INTRODUCTION

Rajiv Gandhi University of Health Sciences Karnataka

Curriculum Development Cell

CONFIRMATION FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

Registration No.

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Name of the Candidate

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PONUKU KEZIAH GRACE DAYAMANI

Address

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I Year M.Sc Nursing, The Karnataka College of Nursing, Bangalore

Name of the Institution

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The Karnataka College of Nursing, Bangalore

Course of Study and Subjected

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M.Sc(Nursing)

Obstetric And Gynaecology

Date of Admission to course

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29-11-2008

Title of the Topic

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DETERMINE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING EPISIOTOMY CARE AMONG PRIMIPARA MOTHERS AT POSTNATAL WARD IN GOVERNMENT GENERAL HOSPITAL BANGALORE.

Brief resume of the intended work

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Attached

Signature of the Student

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Guide Name

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R.PUSHPAMALA

Remarks of the Guide

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Recommended and Forwarded

Signature of the Guide

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Co-Guide Name

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Signature of the Co-Guide

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HOD Name

Signature of the HOD

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R.PUSHPAMALA

Principal Name

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Principal Mobile NO.

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Principal E-Mail ID

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Remarks of the Principal

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Recommended to conduct the study & forwarded.

Principal signature

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PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

PONUKU KEZIAH GRACE DAYAMANI

Ist Year M.Sc (Nursing)

OBSTETRIC AND GYNAECOLOGY

2008-2009

THE KARNATAKA COLLEGE OF NURSING.

12-KOGILU MAIN ROAD, YELAHANKA

BANGALORE.

Rajiv Gandhi University of Health Sciences Karnataka

Curriculum Development Cell

PERFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1.

Name of candidate and address

PONUKU KEZIAH GRACE DAYAMANI, 12 Kogilu Main Road, Yelahanka, Bangalore-64.

2.

Course of study and subject

M.Sc(Nursing) obstetric and gynecology

3.

Date of admission to course

29-11-2008

4.

Title of the topic

DETERMINE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME REGARDING EPISIOTOMY CARE AMONG PRIMIPARA MOTHERS AT POSTNATAL WARD IN GOVERNMENT GENERAL HOSPITAL BANGALORE.

5.

Statement of the problem

A study to DETERMINE THE

EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING EPISIOTOMY CARE AMONG PRIMIPARA MOTHERS AT POSTNATAL WARD IN

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

Motherhood is a beautiful process whereby the mother safely delivery a child, it is the magic of creation. Care must be given to ensure safe childbirth. The mother has a right proper medical care and treatment. Safe motherhood can only be reached if complete care is given to young mothers. Safe motherhood initiative announced in 1987 had set targets to reduce maternal mortality by 50% in one decade where the safe motherhood aim is to enhance the quality of life.

Labour is a natural process, which all pregnant women have to undergo. The birth of a child poses a fundamental challenge to the resisting interactes structure of the family. Injuries and lacerations of the Perineum, Vagina, Cervix, Uterus and their supporting tissues can occur.

Episiotomy is an incision in the perineum, in order to enlarge the vaginal introitus to provide enough room for the head or breech to escape ore safely for both mother and child or to create ample space to facilitate operative delivery. Episiotomy is the second commonest obstetric procedure next has become an integral part of normal delivery.

Health has been recognized as the greatest wealth from time immemorial today in the era of consumerism, self-care is getting more emphasis because there is growing awareness about health in the population. People’s health in people’s hands has become the central theme of all nursing transactions. Nursing care such as perineal toileting, perineal hygiene and episiotomy care are therefore oriented towards making the patient self-sufficient. Episiotomy is a common surgical procedure performed during the second stage of labour. Ould (1942) he suggested in that episiotomy can be as an aid in difficult vaginal delivery Broomal (1878) he advocated episiotomy routine procedure that would prevent perineal rupture.

