PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
DISSERTATION PROPOSAL
A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING PAIN MANAGEMENT DURING LABOUR AMONG NURSES WORKING IN SELECTED HOSPITALS BANGALORE
SUBMITTED BY
ASWATHI.YASODHARAN M.SC. NURSING 1ST YEAR
OBSTETRICS AND GYNECOLOGY NURSING
JOSCO COLLEGE OF NURSING
NELAMANGALA
BANGALORE
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / NAME OF THE CANDIDATE AND ADDRESS / ASWATHI YASHODHARANM.SC. NURSING 1ST YEAR
: JOSCO COLLEGE OF NURSING
NELAMANGALA
BANGALORE
2 / NAME OF THE INSTITUTION / JOSCO COLLEGE OF NURSING
JOSCO NELAMANGALA
BANGALORE
3 / COURSE OF THE STUDY AND SUBJECT / M.SC NURSING 1st YEAR
OBSTETRICS AND GYNECOLOGICAL NURSING
4 / DATE OF ADMISSION / 01/06/2009
5 / TITLE OF THE TOPIC / A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING PAIN MANAGEMENT DURING LABOUR AMONG NURSES WORKING IN SELECTED HOSPITALS BANGALORE
6. BRIEF RESUME OF THE INTENDED WORK
6.1 NEED FOR STUDY
Pain is a normal part of labour and the degree of pain experienced varies from person to person. It may help you to attend antenatal/ parent education classes where you will be taught about the process of labour. At these classes the midwife or a professionally trained teacher (eg: The National Childbirth Trust) will also discuss with you ways of managing the labour pain and this will include self help, non pharmacological (not using medication) and pharmacological (use of medication) methods. Understanding how you can manage the pain of labour will make you feel more confident, relaxed and less anxious. It will also help you to make informed choices during your. You may prefer to have some idea of how you would like to manage your labour pain or alternatively you may wish to wait and see how your labour progresses1.
According to a latest claim by an associate professor in midwifery in the University of Nottingham, women must bear labour pain, as pain-relieving drugs including epidural injections, can lead to serious medical complications2.
The medical chief Dr. Denis Walsh asserted on the need to take the help of yoga, birthing pools and hypnosis, to strengthen the bond between the child and the mother. Walsh said that "it's beneficial for women to suffer the labour pain of a natural birth."
An increasing number of pregnant women try avoiding labour pain caused due to natural birth, by taking pain-killers and injections, to get relief from the pain3.
Latest statistics reveal that there has been an increase in the women-in-labour receiving epidural or spinal anesthesia. In 2007-08, nearly 33 percent women opted for pain-relieving and spinal anaethetising including injections to ease the pain as compared to 17 percent women in 1989-904.
This study conducted on US midwives' knowledge and use of sterile water injections for labor pain. The purpose of this research study was to identify and describe US midwives' knowledge and use of sterile water injections to relieve pain during labor. Research studies have shown that injections of sterile water to relieve low back pain during labor are effective with good maternal satisfaction. Questionnaires were mailed to a random sample of 450 midwives who were members of the American College of Nurse-Midwives (ACNM). While sterile water injections are a good treatment for back pain during labor, there is a lack of knowledge among midwives about this method of pain relief during labor and an interest in knowing more5.
This study examines the perceptions of labour pain by mothers and their attending midwives. The aim of the current study was to examine the perception of pain by labouring women and their attendant midwife, from the onset of labour to delivery. The short form McGill Pain Questionnaire (SF-MPQ), routinely used to assess pain in obstetric environments was used to determine pain perception. Thirteen labouring women and nine midwives completed the SF-MPQ every 15 minutes beginning at the time of admittance to the delivery suite. On each measure of pain on the SF-MPQ, the midwives scores correlated with the mothers' scores across the entire pain range. Further analysis showed that mothers' and midwives' pain scores were similar at mild-moderate pain levels6.
