A STUDY TO ASSESS THE EFFECTIVENESS OF GUIDED IMAGERY THERAPY ON POSTPARTUM BLUES AMONG PRIMI MOTHERS IN SELECTED HOSPITALS AT COIMBATORE DISTRICT. By 30083222 DISSERTATION SUBMITTED TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI, IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING 2008-2010 CERTIFIED THAT THIS IS THE BONAFIDE WORK DONE BY 30083222 CHERRAAN’S COLLEGE OF NURSING, COIMBATORE, TAMILNADU. SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING TO THE TAMIL NADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI. COLLEGE SEAL: Mrs.RANI IRUDAYARAJ. M.Sc(N) Mphil, MBA, PRINCIPAL, CHERRAAN’S COLLEGE OF NURSING COIMBATORE. A STUDY TO ASSESS THE EFFECTIVENESS OF GUIDED IMAGERY THERAPY ON POSTPARTUM BLUES AMONG PRIMI MOTHERS IN SELECTED HOSPITALS AT COIMBATORE DISTRICT. Approved by the Dissertation Committee on ____________ RESEARCH GUIDE…………………………………….. Mrs. Rani Irudayaraj. M.Sc(N) Mphil, MBA, Principal, Cherraans College of Nursing Coimbatore. CLINICAL GUIDE ……………………………………….. Mrs. Muthukarupayee, M.Sc. (N)., OBG., Vice principal, Cherraan’s College of Nursing, Coimbatore. MEDICAL EXPERT …………………………………….. Dr.Rajini Sivakumar, M.B.B.S, D.G.O, Obstetrics & Gynaecologists, Alankrita Clinic, Kovai Pudur Pirivu, Coimbatore. A DISSERTATION SUBMITTED TO THE TAMILNADU Dr. M.G.R. MEDICAL UNIVERSITY, CHENNAI IN PARTIAL FULFILMENT OF THE REQUIREMENT FOR THE DEGREE OF MASTER OF SCIENCE IN NURSING MARCH - 2010. ACKNOWLEDGEMENT “ It is God doing marvelous in my eyes” First and the foremost, I extremely thank the lord almighty for his help and blessing on me during my study period. He is the source of the strength and inspiration in every walk of my life and the foundation of knowledge and wisdom. I express my heartfelt thanks to honourable, Mr. K.C.PALANISAMY, B.E. (Agri), Chairman of Cherraan;s Institute of Health Science. I proudly express my deep sense of gratitude and indebtedness to Prof. Mrs.RANI IRUDAYARAJ, M.Sc(N) Mphil, MBA, Principal of Cherraan’s college of Nursing for her excellent suggestions, valuable guidance, constant encouragement throughout this study. I express my gratitude and sincere thanks to my research guide, Prof. MUTHU KARUPAYEE, M.Sc. NSg (OBG)Vice Principal, HOD, Obstetric and Gynaecology nursing, Cherraan’s college of Nursing, for her valuable and patience guidance, kind encouragement, patience correction and valuable suggestion throughout my endeavor. I extend my thanks to Mr. SURESH, M.Sc.(N), co- ordinator, HOD Medical Surgical Nursing, Cherraan’s College of Nursing, Coimbatore, for his guidance, kind encouragement, patience correction and valuable suggestions and motivation throughout the study period. I owe deep grateful and heartful thanks to Mrs. LINDSIE MARY .L.M.Sc. NSg (OBG)., Lecturer, Cherraan’s College of Nursing, Coimbatore, for her valuable guidance, patience correction and valuable suggestions, encouragement, motivation and support throughout my endeavor. I profusely thank my medical guide Dr. Rajini Sivakumar.M.B.B.S, D.G.O Obstetrics & Gynaecology, Alankrita Clinic for the profound interest taken to guide me in my research study. I express my sincere thanks to all the experts for their valuable guidance, suggestion and patience corrections. I express my gratitude and sincere thanks to Prof. Dr.RATHINASWAMY Managing trustee, Sakthi hospital for granting permission to conduct the study in his esteemed institution. I sincerely express my heartful thanks to Dr. ANANDI, Medical officer, Sundakamuthur PHC for granting permission to conduct the study in the PHC. I wish to express my sincere thanks to Bio – Statistician Mr. RAVISHANKAR. Ph.d carrying out statistical analysis of the data. The investigator whishes to thank the respondents from Sundakamuthur and Gandipuram at Coimbatore district who participated in the study willingly and gave full co-operation during data collection. I express my sincere thanks to librarian Mrs.VASANTHI Cherraan’s college of nursing, Coimbatore, and Dr. M.G.R. Medical university, Chennai for their co-operation. My heartfelt gratitude to Mrs. MANJURI RAJESH, M.Sc. NSg. (OBG) Principal incharge SSSIHMS college of nursing, Mrs.SELVARANI.M.Sc.Nsg.(OBG) and Mrs.HEPZIBAH M.Sc.Nsg.(Medsurg)for their guidance, motivation and patience correction and encouragement throughout the study period. I owe much to my friends Mrs. VASUMATHI, M.Sc. NSg (Paed), Ms. MANJU .S.K and Mrs. SUGANTHI for their guidance, support and help throughout the study. A work of commendation is expressed to Mr. MARUTHAMUTHU,M.A.,Mphil. For editing this manuscript. My thanks are extending to the B.Sc. Nsg students 2009 out going batch who helped me to make the audio CD. I express my sincere thanks to Mr.DEVASIGAMANI for his technical assistant . I express my grateful thanks to my lovable mother Mrs. A.SAKUNTHALA and loveable brother Mr. ADITHYAA SANKAR for their constant support, prayer and motivation and evergreen memorable help throughout my life. I dedicate this study to my lovable mother and brother who always wanted me to be in higher position in my life. Above all the investigator owes her success to almighty. ABSTRACT To assess the effectiveness of guided imagery therapy on post partum blues among primi mothers in selected hospital at Coimbatore district, was conducted by 30083222 as a partial fulfillment of requirement for the degree of Master of Science in Nursing at college of nursing, Cherraan’s institute of health science Coimbatore affiliated to the Tamil nadu Dr. M.G.R. Medical university, Chennai. OBJECTIVES 1) To assess the level of post partum blues among primi mothers in experimental group and control group. 