Goldbar and colleagues (1990) observed that clinical course of 389 women delivered at parkland hospital who sustained fourth degree laceration. These woman represented 2% of these perineal wounds were complicated by infection, episiotomy breakdown or both. Thus the primary and rapid healing of the episiotomy would is of prime importance.

Cunningham et al (2001) describes that episiotomy has become the most common procedure in obstetrics with one exception of operation in obstetrics with one exception of cutting and typing the umbilical cord and therefore episiotomy wound care has gained grater importance for nurse in the management of perineal care for quick recovery from the discomforts caused by the episiotomy would.

Carroli &Belizan (2001), the risk and benefits of episiotomy have been well reviewed. The rationale for its use depends largely on the need to minimize the risk of severe, spontaneous, maternal trauma and to expedite the birth during a normal birth. The indications for its use are few and the midwife should use her skills to avoid this intervention if at all possible.

Hartweg (1991), says that the personal and complex nature of the individual self care system must be acknowledged and this self care if learned within the context of formal education promotes health and well being. As the trend is leading to health promotion, as primary care it would be worthwhile to point out that to manage perineal care at home can become an individual activity, which depends to a large extent on the support received by a nurse or midwife. Bieck(1996) and Davis, et al (1988) say that studies exist on the importance of several maternal needs such as infant illness, cord care, infant feeding and episiotomy care.

A variety of interventions are found to aid the healing process, which include cleanliness, prevention f infection and enhanced comport. The intervention includes applying ice pack, topical applications, dry heat, performance of kegels exercise and perineal care. Other simple comfort measures include encouraging the woman to lie on her side or to use a pillow while sitting. Educate the mother about these interventions while assisting her, will encourage co-operation and ensures that necessary measures are use upon discharge.

There is a great role for the mothers to participate in all these effects. People’s involvement is essential, for it is “awareness leading to action” but this awareness and involvement can only come through self care. Health education programme is to be given in the hospital during the antenatal visit and people gain knowledge through television, radio, magazines, newspapers etc. so education is an essential need of the mother and community in order to gain adequate knowledge for maintaining positive health of herself and her baby.

Health education is an integral part of maternal and child health nursing care. During pregnancy and post partum period nurses educate mothers about health behaviors that enhance positive maternal infant outcomes, particularly those related to self care.

The researcher feat that educating primipara mother would help to improve knowledge and practice of the episiotomy care.

NEED FOR THE STUDY

Practicing perineal care during their postnatal period in hospital will enhance the mothers self esteem, skill knowledge, ability and confidence inperforming self perineal care at home.

Public interest in self care has evolved into a strong force with less hospital care and more community care, cost reduction and primary health care on prevention of disease. The main purpose of early hospital discharge is a decease in costs, less exposure to iatrognic infection and decreased discruption of family life. Today the concept of health focus on emphasis for the people, by the people, of the people. So they also have their own responsibility to maintain their health status.

Rhode and Barger (1990) expressed the view of Williams in (1923) that “many different procedures have been devised, and various antiseptic solutions employed in care of episiotomy and perineum, but if the sutores are not disturbed, he strongly recommends that daily washing with soap and water is fuficient in place of any manipulation over perineal care”. His recommendations were apparently needed in many of the hospitals and now the practice has spread world wide.

WHO (1996) the expert committee estimate on maternal health and safe motherhood programme the major causes of maternal deths were due to puerperal sepsis which accounts for 15% of all maternal deaths in developing countries. If it does not cause death, puerperal sepsis can cause long term health problems such as chronic pelvic inflammatory disease and infertility.

Otoide, Ogbonmwan, Oskonofua he conducted study of all vaginal births in the Nigerian hospital found the prevalence of episiotomy as 46.6% between January 1997 and December 1998. over 90% of primipara mothers and episiotomy they also found that episotomy was associated with statistically significant increased risk of wound break downs.

