DISSERTATION ON A STUDY TO ASSESS THE EFFECTIVENESS OF LOWER BACK MASSAGE AND BREATHING EXERCISES ON REDUCTION OF ANXIETY AND PAIN PERCEPTION AMONG PRIMIGRAVIDA MOTHERS DURING FIRST STAGE OF LABOUR AT DEEPAM HOSPITAL LIMITED, TAMBARAM, CHENNAI. M.SC. (NURSING) DEGREE EXAMINATION BRANCH-III OBSTETRICS AND GYNAECOLOGICAL NURSING PADMASREE COLLEGE OF NURSING WALAJABAD-631605. A Dissertation submitted to THE TAMIL NADU DR. M.G.R. MEDICAL UNIVERSITY, CHENNAI-600 032. In partial fulfillment of the requirements or the degree of MASTER OF SCIENCE IN NURSING OCTOBER 2018 1 CERTIFICATE This is to certify that this dissertation titled, “A study to assess the Effectiveness of lower back massage and breathing exercises on reduction of anxiety and pain perception among primigravida mothers during first stage of labour at Deepam Hospitals Limited, Tambaram, Chennai” is a bonafide work done by Ms.Uma Ranga, M.Sc (N) II year, Padmasree College of Nursing, Walajabad submitted to The Tamil Nadu Dr.M.G.R. Medical University, Chennai in partial fulfillment of requirements for the award of the degree of Master of Science in Nursing, Branch-III, Obstetrics and Gynaecological Nursing under our guidance and supervision during the academic period from 2016-2018. Dr.Mrs.K.Menaka, M.Sc (N)., Ph.D., Principal, Padmasree College of Nursing, Walajabad, Kanchipuram-631605. 2 A STUDY TO ASSESS THE EFFECTIVENESS OF LOWER BACK MASSAGE AND BREATHING EXERCISES ON REDUCTION OF ANXIETY AND PAIN PERCEPTION AMONG PRIMIGRAVIDA MOTHERS DURING FIRST STAGE OF LABOUR AT DEEPAM HOSPITAL LIMITED, TAMBARAM, CHENNAI. Approved by the Ethical Committee on ___________ Research Guide Dr.Mrs.K.Menaka, M.Sc (N)., Ph.D., _____________ Principal, Padmasree College of Nursing, Walajabad, Kanchipuram-631605. Clinical Specialty Guide Mrs.D.Thatchayani, M.Sc(N)., MBA (HM)., _____________ Associate Professor, Department of Obstetrics and Gynaecology, Padmasree College of Nursing, Walajabad, Kanchipuram-631605. Medical Expert Dr.Jayasree, M.B.B.S., DGO, _____________ Managing Director, APJ Hospital, Walajabad. A Dissertation submitted to THE TAMIL NADU DR .M. G. R MEDICAL UNIVERSITY CHENNAI -600032. In partial fulfilment of requirement for the award of degree of MASTER OF SCIENCE IN NURSING OCTOBER 2018 3 ACKNOWLEDGEMENT Praise and thanks to the God almighty who is the source of wisdom and knowledge, whose blessing and inspiration guided me throughout the course of this study end to submit the dissertation in time. I reveal my sense of gratitude to the management of Padmasree College of Nursing, Walajabad, Founder Mr.V.Rishikesavan, Managing Director, Mrs.R.Malliga Rishikesavan, Chairman, Mr.R.Dinesh Kumar, ME., MBA., for their encouragement to complete the study. I wish to express my heartfelt thanks to Dr.K.Menaka, M.Sc (N)., Ph.D., Principal, Padmasree College of Nursing, Walajabad, for their guidance and valuable suggestions and encouragement in conducting the study constant support at every stage of the strudy which enable her in giving shape to this study. I express my sincere thanks to Prof.T.V.Malliga, M.Sc (N)., Vice Principal of Padmasree, College of Nursing, Walajabad for her constant guidance, suggestions to complete the study in time. I express my gratitude to Mrs.D.Thatchayani, M.Sc(N)., MBA (HM)., Associate Professor, Department of Obstetrics and Gynaecology, Padmasree College of Nursing, Walajabad for her constant guidance, valuable suggestions, helped me a lot in the completion of this study. It is my please and privilege to express my deep sense to gratitude to Dr.Pandian, MD., Former Director of Deepam Hospitals Limited, Tambaram, Chennai for permitting me to condut the study. I am immensely grateful to Dr.Jayasree, M.B.B.S., DGO, Managing Director, APJ Hospital, Walajabad for constant guidance, sustained patients, valuable suggestions in the successful completion of this study. 4 It is my duty to express my heartfelt thanks to Associate Professor of Padmasree College of Nursing, Ms.L.Periyanayagi, M.Sc (N)., MBA., Mrs.D.Thatchayani, M.Sc (N)., Mrs.L.Mohana, M.Sc (N)., Mrs.J.Bharathi, M.Sc (N)., for their valuable guidance, moral support and encouragement in conducting & submitting this study. I express my thanks to Mrs.J.Gayathri Devi, M.Sc (N)., and Mrs.Dharani, M.Sc(N)., Assistant Professors, Padmasree College of Nursing for their support and guidance for the study. It is a pleasure and privilege to express deep sense of gratitutde to all medical and nursing experts for validity of the tool and their guidance of the study Prof.Mrs.V.Praba, RN, RM., M.Sc(N)., M.Sc (Psychology), Vice Principal, Arun College of Nursing, Vellore. I acknowledge my sincere thanks to Mr.Muthuraman, M.Sc (Biostatistics), Lecturer in Statistics, Padmasree College of Nursing for his valuable suggestion and guidance in the data analysis and presentation. I express my special thanks to Librarian of the Tamilnadu Dr.MGR Medical University and Mrs.Tamilselvi, Librarian of Padmasree College of Nursing, Walajabad. Finally, I acknowledge the people who mean a lot to me, my parents and my family members for their love and unconditional support. My special thanks to all my friends who gave me support and throught the study. Lastly, I express my thanks to one and all who directly or indirectly helped in a successful completion of this dissertation. 