2) To assess the effectiveness of guided imagery therapy on post partum blues among the primi mothers in experimental group and control group. 3) To associate the post test post partum blue score with demographic variables in experimental group. 4) To associate the post test post partum blue score with selected demographic variables in control group. HYPOTHESIS H1 :There will be a significant difference in the levels of post partum blues among primi mothers in experimental group and control group. H2 : There will be a significant difference in the post test finding on postpartum blues among primi mothers in experimental group and control group. H3 :There will be a significant association between the post test findings on post partum blues with the demographic variables among primi mothers in experimental group. H4 : There will be a significant association between the post test findings on post partum blues with the demographic variables among primi mothers in control group. The investigator organized the review of literature under three sections as follows, studies related to post partum blues, studies related to guided imagery therapy, studies related to effectiveness of guided imagery therapy on post partum blues. The conceptual frame work for the study was based on nursing process model. RESEARCH METHODOLOGY The research design used was quasi - experimental design (post test only control group design) sample size was 60 primi mothers. 30 experimental group and 30 control group. The samples were selected by using convenience sampling method. Modified AM I BLUE self rating post partum blues scale was used for data collection, which was a standardized tool and modified by the investigator after the expert suggestion. The data collection tool was validated by five expert, reliability was established by Karl Pearson’s method (r=0.9) the main study was conducted in Sundakamuthur PHC and Sakthi hospital at Coimbatore. The data collected were tabulated, analyzed and interpreted by using micro soft excel-2007. Inferential statistic was used to evaluate the effectiveness of the guided imagery therapy on pregnancy, child birth process and new born care among primi mothers after 36 weeks of pregnancy ( student ‘t’ test, χ2). Student ‘t’ test was adopted to find out the significant difference between experimental group and control group post partum blues score. χ2 is used to assess the association between the experimental group and control group and demographic variables of the primi mothers. RESULTS AND DISCUSSION In the experimental group after the Guided Imagery Therapy majority 25(83.33%) of the primi mothers had mild post partum blues, where as in control group majority 23(76.66%) had moderate blues. In experimental there is no significant relationship between the demographic variables and guided imagery on post partum blues except for age limit at p<0.05 level. In control group there is significant relationship for income, religion and type of marriage at p<0.05 level. CONCLUSION There was significant difference in guided imagery on post partum blues among experimental group of primi mothers. So the guided imagery therapy was independently effective in reducing post partum blues except the age limit in experimental group. So the guided imagery therapy was effective. TABLE OF CONTENTS S.No. Content Page No. I INTRODUCTION 1-11 Back ground of the study 1 Need for the study 3 Statement of the problem 7 Objectives 7 Hypothesis 7 Operational definition 7 Assumptions 8 Delimitations 8 Conceptual frame work of the study 9 II REVIEW OF LITERATURE 12- 27 1) Studies related to post partum blues 12 2) Studies related to guided imagery 21 3) Studies related to effect of guided imagery on post partum 26 blues. III METHODOLOGY 28-36 Research Approach 28 Research design 28 Variables 31 Setting of the study 31 Population 31 Sample 32 Sample size 32 Sampling criteria 32 Development of tool 33 Description of the tool 33 Scoring 34 Validity of the tool 34 Validating audio CD 34 Try out 34 S.No. Content Page No. III Reliability of the tool 34 Description about guided imagery 35 Data collection procedure 35 Plan for data analysis 36 Ethical issues 36 IV DATA ANALYSIS AND INTERPRETATION 37-54 1) Data on demographic variables of primi postnatal mothers both 38 experimental and control group.