Chindeda (1994) conducted a community based study to determine the awareness of perineal hygiene and attitude among postnatal mothers and found that only 18% of mothers had adequate knowledge about perineal care and 82% of the mothers had no idea about the importance of perineal care and change of pad (as cited by Sharma, 1999).

Latha (1999 conducted a study to assess the effectiveness of structured teaching programme on post – natal exercise of mothers in post natal wards of selected maternity centreers, Madurai. Systematic sampling technique was used to assess the knowledge of mothers regarding postnatal exercise. The findings of the study showed that there was a significant difference in post test and knowledge score of the experimental group (p<01) and there was a positive correlation (r=0.86) between knowledge and practice.

Donna Begar (1997), conducted a cross study to compare mothers and worse perceptions of postpartum learning needs and effective teaching mortality. Mothers were given a questionnaire during their post partum period how important it was for them to learn about maternal infant topics before discharge. Nurses rated similar items on the basis of their perception. study findings shows that the learning needs felt important by the mothers were post partum complication (62%) episiotomy (60.5%) and the nurse felt episiotomy (70.7%) and post partum complicating (64.6%) as an important learning need.

Considering the above factors, the investigator felt that there is a need of preparing a structure teaching programme on episiotomy care which will modify their knowledge and action towards episiotomy care. Improving the knowledge and practice helps to prevent complications and them to lead to normal healthy life.

6.2 REVIEW OF LITERATURE.

The literature review is arranged in the following sections.

1. Episiotomy

2. Episiotomy care and

3. Studies related to structured teaching program.

Literature related to episiotomy

Episiotomy is a surgical procedure to widen the perineum and prevent perineal tears, was reported in 1941. Episiotomy has been justified on the basic that it reduced the risk of the third degree perineal tears and prevents unnecessary trauma to the fetal head.

The risk of episiotomy has been given through clinical research and practice as severe post episiotomy pain in 60% of women and increased risk of infection, pain, edema, inhibiting urination, defecation after delivery, and increased risk of significant blood loss.

Cunningham et at. 2001, obstetric practice varies as to how often episiotomies are done. They were once done only when training seemed imminent, then were considered routine with a normal birth, and now is used less frequently. The advantage of on episiotomy is that is substitutes clean cut for a ragged tear. Minimize pressure on the fetal head, and shortens the last port in of the second stage as labor.

Grundy.L.(1997) Conducted a study to find out the important role to play in the care of perienal wounds following childbirth. It was observed some of that current practices may not be beneficial to the promotion as wound healing. It is important that midwives recognize the need for research – based practice and that an audit is set up nationally to evaluate the efficacy of treatments and practice. Research, audit and evaluation of services are the central processes involved in providing effective and efficient care, as advocated by the Department of Health (1993).

Reynold J.L.(1995), determined the effectiveness of a continuous quality improvement (CQI) program in reducing episiotomy rates. It was found that structured teaching programme was effectiveness on reducing the episiotomy rate. Over the priod of study the rate decreased significantly from 44.5% to 33.3% (p<0.001)

While still a common obstetrical procedure the use of episiotomy has decreased remarkable over the post 20 years. Through the 1970s, it was common practice to cut an episiotomy for almost all women having their first delivery. This practice became controversial, and with the concept of evidence – based out comes; a number of large studies has been carried out, to address these controversies. Henriksen (1992) commonly cited by unproven benefit of routine episiotomy was that it prevented pelvic relaxation that is, cytokine, reconcile and urinary incontinence. A number of observational studies and randomized trial showed that routine episiotomy is associated with and rectal tears.

Carroli and Belizean (2000) reviewed the Cochrane pregnancy and childbirth group trials registry. There were six randomized trials of nearly 5000 deliveries in which routine (73 percent rate) use of episiotomy was evaluated. There was less posterior perineal trauma, need for repair, and healing. Complications in the restrictive – use group. Alternatively, there was less anterior perineal trauma in the routine – use group. Along with there findings if has come to the realization that while episiotomy did not protect the perineal body, it contributed to anal sphincter incontinence by increasing the risk as third and fourth – degree tears.

