will comprise all postnatal mothers with episiotomy at selected hospital, Bangalore. 7.2.5 SAMPLE SIZE
A sample of the study consists of 60 postnatal mothers with episiotomy in a selected hospital, Bangalore.
7.2.6 SAMPLING TECHNIQUE
Sample (n=60) will be selected through convenient sampling technique and will be allotted 30 each in control as well as in experimental group.
7.2.7 SAMPLING CRITERIA
INCLUSION CRITERIA
The study includes postnatal mothers
. With episiotomy wound on 0 or 1st post natal day to 3rd postnatal day.
. Admitted at selected hospital, Bangalore.
. Who can able to understand Kannada and English.
. Mother who is accepts this study.
EXCLUSION CRITERIA
The study excludes postnatal mother
. Who are not available at the time of intervention
. High risk post natal mothers
. Not willing to participate in the study.
7.2.8 DATA COLLECTION TOOL
REEDA Scale. 7.2.9 DATA ANALYSIS METHOD
. The collected data will be analyzed by the descriptive and inferential analysis
. Frequency and percent will be used to describe the demographic
characteristics of post natal mothers of two groups.
. Descriptive measures such as mean, standard deviation will be used assess
post scores of two groups
. Unpaired t-test will be used to compare the post scores of two groups
. Chi-squre analysis will be carried out to bring out the association between
rate of episiotomy wound healing of post natal mothers and their demographic
characters
7.3 Does the study require any investigations or interventions to the
patients or other human beings or animals?
Yes, the neem extract sitz bath will be provided for the post natal mothers
with episiotomy at selected hospital, Bangalore.
7.4 Ethical clearance
The permission will be obtained from
-The Research committee of the Varalakshmi college of nursing
-Authorities of selected Hospital at Bangalore.
8. LIST OF REFERENCE
1. Aiien,R.E.Hoster,G.L.Smith,A.R.Warrell.Pelvic floor damage and
childbirth.British journal of obstetrics and gynaecology.1990;97, pp770-9.
2. Carroli, Blizan.Episiotomy for vaginal birth. Journal of cocharne review, The
cocharne library. Jan very.2004;3,24-32.
3. D.C.Dutta.Text book of obstetrics”, 6th edition, published by new central book
of agency, 2004,p.
4 .Biswas,Kausik.,Ishita chattopadhyay,Ranajitk,Banerjee, Uday bandyopadhyay.
Biological activities and medicinal properties of neem.jornal of current
science.2002;82(11):1336-1345.
5. Newsfindder,A literary favor to world culture. Established on June 16.2002
6. Hur.M.H,Han S.H. Clinical trial of aromatherapy on postpartum mothers
perineal healing. Tachan Kanho Hakhow chi.June 2004.
7. Anupama Dutta.Evaluate the effectiveness of moist and dry heat application on
healing of episiotomy wound. Dissertation.RGUHS.2004.
8. Molkizadeh.M, Khadivzadeh.T, Rakshandeh.H, Khajedaleui.M. Evaluation of
lavender cream effect on perineal pain and episiotomy wound healing.
9.Tejirian.T. Abbas M.A.sitz bath.Scientific basis of common practice. Diseases
of colon rectum. June 2005.
9. SIGNATURE OF THE STUDENT :
10. REMARKS OF THE GUIDE : The present study help the researcher to discover the fabulous effects of Neem leaf extracts sitz bath for episiotomy wound healing versus Betadine sitz bath;The researcher can prepare a pamphlet about proved scientific benefits of Neem leaves which will be helpful for the mother’s undergone normal delivery.
11 NAME AND DESIGNATION OF 11.1. GUIDE : Mrs. Nisha clament.Msc(N). Associate Professor, Department of Obstetric and Gynaecological Nursing. Varalakshmi College of Nursing, Bangalore. 11.2 SIGNATURE:
11.3 HEAD OF THE DEPARTMENT : Mrs. Nisha clament.Msc(N).. Associate Professor, Department of Obstetric and Gynaecological Nursing. Varalakshmi College of Nursing, Bangalore.
11.4 SIGNATURE :
12. REMARKS OF PRINCIPAL : The topic is appropriate for the specialty chosen. 12.1 SIGNATURE :