The Genesis ISSN 2395-2164 Volume: 5 Issue: 3 July – September – 2018 an2015

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EVALUATING THE EFFECTIVENESS OF HOT APPLICATION ON PERINEOTOMY WOUND HEALING AND PAIN AMONG POSTNATAL MOTHERS

Mrs. Kalaiselvi, T. *| Dr. Chandra Prakash Sharma ** * Ph.D. Scholar at Himalayan University, Itanagar, Arunachal Pradesh, India

** Ph.D. Guide at Himalayan University, Itanagar, Arunachal Pradesh, India

ABSTRACT

A real experimental study was conducted to gauge the effectiveness of Hot Application on perineotomy wound

healing and pain among postnatal mothers in an especially hand-picked hospital at Kanyakumari district of Tamil

Nadu. The study was conducted among postnatal mothers in St. George Mission Hospital, CSI hospital and JK

Hospital, Nagercoil, Tamil Nadu. The sample size was sixty of which thirty were assigned to control cluster, thirty were

assigned to experimental cluster. The standardised REEDA and Numerical pain rating scale was used for the study. Hot

application with permanganate bathing tub was given for the experimental cluster for three days while the control

cluster received solely routine care. Post-test evaluation was conducted on the third day by employing REEDA scale

and Numerical pain rating scale for every cluster. The information gathered was analysed by descriptive and

inferential statistics and interpretation made was supported the objectives of the study., The result revealed, 20

(66.66%) postnatal mothers had delicate wound healing and 10 (33.33%) postnatal mothers had moderate wound

healing in the experimental cluster; whereas in the control cluster 14 (46.66%) postnatal mothers had delicate wound

healing, 8 (26.66%) postnatal mothers had moderate wound healing and 8 (26.66%) postnatal mothers had poor

wound healing. As regards perineotomy pain 22 (73.33%) postnatal mothers had delicate pain and 8 (26.66 %)

postnatal mothers had moderate pain in the experimental cluster; whereas in the control cluster 16 (53.33%)

postnatal mothers had delicate pain, 9 (30.00%) postnatal mothers had moderate pain and 5 (16.66%) postnatal

mothers had severe pain. The findings discovered that the post-test mean wound healing score among postnatal

mothers in the experimental cluster, was 4.7 and mean SD was 1.639; whereas in the control cluster the post-test

mean wound healing score was 6.01 and SD was 3.814. The calculated ‘t’ check value was 13.890 which is significant

at P<0.05 level. In the experimental cluster, the mean post-test, pain score was 3.82 and mean SD was 1.437 whereas

in the control cluster the mean post-test pain score was 4.08 and SD was2.137. The calculated ‘t’ check value was

15.946 which is considered significant at P<0.05 level. It revealed that the hot application was effective in

perineotomy wound healing and in reduction of pain among postnatal mothers.

Keywords: Hot Application, Perineotomy wound healing, Pain, Postnatal mothers.

About Authors

Author Mrs. Kalaiselvi, T. is a Ph.D. Scholar at Himalayan University in Itanagar in the Indian state of Arunachal

Pradesh.

.

Author Dr. Chandra Prakash Sharma is Ph.D Guide at Himalayan University in Itanagar in the Indian state of Arunachal

Pradesh.

The Genesis ISSN 2395-2164 Volume: 5 Issue: 3 July – September – 2018 an2015

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INTRODUCTION

Giving birth may be a powerful and dynamic life event with an enduring impact on girls and their families. Each girl

that becomes pregnant has got to bear the phenomenon of delivery. Typically, it should be traditional or aided by

vacuum extractor or by caesarean section. In traditional method of delivery, the baby is delivered through the birth

canal, often complemented by perineotomy (surgical incision of the perineum) performed by healthcare provider or

nurse/ midwife.

The World Health Organisation (WHO) recommends perineotomy rate of 100% for traditional deliveries. Though the

frequency of practice of perineotomy is decreasing, thirty percent to fifty percent of girls should still be receiving

perineotomy.

The rate of perineotomy varies between 8% in Holland and ninety nine percent in Japan and Europe. Asian girls are

more likely to want perineotomy compared to non-Asian girls as asian skin tends not to stretch as much as the

Caucasians. Perineal trauma in case of duct delivery is quite common occurrence in one in four-hundred cases among

primigravidae and one in two hundred cases among multiparous girls.