Aldridge and Watson (1935) conducted a study with 2800 primipara mothers and found that injuries to the pelvic floor were substantially decreased when midline episiotomy and prophylactic forceps were used. According to the study the definitions of pelvic floor injury were not clearly defined and the episiotomy rate was 20%

Gainey (1995) he believed that an episiotomy that extended up in to vaginal canal, rather than down toward the perineal body would decrease trauma to both the external anal sphincter and to the vagina and endopelvic fascia, they arose the idea that a deep midline incision performed before the vertex distended the perineum would preserve the endopelvic fascia and the vaginal support

Richardson (2002) conducted a study to find out would and patients is different so there is no single guiding principles that can assist in the decision-making process. On the management of acute would are suitable for primary closer, for example with sutures, while for other would closure is either delayed or not attempted. Atiyeh et.al (2002), Provide a list of principles of would care that must always be observed in order to avoid sepsis and to achieve optimal would healing

Cleary-Goldman J, Robinson JN.(2003) this review traces the clinical use of episiotomy from the eighteenth century to the present and explains why the procedure has a restricted function in current practice. The modern indications for episiotomy including the procedure’s place at operative vaginal delivery are discussed. Although the role fo the episiotomy in modern obstetrics may be limited, the procedure is important in situations involving no reassuring fetal status, shoulder dystocia, and perhaps operative vaginal delivery. The optimal type of episiotomy, if any, at forceps or vacuum delivery is yet to be determined.

A study conducted by Korczynski J. (2002) to review the benefits and risk of the routine epeisiotomy during the second stage of labour. The study findings revealed the routine episiotomy gies poor effects in many cases. Perineal massage during pregnancy, water birth, are most interesting methods to avoid routine episiotomy and in improve the quality of life aim post partum women.

Walfisch A, Hallak M. (2002) conducted a study in the 18th century on the importance of episiotomy. The benefits traditionally ascribed to episotomy include prevention of perineal damange and its sequelae, prevention of pelvic floor relaxation and its sequelae, and protection of the newborn form either intracranial hemorrhage of intrapartum asphyxia. Revelaed findings episiotomy prevents anterior perineal lacerations, but fails to accomplish any of that the other fetal or maternal benefits. On the other hand, the incision substantially increases maternal blood loss, thelength and depth of posterior perineal injury and the risk of anal injury.

Webb DA.Culhane J. (2002) Episiotomies are the most frequently performed surgical procedure among women in but there are no published epidemiological studies of the extent of variation in episiotomy use among different obstetrical providers, or the outcomes associated with different levels of use. The objective of this study was to assess the extent of hospital variation in the use at episiotomy and the relationship between hospital episiotomy use the incidence and risk of perinea trauma among women residing in a large urban are in the United States. The findings revealed that Hospital episiotomy rates ranged from approximately 20 to 73 percent. The rate of third or fourth degree perineal lacerations varied from a low of four percent to a high of more than 13% among hospitals. Rates of episiotomy were significantly correlated with rates of a third or fourth degree perineal laceration (r=0/.70:p<0.01).

Goldberg J. Holtzd, (2002) conducted a study to determine if practice patterns have been altered by the large body of literature strongly advocating the selective use of episiotomy. It was observed that overall episiotomy rtes in 34.048 vaginal births showed a significant reduction from 69.9% in 1983 to 19.4% in 2000. Significantly decreased risk of episiotomy was seen based up on year of child birth. Increased association with episiotomy was seen in forceps deliveries (or 4.04, 95% Ci 3.46, 4.72). There was a statistically significant reduction in the overall episiotomy rate between 1983 and 2000. white women consistently underwent episiotomy more frequently that black women even when controlling for age, parity, insurance status, and operative vaginal delivery.

