RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BENGALURU, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. Y. ZUCHANBENI HUMTSOE

1styear M.Sc nursing

Obstetrics & Gynaecological Nursing

Year 2009-2010

PADMASHREE INSTITUTE OF NURSING

BENGALURU

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BENGALURU, KARNATAKA.

PROFORMA FOR RESGISTRATION OF SUBJECTS FORDISSERTATION

1 / NAME OF THE
CANDIDATE & ADDRESS / Ms. Y. Zuchanbeni Humtsoe1st year M.Sc nursing
Padmashree Institute of Nursing,
Bengaluru.
2 / NAME OF THE INSTITUTION / Padmashree Institute of Nursing,
Bengaluru.
3 / COURSE OF STUDY
AND SUBJECT / 1st year M.Sc Nursing
Obstetrics & Gynaecological Nursing
4 / DATE OF ADMISSION
TO COURSE / 19thJune2009
5 / TITLE OF THE STUDY / Assessment of effectiveness of Structured Teaching Programme on knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers.

6. BRIEF RESUME OF THE INTENDED WORK

6.1 INTRODUCTION

“Healthy pregnancy result in healthier child”

1

Conception is the beginning of life of the fetus anda new beginning forthe whole familyin the form of additional new member and changing relationship.The birth of the baby is a significant event in any family and the health of a growing child is always a concern to the parents.1

1

Pregnancy is a time of great change and adaptation. Many a times, women proceed through the process unaware of the total picture. A first pregnancy is like any other first experience. The expectant mother feels curious and concern about the changes ahead. Even the most carefully planned educational programme sometimes may not fully relieve the tension. Nurses play a vital role in helping a woman achieve a healthy and successful pregnancy by supporting, nurturing, educating and caring for the pregnant mother and her family.

During pregnancy,from the very start, the baby-to-be alters the mother’s body and the way she live her daily life. Preconception care visit is essential for mothers planning to become pregnant. As soon as pregnancy is suspected regular prenatal care needs to be provided after ensuring that mothers are well-informed when making decisions, and follow a healthy lifestyle. This will help the baby to have a healthy start in life and helps the mother to feel best.2

Health promotion encompasses all areas of a woman’s health. Choices related to Health promotion is an important health care measure. It not only helps to maintain optimum health and disease prevention but also decrease health epidemics andprovides cost effective approach to women’s health.

Health promotion consists of education and counseling activities that help enhance and maintain health and healthy behaviors. Poor pregnancy outcome is associated with limited or late prenatal education/care. The value of prenatal education can be presented in-terms of healthy birth of a baby.Health practice of individual or group designed to inform pregnant women (and their partners)includes prevention and early screening of minor disorders, nutrition, immunization, exercise, relaxation and breathing, hygiene, avoidance of junk foods, smoking, beverages,and alcohol, contraceptive information, labour and infant care.3

Since mother is the primary health care provider, health information regarding health promoting practices and its influence on pregnancy outcome is vital. As children and mother constitute the most important and vulnerable segment of the society health education is utmost importance.

The goal of prenatal education/care is the delivery of a healthy infant by a healthy mother at the end of a healthy pregnancy. Healthy people 2010 have a goal for increasing prenatal care and reducing maternal-infant-mortality.4

The nutritional status of women entering the reproductive phase of life plays a direct role in the development of the fetus as well as the health of the woman. Currently, the recommended supplementation of folic acid 4gm daily prior to and during pregnancy helps to lower the risk of neural tube defects. Maintenance of the normal weight gain of 10-12kg during pregnancy is useful in terms of positive pregnancy result. Dietary supplementation like iron, zinc, copper, calcium, andmulti-vitamins need to be taken by the pregnant mother as per the requirement to prevent fetal anomalies that may result due to lack of it. However excessive intake of vitamin A (>10,000/day) need to be avoided to prevent fetal anomaly.5

Increased demand of iron during pregnancy place the mother at risk for iron deficiency anemia. Eating foods rich in vitamin C like fruits, juices, and vegetables- legumes, nuts, breads, red meat, cereals, etc facilitates the body’s absorption of iron. Calcium demands also increases with pregnancy. Women need to be educated about its requirements and sources of dietary calcium like, milk products, orange and grape juices, cereals, fish, etc along with vitamin D (400-800 IU) supplement for proper calcium absorption.

Regular exercises strengthen bones and muscles and helps in staying healthy and fit. Exercise during pregnancy helps to prepare for labour and childbirth while exercise afterward helps the mother to get back in shape. Other benefits of exercise during pregnancy includes- weight control, reduced stress, improve mood, reduced backaches, controls constipation, bloating and swelling. It also helps to control gestational diabetes, increase energy, promotes muscle tone and endurance, improves posture and helps sleep better.6

Hygiene maintenance is very important not only for the benefit of the mother but also to prevent transmission of infection to the baby that may cause fetal anomalies and even fetal loss. Infection during pregnancy is increased due to certain hormonal change, which calls for special attention and care. Perineal hygiene education, safe sex, immunization etc needs to be reinenforced.