Perineotomy may be a common surgical planned incision of the perineum and the posterior vaginal wall usually

performed during second stage of labour to quickly enlarge the vaginal opening for the foetus to pass through, to

reduce over stretching and rupture of area muscles and fascia and to scale back the stress and strain on the craniates’

head. Perineotomy is conjointly useful in reduction in length of second stage of labour. The first performance of

perineotomy was done in 1742, whence perineal incisions were used to facilitate deliveries. According to Journal of

American science [2012] most ladies have a point of discomfort throughout the first few postnatal days. One usually

common cause of discomfort is perineotomy. Nursing interventions are supposed to scale back the discomfort and

provide the girl with required care of herself and her baby. Straight forward interventions that may decrease the

discomfort related to perineal trauma include applying ice pack, wet or dry or topical applications, cleansing the

region with a squeeze bottle and taking a heat shower or using a bathing tub.

A similar experimental study was undertaken to assess the effectiveness of medicated and non-medicated bathing

tub for perineotomy wound healing among postnatal mothers at Govt. SMGS hospital, Jammu (J&K). The sample

consisted of forty postnatal mothers (20 in experimental and twenty on control group). Purposive sampling technique

was employed to choose the sample. Socio-demographic profile, medical REEDA scale were employed to collect the

information from the subjects. The results discovered that medicated and non-medicated bathing tubs are both

equally effective in perineotomy wound healing among postnatal mothers. Thus, bathing tub, either medicated or

non-medicated ought to be familiarised among post natal mothers to hasten perineotomy wound healing and

smoother recovery of postnatal mothers.

Hence, it's necessary that tending professionals, who attend to new puerperas, must have adequate knowledge to

assess and treat perineal pain and perineotomy wound healing. Considering the high rates of perineal tear trauma

following vaginal deliveries, an attempt is made to offer patient treatment alternatives for alleviating perineal pain

and wound healing, supported by scientific proofs. The current study is an endeavour towards this direction.

OBJECTIVES

1. To assess the post-test effectiveness of Hot Application on perineotomy wound healing and pain among

postnatal mothers in both experimental and control cluster.

2. To compare the important post-test distinctions between the experimental cluster and control cluster in respect

of perineotomy wound healing and pain among the postnatal mothers.

3. To find post-test the association between perineotomy wound healing and pain among the postnatal mothers in

both experimental and control cluster with their hand-picked demographic variables such as age of the mother,

her parity, educational status, occupation, type of family, indication of perineotomy, and kinds of perineotomy.

The Genesis ISSN 2395-2164 Volume: 5 Issue: 3 July – September – 2018 an2015

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METHODOLOGY

Research approach

Quantitative analysis approach was used for the study.

Research Style

The study utilised true experimental style (Post-test only control design)

Cluster Intervention Post-test

E R X O2

C R - O2

E Experimental cluster

C Control cluster

R Randomisation

X Hot application by potassium permanganate

O2Post-test

Setting of the study

The study was conducted in CSI Hospital, JK Hospital and George Mission Hospital, Nagercoil, Tamilnadu, India.

Population

Target population: Postnatal mothers

Accessible population: Postnatal mothers at CSI Hospital, JK Hospital and George Mission Hospital, Nagercoil.

Sample

Sample consists of postnatal mothers who had delivered by traditional vaginal deliverieswithperineotomy. fromCSI

Hospital, JK Hospital and George Mission Hospital, Kanyakumari District, Tamilnadu.

Sample Size

Sample size consisted of 60 postnatal mothers who fulfilled the inclusion criteria from CSI hospital, JK Hospital and

George Mission Hospital – Kanyakumari district [30 in Experimental cluster and 30 in control cluster]

Sampling technique

Probability, Simple random sampling technique was used.

Description of the tool

The tool consisted of 3 parts

Part-1: Assessment of demographic variables

Part-2: It consisted of REEDA scale to assess the episiotomy wound healing.

Part-3: It consisted of Numerical pain rating scale to assess the pain.