The study conducted by Minerva Ginecol (1996) investigated, selective utilization of episiotomy. Recent retrospective reports proved episiotomy could have a protective effect on 1st and 2nd grade lacations and a predis post effect on 3rd and 4th grade ones As far as prevention of genital prolapse is concerned. Few reports now exist that can confirm this role attributed to episiotomy. Concerning episiotomy efficacy in preventing neurologic damage risks to the fetus during labour no difference was found in apgar scores and in mortality rates in newborns with or without episiotomy. Both in preterm labours and at term born babies. On the contrary episiotomy possible complications are fairly well documented particularly dispaurenia and sexual dysfunctions on intercourse resumption after delivery.

Klein MC. Kaczorowski J. (1995) found that whether physicians beliefs concerning episiotomy are related to their use of procedures and to differential outcomes in childbirth. Participants of the 703 women at low risk of medical or obstetric problems enrolled in the trial we studies 447 women attended by 43 physicians. Subjects attended by residents of nurses were excluded. Main outcome measures patients intent perineum v.perineal trauma. Length of labour, procedures used. Position for birth, rate of and reasons for not assigning women to a study arm postpartum perinea pain and satisfaction with the birth experience, physicians : beliefs concerning episiotomy. Finding revealed that women attended by physicians who viewed episiotomy very unfavorable were more likely than women attended by the other physicans to have an intant perineum (23% values 11% to 13% p< 0.05) and to experience less perineal trauma. The first stage of labour was 2.3 to 3.5 hours shorter for women attended by physicans who viewed episiotomy favourably that for women attended by physicians who viewed episiotomy very unfavourably (p<0.05 to 0.01)

LITERATURE RELATED TO EPISIOTOMY

PERINEAL CARE:

Perineum in one as the body parts which is involved in the child birth the perineum is the moist area and consists as more hair follicles. This area consists for more microorganisms. But the care as perineum is neglected by most fo the mothers. If adequate care is not given to the perineum, it may lead to causes puerperal sepsis, improper perineal care cause puerperal infections. Puerperal infection is still responsible for high incidence of puerperal morbidity.

Cunningham et al (2001) very woman needs attention to perineal cleanliness in the postpartal period to prevent infection. Woman are particularly prone to this because lochia. If allowed to dry and haiden on the valve and perineum. Furnishes a bed for bacterial growth. Because the rectum, there is also always to danger that bacteria will spread from the rectum to the vagina and cause uterine infection or urinary infection. Interruption is skin intergrity from on episiotomy also increases the client’s risk of infection.

Lowenstein L (2005) conducted a study to assess the potential effect of educational intervention on episiotomy practice. A survey of the attitude of obstetrical caregivers toward episiotomy was conducted among obstetricians and midwives in the three public hospitals in Haifa. Data regarding episiotomy rates was collected for the years 2001-2003. At the beginning of 2002. Lectures on the risks and benefits of episiotomy were given in two hospitals. Episiotomy rates before and after the lecture were compared. A significant and lasting reducting in episiotomy rates was observed in the two hospitals where lectures were given. There were no clinically significant and consistent changes in the episiotomy practices in the third hospital. Education may play an important role in changing common medical practices, as in episiotomy. It was clearly shown that our beliefs are not always up to date. We call for periodic reassessment of all medical procedures, as common and accepted as they are.

PELVIC FLOOR MUSCLE EXERCISES:

Pelvic floor exercises are valuable during Puerperium for their strengthening of pelvic floor muscle and pain relieving properties. It also speeds healing by reducing edema and encouraging good circulation. Normally postnatal mothers should start doing this exercise on the day after a normal delivery.

Meyer et at. (2001) some woman find that carrying out perineal exercise three or four times a day greatly relieves episiotomy discomfort. The exercise consists at contracting and relaxing the muscles at the perineum five to ten tiems in success as if trying to stop voiding (Kegel exercise). This improves circulation to the reas and so helps decrese edema. When repeacted frequently, kegel exercises help the woman regain her prepregant muscle done.