Education on infant care/feeding to the pregnant mother is very essential. The problem of nutrition begins from infancy itself if the infant do not receive enough breast milk. This may be due to lack of knowledge and confidence in breast-feeding and complementary feeding, which is essential for complete physical, mental and psychological growth of the child. Besides, breast-feeding helps the mother to get back in shape after childbirth.One of the factors that contribute to infant mortality is the ignorance of childcare and immunization. Lack of infant feeding andfaulty feeding practices during weaning is one of the main factor that can be avoided by proper education and counseling during prenatal period itself.7

Getting early and regular prenatal care is one of the best ways to promote a healthy pregnancy. Prenatal care is more than just health care; it often includes education and counseling about how to handle different aspects of pregnancy, such as nutrition and physical activity, immunization, what to expect from the birth itself, and basic skills for caring for infant. Prenatal visits also give mothers and family a chance to talk to the health care provider about any questions or concerns they may have related to pregnancy, birth, or parenthood.

The first 6 weeks after conception are extremely important for optimum fetal development and thus women must be aware of and avoid ingestion of teratogenic substances. This includes consumption of alcohol, tobacco, prescription, over the counter and illegal drugs. Addiction to drugs causes a higher risk of poor nutrition, sexually transmitted diseases, missed appointments, etc. ‘Babies born to opiate users tend to be of a lower birth weight and may have a smaller head circumference and are more at risk of Sudden Infant Death’.

Alcohol misuse is also an associated problem. Problem drinking can severely affect the well-being of the unborn fetus and sudden infant deaths (SIDs). Drinking during pregnancy may give rise to foetal alcohol syndrome, and babies are more at risk of sudden infant death. Women need to be encouraged to avoid/limit the intake of caffeine, artificial sweeteners, etc.8

When providing care or education, the client’s cultural beliefs and practices need to be considered and explore ways to promote seeking preventive care and early medical treatment consistent with the client’s value system.

Socio-economic factors and cultural beliefs and practices affect the health behaviors of pregnant mothers, thereby influencing their access to and use of health services, confidence in practitioners, and general health beliefs.

Psychosocial health of the pregnant mother is another important component for promoting health of the mother as well as the unborn child. Psychosocial health includes factors in women’s life related to balancing work, home, stress, relationships, family and sense of meaning and healing. Teaching on psychosocial health include finding time for one-self, exercises, nutritious diet, regular check-up for common conditions like hypertension, diabetes, depression, etc, changing lifestyle, sleep and rest, quitting smoking, alcohol, drugs, safe sex practice, avoiding undue stress anxiety,etc.

6.2 NEED FOR STUDY

Women who have a positive sense of their own maternal competency in early parenthood feel more comfortable while performing infant skills and interpreting their infant's cues.

To improve pregnancy outcomes, education, motivation and mobilization of the pregnant mothers, families and community as a whole need to be given regarding health promoting outcomes as illiteracy is one of the greatest barriers for any improvement in health condition.

India has the highest incidence of maternal mortality 5/1000 live births and the main causes of maternal death are hemorrhage, sepsis, anemiaand toxemias of pregnancy. Incidence of maternal mortality is highest between the age group of 15-24 years (95.6%). Overall, 24% deaths are antenatal, 48% Intrapartum and 27% postpartum.Nearly 50% of deaths among young mothers in the reproductive age group could be avoided by timely identification and treatment or early referral through proper education and counseling.

The infant mortality rate is still high, 38/1000 live births.1 million infant die in India every 15 seconds- UNICEF feb’09. The most common causes are prematurity, asphyxia and low birth weight. Study findings have revealed that utilization of health services have a definite impact on the mortality of babies and morbidity status of the mothers during pregnancy. Literacy also play a role –lower literacy status also have adversely affected the acceptance of maternity care services.9

A non-experimentalstudy to assess the knowledge and confidence of primi mothers regarding exclusive breast feeding using purposive non-probability sampling with 110 samples in Belgaum showed 15.45% mothers had good knowledge, 19% had poor knowledge on exclusive breast-feeding, 34.54% were very confident and 21.81% were not at all confident. The study concluded that primi mothers needs to be more educated regarding the benefits of exclusive breast-feeding.

A descriptive study was conducted to assess the knowledge of mothers regarding knowledge and attitude of infant rearing practice with a sample size of 40 in Saravanampatti, Coimbatore. The content areas of planned teaching programme were breast-feeding, artificial feeding, weaning and immunization. Out of the 40 sample, 34 mothers were found to have above 50% knowledge in feeding and immunization. The pre-test knowledge was 58.82% and post-test was 87.94%. Knowledge and attitude correlation was 0.55 in pretest and 0.46 in the post-test and concluded that mothers have inadequate knowledge on infant rearing practice and less immunization knowledge.

Many pregnant women limit their food intake for fear of gaining excess weight that may result in big baby and difficulty in shedding the extra weight. Considering this fears, education in this area regarding eating a well balanced diet coupled with weight check, is essential for positive outcome. During pregnancy, mother is not only eating for herself but for the baby as well.