The activities are useful in alleviating pain are Learning to relax helps to promote calmness, Antenatal classes place the emphasis on being fit and what choices there are, offering more control in labour, Position during the birth can also make a difference. Some women like to kneel, walk around or rock backwards and forwards, Feeling in control of what is happening is important. Don’t hesitate to ask questions or to ask for anything at any time, having a partner, friend or relative to ‘lean on’ who can provide support during labour helps. If this is not possible, don’t worry, as the midwife will give support and Warm water and baths can reduce pain7.
So nurses have an important role in controlling the labour pain. Lack of study conducted among nurses regarding knowledge of labour pain motivated the researchers to do this study
6.2 REVIEW OF LITERATURE
Review of literature provides basis for future investigations, justifies the need for replication, throws light up on feasibility of the study, and indicates constraints of data collection and help to relate findings of one another.
A. Studies related to importance of education regarding pain management during labour
B. Studies related to the importance of pain management during labour
A. Studies related to importance of education regarding pain management during labour
This study conducted on Knowledge and decision-making for labour analgesia of Australian primiparous women to assess and investigate knowledge of labour pain management options and decision-making among primiparous women in a major tertiary obstetric hospital in metropolitan Sydney, Australia.. A semi-structured guide was used in focus groups to gather pregnant women's knowledge concerning labour analgesia. There was a large discrepancy between perception and actual knowledge. The main source of knowledge was anecdotal information. Late in pregnancy was considered the ideal time to be given information about labour analgesia. Women described their labour pain relief plans as flexible in relation to their labour circumstances; however, most women wanted to take an active role in decision-making8.
This study determined women's knowledge of and attitudes to pain relief during labour. This descriptive study included 151 women, 18 years or older, attending the antenatal clinic of Cecilia Makiwane Hospital. Women were interviewed using a questionnaire that determined their knowledge of and attitudes regarding pain relief. Half the women (51.7%) believed that they should experience mild pain, however, while 55.7% had experienced severe pain during previous labour and 65.3% of these had found the experience to be unacceptable. Most women (59.8%) who had been pregnant were not told what to expect when in labour. Even though the few women who received information about what to expect during labour found the information useful, most expressed little confidence in labour pain relief9.
B. Studies related to the importance of pain management during labour
This study examines the labor pain at the time of epidural analgesia and mode of delivery in nulliparous women presenting for an induction of labor. The objective of the study is to assess whether the degree of labor pain at the initiation of neuraxial analgesia is associated with mode of delivery. Nulliparous women who presented to the labor department for an induction of labor, who were between 37 and 41 weeks of gestation, and who requested labor epidural analgesia with a pain score of 0-3 (low pain) and a cervical dilatation less than 4 cm were assessed retrospectively. We found 185 nulliparous women with low pain and compared them with a randomly selected equal number of women in each of the other pain groups. There was no significant association between pain groups in terms of duration of the first or second stage of labor or mode of delivery10.
This study conducted on mathematical modeling of the pain and progress of the first stage of nulliparous labor. The authors retrospectively studied 100 sequential deliveries from each of five self-reported ethnic groups (Asian, Black, Hispanic, Other, and White). Demographic variables, cervical dilation, and numerical rating scores for pain before analgesia and cervical dilation were abstracted from the automated medical record. Mathematical models can be used to detect subtle effects of patient covariates on the progress and pain of the first stage of labor. Asian women and heavier women had slower labor and slower onset of labor pain than others. These effects were modest compared with the substantial remaining unexplained subject-to-subject variability in labor progress and labor pain11.
This study conducted on time and obstetric anesthesia from chaotic cosmology to chronobiology. Temporal cycles (dark/light; birth/death; etc.), along with environmental conditions (synchronizers), influence labor physiology because of the presence of endogenous clocks (oscillators) that interact with social diuturnal clues. In this review, the most important cyclic anesthetic-obstetric parameters in parturient care are listed. This study concluded that the chronobiological approach of labor anesthesia emphasizes the obstetric importance of circadian rhythmicity in labor humanization and safety12.