Morkved & Bo (2000) the benefits from post partum pelvic floor muscle training are still present 1st year after delivery. If mothers find the pelvic floor exercise difficulty at first then performing the same time will help the activation of the pelvic floor.

Korczynski J.(2002) The study presents a literature review on the benefits and risk of the routine episiotomy during the second stage of lab our. Perineal trauma complications as well as perineal out comes are discussed. The risk of stress in continene and sexual dysfunction are described new techniques for improved of perineal outcomes and prevent of post partum in continues are described. Rountine episiontomy gives poor effects in many cases perineal massange during pregnancy water birth, are most interesting methods to a avoid routine episiotomy and in improved the quality of life in post partum women.

Determine whether scientific evidence supports an “appropriate” espisiotomy are and whether this rate can be reduced via medical intervention and or preventive actions during pregnancy or at the time of delivery. A survey of the literature available on Medline and the Cochrane Library between 1980 and 2005 and dealing with the objectives of the present study was undertaken. In France, the national episiotomy rate should not reach 30%. A program aiming at continuous improvement in quality – of – care after episiotomy and including various actions – training courses, audits, presence of staff leader, episiotomy rate feedback per midwife or obstetrician – could help reduce the use of episiotomies.

Scientific proof is not sufficient to advise favoring a particular type of puprshing or a specific manner to release the baby’s head. More randomized studies are necessary to assess the relevance of the these preventive measures as regards the use of episiotomy.

Literature Related to Effectiveness of Structured Teaching Programme:

Soya.K (2000) conducted a study on self-care activities of PIH and maternal out come at the institute of maternal and child health, kozhikode among primigravid women with PIH. The experimental and control groups. Consisted of 35 participants each. Pre-test was done using structured interview schedule to both the groups. The experimental group was exposed to the session on selected self-care activities (SSCA) Post-test on both the groups was done after two weeks. The post –test knowledge score was higher than the pre-test knowledge score in the experimental group. Thus, the session SSCA enhanced the knowledge and the women were able to practice and SSCA: this helped to attain favorable maternal outcome in the experimental group.

Effectiveness of a planned teaching programme regarding self-care to patients with pulmonary tuberculosis in a selected tuberculosis, hospital, managalore was a conducted by Kumar A.S. (2002). Purposive sampling teachinque was used. The data was collected from 75 respondents before and after the administration of the planned teaching programme. The total knowledge score of the patients in the pre-test was (38.40%) and in the post-test, the knowledge score was (83.40%). This shows the effectiveness of the planned teaching programme.

Chamuah A.R. (2003) conducted a study to determine the effectiveness of a planned teaching programme on human sexuality to adolescents in a selected educational institution of Udupi district. Non – probability sampling technique was used. Data was collected from 36 adolescent girls and boys. The findings of the study revealed that the post-test mean knowledge score (94.31%) was apparently higher than the pre-test knowledge score (62.37%). Paired ‘t’ value was computed ‘t’=13.34 p<0.05. the planned teaching programme was found to be effective in increasing the knowledge of adolescent on human sexuality.

Effectiveness of planned teaching programme on preventive practice regarding needle stick. Other sharp injuries among final year general nursing and midwifery students in selected nursing schools, Managalore was conducted by Bhasam C (2004), multistage random sampling technique was used to selected 120 samples. The data obtained was analysed by using both descriptive and inferential statistics. Findings of quarterly distribution of pre-test and post-test shows that there was significant difference between the knowledge scores. By graphical method the pre-test median score was (21.6%) whereas post-test median score was (35.65%). This shows the effectiveness of the planned teaching programme.

6.3 STATEMENT OF THE PROBLEM

A study to determine the effectiveness of structured teaching programmer, regarding episiotomy care among primipara mothers at postnatal ward in Government Hospital Bangalore

6.4 OBJECTIVES OF THE STUDY

· To assess the knowledge and practice of primipara mothers regarding episiotomy care respectively .

