1 EFFECTIVENESS OF PACED BREATHING ON LABOR PAIN PERCEPTION AMONG PRIMI MOTHERS DURING FIRST STAGE OF LABOR IN A SELECTED HOSPITAL, KANYAKUMARI DISTRICT 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 OBSTETRICS AND GYNAECOLOGICAL NURSING APRIL 2014 2 CERTIFICATE Certified that this is a bonafide work of Mrs REMYA S. NAIR, final year M.Sc., (Nursing) student of St Xavier‘s Catholic College of Nursing, Chunkankadai, submitted in partial fulfilment of the requirement for the Degree of Master of Science in Nursing to The Tamil Nadu Dr. M. G. R. Medical University, Chennai under the Registration No. 301221902. College Seal: Signature of the Principal: __________________________________ Dr. A. Reena Evency, M. Sc., (N), Ph.D., (N), Principal, St. Xavier‘s Catholic College of Nursing, Chunkankadai, Nagercoil, Kanyakumari District, Pin Code- 629 003. 3 EFFECTIVENESS OF PACED BREATHING ON LABOR PAIN PERCEPTION AMONG PRIMI MOTHERS DURING FIRST STAGE OF LABOR IN A SELECTED HOSPITAL, KANYAKUMARI DISTRICT Approved by the dissertation committee on: 27th December 2012 Professor in Nursing Research: ________________________________ Dr. A. Reena Evency, M. Sc., (N), Ph.D., (N), Principal, St. Xavier‘s Catholic College of Nursing, Chunkankadai, Nagercoil, Kanyakumari District, Pin Code- 629 003. Clinical Speciality Guide : _________________________________ Mrs. S. Anita Mary Leena, M. Sc., (N), Head of the Department, Obstetrics and Gynaecological Nursing, St. Xavier‘s Catholic College of Nursing, Chunkankadai, Nagercoil, Kanyakumari District, Pin Code- 629 003. Medical Expert : __________________________________ Dr. F. Caroline Felicia Mary, M.D. DGO. Director and Consultant, Caroline John Hospital, Asaripallam Road, Nesamony Nagar, Nagercoil Pin Code- 629 001. ___________________________ __________________________ Signature of the Internal Examiner Signature of the External Examiner with date with date 4 ACKNOWLEDGEMENT I wish to express my humble and sincere gratitude to God Almighty for his endless grace, love, care and blessings showered on me to complete and present this Dissertation successfully. I express my heartfelt thanks to Rev. Fr. Dominic M. Kadatchadhas, Correspondent and Rev. Fr. Dr. Maria William, Co-correspondent, St. Xavier‘s Catholic College of Nursing, Chunkankadai for their encouragement at each level of this study. I express my heart felt gratitude to Dr. A. Reena Evency, M. Sc., (N), Ph.D., (N), Principal, St. Xavier‘s Catholic College of Nursing, Chunkankadai for her valuable support, suggestions and immense direction for conducting this study in a successful way. I express my respectful thanks to Mr A. George Joe Kumar, M. Sc., (N)., Vice Principal and II year MSc., (N) Class Co-ordinator, St. Xavier‘s Catholic College of Nursing, Chunkankadai for his valuable suggestions and continuous support which made my study smooth and successful. I express my sincere and exclusive thanks to my clinical speciality guide Mrs S. Anita Mary Leena, M. Sc., (N)., Head of the Department of Obstetrics and Gynaecological Nursing, for her constant support, suggestions and catalytic encouragement at each level which enabled me to complete this study successfully. I express my sincere thanks to Dr. A. Judie, M. Sc., (N), Ph. D., (N), Dean, S R M College of Nursing for her valuable suggestions and support. It is the most pleasant time to express my sincere and exclusive thanks to Mrs Jenila, M.Sc., (N), Ms Brinda, M.Sc.,(N), Mrs Ajitha Mini, M.Sc., (N), Mrs Nancy Mary, M.Sc.,(N), Mrs Shiny Mary, M.Sc.,(N) and Mrs Amalit Vimala, M.Sc., (N) Lecturers of the Department of Obstetrics and 5 Gynaecological Nursing for their innovative and constant effort to ensure the best quality in my work, which helped me to do my study in a wonderful and fruitful manner. I extend my sincere thanks to Dr. G. Immanuel, Ph.D., Biostatistician, for his support and guidance in statistical analysis and interpretation of data. I express my sincere gratitude to Dr F. Caroline Felicia Mary, M.D,DGO, Director and Consultant, Caroline John Hospital, for validating the tool and for her constant guidance and valuable suggestions. I am grateful to Dr. Felsit Punitha, M.D. DGO, Obstetric Consultant, P.P.K. Hospital, Marthandam, who gave me the opportunity to do the data collection in their hospital and also I extend my heartfelt gratitude to The Management of P.P.K. Hospital, Marthandam, for giving me permission to conduct this study. I wish to express my sincere thanks to the participants of this study and staff nurses of P.P.K Hospital for their co-operation and best wishes. I also express my special thanks to Mrs Selestine Mary and Mrs Sweety, Librarians of St. Xavier‘s Catholic