A cross-sectional survey in selected 1480 women (18-45yrs) using multi-stage sampling technique to assess the knowledge, attitude and practice on folic acid intake among women findings showed that 53.7% reported they have idea about folate. Overall 20.3% of the respondents took folic acid. The most common source of information on folate were from physicians (63.4%), newspaper/ magazine/ books (21.7%). Out of them, only 14% were aware that it can help prevent birth defects and 40.6% were aware that one of its sources is green leafy vegetables. Again, higher educated women (41.3%) knew more about folic acid and used it more often in the periconceptional and first trimester period. The study revealed that awareness and the use of folic acid was less prevalent among pregnant women.

Exercise during pregnancy is essential as in non-pregnant state to keep the body well toned and fit. Breathing and relaxation helps relieve stress and anxiety. Exercises promote endurance during childbirth. Pregnant women sometimes lead a sedentary lifestyle. Balancing exercise, rest and diet, and their positive impact on health need to be emphasized. Improving the practice of antenatal exercises helps to prevent complications and lead to safe delivery. Thus,education on antenatal exercises for pregnant mothers for modifying their action is a felt need.

During pregnancy, demand for optimal hygiene care is essential as hormonal changes during pregnancy increases the risk for infection. Areas of concern include proper perineal hygiene, safe sex practice, regular health check-up, etc which are seldom overlooked.

Immunization during pregnancy not only benefits the mother but it also has a positive effect on the unborn child as well. Many new mothers though they have a vague knowledge on TT immunization during pregnancy have little or no knowledge on the benefits of it or hazard associated with it if no timely immunization is taken. Mothers also need to be well informed regarding Rubella treatment through MMR immunization.

Many research studies have reported on the congenital health hazards of the unborn due to unhealthy lifestyle practices like smoking, alcohol, indiscriminate drug use and exposure to harmful Teratogens. Creating awareness in this area is essential to preventing the disease.

The research studies on different aspects with regard to health promoting practices created an insight that there is still a greater need for education in this regard. Hence, the investigator felt the need to evaluate the effectiveness of structured teaching programme regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers. This study is aimed to help in ensuring health promoting practices by throwing light on aspects like healthy lifestyles- nutrition, hygiene, exercises, breathing and relaxation, immunization, antenatal check-up, avoidance of alcohol, unsafe drug use, smoking cessation, avoidance of infection, stress and anxiety control, infant care, breast feeding, etc

6.3 STATEMENT OF PROBLEM

A study to assess the effectiveness of a Structured Teaching Programme on knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers in selected MaternityHospital, Bengaluru.

7.4OBJECTIVES

1. To assess the existing knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers.

2. To assess the post-test knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers.

3. To compare the pre-test and post-test knowledge and attitude regardinghealth promoting practices and its influence on pregnancy outcome among primigravida mothers.

4. To correlate between the pre-test and post-test knowledge and attitude regardinghealth promoting practices and its influence on pregnancy outcome among primigravida mothers.

5.To associate the pre-test knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers with their selected demographic variables.

1.4OPERATIONAL DEFINITIONS

  1. Effectiveness

Itrefers to the outcome of structured teaching programme in increasing the knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome.

2.Structured Teaching Program

It refers to the systematically developed instructional and teaching aids that include all the aspects of health promoting practices and its influence on pregnancy outcome.

  1. Knowledge

Knowledge refers to the awareness and understanding of health promoting practices and its influence on pregnancy outcome.

  1. Attitude

It refers to the opinion of expressed by the primigravida mothers regarding health promoting practices and its influence on pregnancy outcome.

  1. Health promoting practices

It refers to the practice of healthy behaviours such as maintaining healthy lifestyle, nutrition, exercise, hygiene, avoidance of undue stress, regular antenatal check-up, immunization, balancing rest and work and management of minor disorders of pregnancy.

  1. Pregnancy outcome

It refers to the delivery of a healthy baby.

  1. Primigravida mothers

Refers to a woman who is pregnant for the first time.

6.6ASSUMPTIONS

  1. The primigravidamothers may have inadequate knowledge and unfavorable attituderegardinghealth promoting practices and its influence on pregnancy outcome.
  2. Structured teaching programmemay improve the level of knowledge andattitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers.

6.7RESEARCH HYPOTHESIS

H1-There will be significant difference between mean pre-test and post-test level of knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers.

H2- There will besignificant correlation between the pre-test and post-test level of knowledge andattitude regardinghealth promoting practicesand its influence on pregnancy outcome among primigravida mothers.

H3-There will be significant association between pre-test knowledge and attitude regarding health promoting practices and its influence on pregnancy outcome among primigravida mothers with their selected demographical variables.

6.8REVIEW OF LITERATURE

A comparative study was done to assess the antenatal practices among selected tribal and non-tribal community in Coimbatore district. The sample size was 60 mothers. Inferential and descriptive statistics was used to analyze the data. The study findings revealed that there are innumerable differences in the antenatal practices between the tribal and non-tribal community like-many tribal women hold their confidence on nature alone, do not register in the antenatal clinic and immunization is not taken properly. Dietary modifications during pregnancy were not done and many women in non-tribal community opted for caesarean section than normal labour. The study revealed that education in this regard needs to be emphasized to remove misconception and to improve antenatal practices.10