· Conduct a structured teaching programmer on episiotomy care for primipara mothers

· Evaluate the effectiveness of structure teaching programmer on episiotomy for primipara mothers in terms of gain in knowledge score.

· Determine the relationship between demographic data & primipara mothers

6.5 OPERATIONAL DEFINITIONS

EFFECTIVENESS

In this study , effectiveness refers to the extent to which the structured teaching programmer on episiotomy care & self perineal care has achieved the desired effect in improving the knowledge of the primipara of the primipara mothers as evidenced by gain in post-test knowledge scores.

EPISIOTOMY

A surgically planned incision on the perineum and the posterior vaginal wall during the second stage of lab our in called episiotomy (perineotomy)

PRIMIPARA

A woman who has given birth to one child past age of viability.

KNOWLEDGE

Refers to the verbal responses of respondents to the knowledge on episiotomy care and self-perineal care as measured by the structured interview schedule.

PRACTICE

Refers to the action of post natal mothers regarding self – perineal care carried out by the observation.

STRUCTURED TEACHING PROGRAMMER

Refers to the systematically planned group instruction designed to provide information regarding episiotomy care and self perineal care for primipara mothers

HYPOTHESES

1) Mean post test knowledge score will be significantly higher than the mean pretest knowledge score of the experimental group.

2) There will be a significant relationship between knowledge and practice regarding episiotomy care among postnatal mothers.

6.6 ASSUMPTIONS

· Primipara mothers will have some knowledge on episiotomy care and self perineal care.

· Structured teaching programmer will enhance the knowledge of primipara mothers regarding episiotomy care and self- perineal care.

· The nurse has an important role in importing education about episiotomy care among postnatal mothers.

6.7 DELIMITATIONS

Study is limited to

· Primipara mothers who had normal vaginal delivery with episiotomy

· Those who are willing to participate

· Those who are not having any systemic illness.

· Within 6 hours after delivery

6.8 PROJECTED OUT COME

The results of the study will determine the existing knowledge of primipara mothers on episiotomy care and self-perineal care. It also gives insight to teach the mothers about perineal hygiene. The study of wound healing will influence self –care at home and increase the cost effectiveness –Besides staff can use more time for counseling the mothers which will ultimately reduce post partum morbility.

MATERIALS AND METHODS

7.1 SOURCE OF DATA COLLECTION

Data will be collected from the primipara mothers who admitted in Govt -general hospital –bangalore.

7.2.1 SAMPLING CRITERIA INCLUSION CRITERIA

· Those mothers who are willing to participate the study.

· Those who can understand and speak kanada

EXCLUSIVE CRITERIA

· Those who are not willing to participate in the study

· Those who have any systemic illness.

7.2.2 RESEARCH DESIGN

· The research design adopted for the study is pre -experimental design.

7.2.3 VARIABLES UNDERSTUDY

Independent variable

· Structured teaching programmer on episiotomy care.

Dependent variable

· Knowledge of primipara mother regarding episiotomy care

7.2.4 SETTING OF THE STUDY

· Study will be conducted in Govt –General Hospital -Bangalore

7.2.5 SAMPLING TECHNIQUE

· Purposive sampling will be used to select the sample of the used to select the sample of the study

7.2-6 Sample Size

· The sample size proposed for the present study is 30

7.2.7 TOOL OF RESEARCH

· A structured questionnaire include following sections.

Section-1

Pre test questionnaire prepared by investigator.

Sectiom-2

Post – test questionnaire to determine effectiveness of structured teaching programme in episiotomy care

7.2.8 COLLECTION OF DATA

· A prior formal permission who be obtained form concerned authonty.

· The purpose of the study will be explained

· Consent of the participants will be obtained.

· A pre – test will be administered

· Post – test will be given after intervention

· The duration of the data collection will be 30-40 mts per sample.

7.2.9 METHOD OF DATA ANALYSIS AND INTERPRETATION

It includes descriptive and inferential statistics.