Level of Episiotomy Wound healing:

LEVEL OF WOUND HEALING SCORE

Good wound healing 0

Mild wound healing 1 - 5

Moderate wound healing 6 - 10

Poor wound healing 11 - 15

Level of pain

The level of pain among postnatal mothers was assessed employing Numerical pain rating scale

The Genesis ISSN 2395-2164 Volume: 5 Issue: 3 July – September – 2018 an2015

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Scoring key:

Score Category of Pain

0 No pain

1 to 3 Mild pain

4 to 6 Moderate pain

7 to 9 Severe pain

10 Worst pain.

Method of data collection

Step 1: Getting permission

Step 2: Intervention given for 3 days, 3 times a day

Step 3: Post-test assessment of wound healing and pain

Data analysis and interpretation

I. Assess the extent of wound healing using REEDA scale

Frequency and proportion distribution of post-test levels of perineotomy wound healing among the postnatal

mothers in experimental and control cluster

N=30+30= 60

Sl. No. Extent of Wound Healing Experimental Cluster Control Cluster

FREQUENCY PERCENTAGE FREQUENCY PERCENTAGE

1. Mild wound healing 20 66.66 14 46.66

2. Moderate wound healing 10 33.33 08 26.66

3. Poor wound healing ― ― 08 26.66

The above table reveals that, 20 (66.66%) postnatal mothers experienced mild wound healing and 10 (33.33%)

postnatal mothers had moderate wound healing in experimental cluster; whereas in control cluster 14 (46.66%)

postnatal mothers had mild wound healing, 08 (26.66%) postnatal mothers had moderate wound healing and 08

(26.66%) postnatal mothers had poor wound healing.

II. Assess the level of pain using numerical visual analogue pain scale.

Post-test frequency and proportional distribution of perineotomy pain among the postnatal mothers in

experimental and control cluster.

N=30+30= 60

Sl. No. Level of Pain Experimental Group Control Group

Frequency Percentage Frequency Percentage

1. Mild Pain 22 73.33 16 53.33

2. Moderate Pain 08 26.66 09 30.00

3. Severe pain - - 05 16.66

The table above shows that 22 (73.33%) postnatal mothers had mild pain and 8 (26.66%) postnatal mothers had

moderate pain in the experimental cluster; whereas in the control cluster 16 (53.33%) postnatal mothers had mild

pain, 09 (30.00%) postnatal mothers had moderate pain and 5 (16.66%) postnatal mothers had severe pain.

The Genesis ISSN 2395-2164 Volume: 5 Issue: 3 July – September – 2018 an2015

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Comparison of the important distinction between experimental and control clusters among the postnatal mothers

in respect of perineotomy wound healing and pain.

N=30+30= 60

POST TEST EXPERIMENTAL CLUSTER CONTROL CLUSTER PAIRED ’t’ VALUE

Mean SD Mean SD

Perineotomy wound healing 4.7 1.639 6.01 3.814 13.890*

Pain 3.82 1.437 4.08 2.137 15.946*

* Significant at P < 0.05

The table above reveals that the mean post-test score of wound healing in the experimental cluster was 4.7 with

standard deviation 1.639 and the mean (post-test) score of wound healing in the control cluster was 6.01 with

standard deviation 3.814. The ‘t’ check value was 13.890 which was significant at P<0.05 level. The mean post-test

pain score in the experimental cluster was 3.82 with standard deviation 1.437 and that (post-test pain score) in the

control cluster was 4.08 with standard deviation 2.137. The ‘t’ check value was 15.946 which was significant at P<0.05

level. Thus it becomes evident that hot application was effective in wound healing and reduction of perineotomy pain

in the experimental cluster.

CONCLUSION

The present study was aimed to assess the effectiveness of Hot Application on episiotomy wound healing and pain

among postnatal mothers. The findings discovered that the post-test mean wound healing score was 4.7 and mean

SD was 1.639 among postnatal mothers in the experimental cluster; whereas in the control cluster the post-test

mean wound healing score was 6.01 and SD was 3.814. The calculated ‘t’ check value was 13.890 which was

significant at P<0.05 level. In the experimental cluster, the post-test mean pain score was 3.82 and mean SD was

1.437; whereas in the control cluster the mean post-test pain score was 4.08 and SD was 2.137. The calculated ‘t’

check value was 15.946 which was significant at P<0.05 level. Thus it becomes evident that the hot application was

effective in perineotomy wound healing and reduction of pain among postnatal mothers. With administration of hot

application on perineotomy wound, blood circulation increases; prevents growth of micro-organisms; loosens up

tight muscles; aids healing of broken tissue; heals Redness, Ecchymosis, oedema, Discharge, Approximation of wound

edges (REEDA); offers pain relief & comfort and quickens wound healing. The findings of the study can facilitate the

postnatal mothers to safeguard against pain and inflammation for the ensuing delivery.

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