5 TABLE OF CONTENTS Chapter TITLE Page No I INTRODUCTION 1 1.1 Need for the study 2 1.2 Statement of the Problem 6 1.3 Objectives 6 1.4 Operational definition 7 1.5 Assumption 8 1.6 Hypothesis 8 II REVIEW OF LITERATURE 2.1 Review of related literature 9 2.2 Conceptual frame work 25 III RESEARCH METHODOLOGY 3.1 Research Approach 26 3.2 Research Design 26 3.3 Variables 26 3.4 Setting of the study 27 3.5 Study population 27 3.6 Sample 28 3.7 Sample size 28 3.8 Sampling Technique 28 3.9 Criteria for sample selection 28 3.10 Development and description of the tool 29 3.11 Ethical consideration 29 3.12 Testing of the tool 29 3.12.1 Content Validity 29 3.12.2 Pilot Study 30 3.12.3 Reliability 30 3.13 Data Collection Procedure 30 3.14 Plan for data analysis 31 6 Chapter TITLE Page No IV DATA ANALYSIS AND INTERPRETATION 33 V DISCUSSION 81 VI SUMMARY& CONCLUSION 6.1 Summary 88 6.2 Major findings 88 6.3 Implication of the study 90 6.4 Recommendations 92 6.5 Conclusion 92 REFERENCE APPENDICES 7 LIST OF TABLES Table Page Title No. No. 1. Demographic profile 34 2 Obstetrical History 40 3. Pre-test level of Anxiety between experimental and 44 control group 4. Pre-test level of pain score between experimental 46 group and control group 5. Post-test level of Anxiety between experimental 48 and control group 6. Post-test level of pain score between 50 experimental and control group 7. Pre-test and post-test level of Anxiety 52 8 Comparison of Anxiety score 53 9 Pre-test and post-test level of pain 54 10 Comparison of Pain score 55 11 Effectiveness of Lower back massage, breathing 56 exercises on anxiety 12 Effectiveness of Lower back massage, breathing 57 exercises on pain reduction 13 Correlation between anxiety score and pain score 59 14 Association between level of Anxiety reduction 60 score and demographic variables (Experimental Group) 15 Association between level of Anxiety reduction 64 score and Obstetrical variables (Experimental Group) 16 Association between level of Anxiety reduction 68 score and demographic variables (Control Group) 8 Table Page Title No. No. 17 Association between level of Anxiety reduction 70 score and Obstetrical variables (Control Group) 18 Association between level of Pain reduction score 71 and demographic variables (Experimental Group) 19 Association between level of Pain reduction score 75 and Obstetrical variables (Experimental Group) 20 Association between level of pain reduction score 78 and demographic variables (Control Group) 21 Association between level of Anxiety reduction 80 score and Obstetrical variables (Control Group) 9 LIST OF FIGURES Figure Page Title No. No. 1. Conceptual Frame work of Roy’s Adaptation 25 Model (1984)shows effectiveness of back massage 2. Schematic Representation of Research Design 32 3. Distribution of mothers according to their age 37 4. Distribution of mothers according to their 38 educational status 5. Distribution of mothers according to their 39 monthly income 6. Distribution of mothers according to their 41 Gestational age 7. Distribution of mothers according to their 42 menstrual cycle 8. Distribution of mothers according to their 43 Antenatal visit 9. Pre-test level of anxiety between experimental 45 and control group 10 Pre-test level of pain score between experimental 47 and control group 11 Post-test level of anxiety between experimental 49 and control group 12 Post-test level of pain score between 51 experimental and control group 13 Correlation between posttest anxiety score and 59 posttest pain score 14 Association between level of anxiety reduction 62 and age in Experimental group 15 Association between level of anxiety reduction 63 and type of family 10 Figure Page Title No. No. 16 Association between level of anxiety reduction 66 and menstrual cycle 17 Association between level of anxiety reduction 67 and number of antenatal visit 18 Association between level of pain reduction and 73 mother’s age 19 Association between level of pain reduction and 74 mother’s educational status 20 Association between level of pain reduction and 76 mother’s menstrual cycle 21 Association between level of pain reduction and 77 number of antenatal visit 11 LIST OF APPENDICES S. No. Appendices 1. Tool for Data Collection 2. Ethical Committee Approval Letter 3. Content validity certificates. 4. Letter seeking permission to conduct the study 5.