Descriptive statistics

Demographic variable and level of pre test and past test knowledge ( scores) will be given in frequencies with their percentage.

Pretest and post test average scores will be given suing mean and standard deviation

Inferential statistics

Pre-test and post test difference will be analysed by using paired ‘t’ test and chi-squared test

7.3 Does the study require any investigation or intervention to be conducted on patients or other numans or animals” If so please describe briefly ?

Yes, the study will be conducted on primipara mothers of Govt General Hospital – Bangalore. This study has the structured teaching programme as intervention.

7.4 Was ethical clearance been obtained from your institution in case of 7.3?

Yes, informed consent will be obtained from the institution authorities and subjects. Privacy confidentiality and anonymity will be quarded scientific objectivity of the study will be maintained with honesty and impartiality

8. LIST OF REFERENCE

1. Barger M.K. (1990) perineal care journal of Midwifery,

2. Bhasan C. (2004) The effectiveness of planned teaching programme on preventive practices on needle stick / sharp injuries among the final year general nursing and midwifery students in selected nursing schools managore, Unpublished M.Sc Nursing thesis submitted to Rajiv Gandhi University of Health Sciences, Banagalore, Karnataka.

3. Cunningham, et, al (2001) Williams obstetrics (20th ed) Stamford, Appleton and Lange

4. Cleary-Goldman J.Robinson, J.N. (2003) the role of Episiotomy in current objstetric practice.

5. Chamuah AR. A study to determine the effectiveness of planned teaching programme on human sexuality to adolescents in selected educational institution of Udupi District , inpublished M.SC Nursing thesis submitted to University of MAHE, Manipal 2003.

6. D.C. Dutta (2004) Text book of obstetrics including perinatology and contraception, (Sixth edition) new central book agency (p) Ltd., chintamoni DAs Lane, Calcutta

7. Faruel – Fosse- Fosse H. Vendittelli F (2006) can we Reduce the episiotomy rate Journal of Gynecol obstet Biol Reprod IS68-IS

8. Grundy1 (1997) role of the Midwife in perineal wound care following childbirth

9. goldberg J. (2002) obstet gynecol Examinationof Episiotomy rates from 1983

10. Kaveri B (1999) episiotomy should be given ain all primigravidas obsterics and Gynaecology today.

11. Korczynski J. (2002) Routine episiotomy in modern obsterics

12. Kumar AS (2002) The effectiveness of a planned teaching programme reagarding self –care to patients with pulmonary tuberculosis in the selected tuberculosis hospital, Mangalore, un published M.Sc Nursing thesis submitted to Rajiv Gandhi Unviersity of Health Science, Bangalore, Karnataka.

13. Klein MC Kaczorwski J. (1995) beliefs and behaviour duringa randomized controlled trial of episiotomy 6th Edition.

14. Latha M. (1999) A study to assess the effectiveness of STP on postnatal exercise of mothers in postnatal word of selected maternity center in madurai. Unpublished masters thesis Dr.M.G.R. Medical Unviersity Chennai. India.

15. Melesis AI Theoretical Nursing development and progress 2nd edition philadelpha, J.B. Lippincott Company 1991.

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29. Williams and Wilking (1976) vaginal surgery (1st edition) A Williams & wilking A waveryly company London.

9.

SIGNATURE OF THE CANDIDATE

10

REMARKS OF THE GUIDE

RECOMMENDED AND FORWARDED

11.

NAME AND DESIGNATION OF (IN BLOCK LETTERS)

11.1

GUIDE

R. PUSHPAMALA

11.2

SIGNATURE

11.3

CO-GUIDE(IF ANY)

11.4

SIGNATURE

11.5

HEAD OF DEPARTMENT

R.PUSHPAMALA

11.6

SIGNATURE

12.1

REMARKS OF THE CHAIRMAN AND PRINCIPAL

RECOMMENDED AND FORWARDED

12.2

SIGNATURE