college of Nursing, for helping me to review and for extending library facilities throughout the study. I express my special thanks to Print land computer centres, Nagercoil for their excellent and untiring effort in materializing my dissertation work. I would like to express my deep felt gratitude to my Parents Mr K.K. Sreekantan Nair, Mrs Geetha, my brother Mr Rahul, my mother-in- law Mrs Valsala, my beloved husband Mr Jitheesh Kumar and all my family members for their fruitful prayers, endless patience, inspiration and support throughout this endeavour. (REMYA S. NAIR) 6 TABLE OF CONTENTS CHAPTER CONTENT PAGE NO I INTRODUCTION 1-14 Background of the study 3 Need for the study 7 Statement of the problem 9 Objectives 9 Hypotheses 10 Assumptions 10 Operational definitions 10 Delimitations 11 Projected out come 11 Conceptual frame work 12 15-21 II REVIEW OF LITERATURE Studies related to first stage of labor 15 Studies related to pain relief during first stage 17 of labor Studies related to Paced breathing exercise 19 Studies related to Paced breathing on Labor 20 pain perception 7 III RESEARCH METHODOLOGY 22-28 Research approach 22 Research design 22 Variables 23 Setting 23 Population 23 Sample 23 Sample size 23 Sampling technique 23 Criteria for sample selection 24 Description of tool 24 Description of Intervention 25 Content validity 25 Reliability 25 Pilot study 25 Data collection procedure 26 Plan for data analysis 28 Protection of human rights 28 IV DATA ANALYSIS AND INTERPRETATION 29-50 V DISCUSSION 51-54 VI SUMMARY, CONCLUSION, IMPLICATIONS AND RECOMMENDATIONS 55-59 REFERENCE 60-63 ANNEXURES i -xv 8 LIST OF TABLES TABLE TITLE PAGE NO. Data collection period, number of samples and 3.1 27 method of sample selection Frequency and percentage distribution of primi 4.1 30 mothers according to the demographic variables Frequency and percentage distribution of primi 4.2 mothers according to the pre and post test level of 41 pain perception in Study and Control group Comparison of pre test and post test scores of paced 4.3 breathing on level of labor pain perception among 44 primi mothers in Study and Control group Comparison of post test scores of paced breathing on 4.4 level of labor pain perception among primi mothers 46 in Study group and Control group. Association between the post test level of pain 4.5 perception with their Selected demographic variables 48 in Study group and Control group 9 LIST OF FIGURES FIGURE TITLE PAGE No. Conceptual Framework based on Ludwig Von 1.1 Bertalanffy (1968), as cited by Christensen J. Paula 14 and Kenny W. Janet (1995) General System model Percentage distribution of primi mothers according 4.1 34 to the age of the mother Percentage allocation of primi mothers according to 4.2 35 the Religion Percentage dispersion of primi mothers according to 4.3 36 Education Percentage scattering of primi mothers according to 4.4 37 Occupation Percentage distribution of primi mothers according to 4.5 38 Family monthly income Percentage allocation of primi mothers according to 4.6 39 Area of residence Percentage scattering of primi mothers according to 4.7 40 the type of family Distribution of primi mothers according to the pretest 4.8 42 level of pain perception in Study and Control group Distribution of primi mothers according to the post 4.9 test level of pain perception in Study and Control 43 group Comparison between pre test and post test level of 4.10 pain perception in Study group and Control group. 45 Comparison between the post test level of pain 4.11 47 perception in Study group and Control group 10 LIST OF ANNEXURES ANNEXURES TITLE PAGE No Letter seeking permission to conduct the research I study i II Letter granting permission to conduct the study ii Letter requesting opinion and suggestion of experts for III content validity of the research tool iii IV Evaluation criteria check list for tool validation iv V List of experts who validated the tool vii VI Certificate of Editing viii VII Tool for data collection ix-xi VIII Formulas used for statistical analysis xii IX Certificate of statistical analysis and interpretation xiii X Paced breathing exercise xiv Photograph of paced breathing exercise XI xv 11 ABSTRACT An experimental study was conducted to evaluate the effectiveness of paced breathing on labor pain perception among primi mothers during first stage of labor in a selected hospital, Kanyakumari District. The investigator used true experimental pre test post test Control group design with sample size 60 by Simple random sampling technique (Lottery method), and Numerical pain scale as the tool for assessing the level of labor pain perception. Paced breathing exercise taught for the Study group and the