This study examines the effects on mother and fetus of epidural and combined spinal-epidural techniques for labor analgesia. The objective of the study is Epidural (EA) and combined spinal-epidural (CSE) techniques have both been utilized for labor analgesia. This study compared the effects on the mother and newborn of these techniques in labor analgesia and anesthesia. Forty pregnant women received epidural analgesia with 15 mL of 0.125% ropivacaine (EA group) and 5 microg of sufentanil plus 2.5mg bupivacaine in the subarachnoid space (CSE group). Epidural (EA) and combined spinal-epidural (CSE) analgesia relieved maternal pain during obstetric analgesia13
This study explain that the epidural Analgesia in the Latent Phase of Labor and the Risk of Cesarean Deliver. The objective of this trial was to test the hypothesis that patient-controlled epidural analgesia given at cervical dilation of 1.0 cm or more does not increase the risk of prolonged labor or Cesarean delivery. After institutional review board approval and patient consent, 12,793 nulliparous patients requesting neuraxial analgesia were enrolled and randomized to an early epidural (cervical dilation at least 1.0 cm) or delayed epidural (cervical dilation at least 4.0 cm) group. Epidural analgesia in the latent phase of labor at cervical dilation of 1.0 cm or more does not prolong the progression of labor and does not increase the rate of Cesarean in nulliparous women compared with the delayed analgesia at the cervical dilation of 4.0 cm or more14.
This study conducted on hypnosis for pain relief in labour and childbirth. Reference lists from retrieved papers and hypnotherapy texts were also examined. There were no language restrictions. Our primary outcome measures were labour analgesia requirements (no analgesia, opiate, or epidural use), and pain scores in labour. Suitable comparative studies were included for further assessment according to predefined criteria. Meta-analyses were performed of the included randomized controlled trials (RCTs), assessed as being of ‘good’ or ‘adequate’ quality by a predefined score. This study concluded that the risk/benefit profile of hypnosis demonstrates a need for well-designed trials to confirm the effects of hypnosis in childbirth15.
This study examines the analgesia for labour pain by analysis of the trends and associations in the Grampian region of Scotland between 1986 and 2001. The rates of the use of epidural, opioid and Entonox or no analgesia for pain relief in labour in each year were calculated. Maternal, pregnancy, labour and delivery characteristics were compared among the users of three different analgesics by univariate and multivariate analyses. This study highlight the non epidural analgesia was found to be the most popular choice for pain relief in labour in the Grampian region between 1986 and 2001, although an increase in the uptake of epidural services is starting to occur. The type of labour analgesia used is associated with the epidemiological characteristics of the women's pregnancy, labour and delivery16.
A study conducted on Lesotho midwives' utilization of non-pharmacological pain management methods during the first of stage labour. The purpose of this study was to determine the use of non-pharmacologic methods of pain management used by midwives in Lesotho. The research design was non-experimental and of a descriptive nature. The data was obtained by means of a structured questionnaire which was compiled after a thorough literature analysis was done. According to the results, the midwives indicated that they were taught non-pharmacologic methods of pain management, however they expressed that they inadequately use these methods during the first stage of labour due to shortage of staff, lack of privacy and space, a high midwife-mother ratio, culture and hospital policies. In the light of these findings, recommendations were made of maximizing the use of non-pharmacologic methods during the first stage of labour17.
STATEMENT OF THE PROBLEM
A study to evaluate the effectiveness of structured teaching programme regarding pain management during labour among nurses working selected hospitals Bangalore
6.3 OBJECTIVES OF THE STUDY
- Assessing the knowledge on pain management during labour among nurses in the terms of pretest
- Evaluate the effectiveness of structured teaching programme regarding pain management during labour by comparing pretest score on post test knowledge score
- Find out the association between knowledge score on post test knowledge score and selected demographic variables.
6.4 OPERATIONAL DEFINITIONS
1) Effectiveness: Refers to the extent to which the structured teaching programmes on pain management during labour has achieved the desired effect in improving the knowledge of patients as assessed by structured questionnaire
2) Structured Teaching Programme: Refers to systematically planned group instructions by lecture cum discussion method designed to provide information regarding pain management during labour.
3) Pain management during labour: Refers to managing the labour pain by using a supportive Birth Partner, Relaxation, Movement and Position, Breathing, Massage, Complementary Therapies like homeopathy, acupuncture, reflexology, and aromatherapy and water tub.
4) Nurses: Refers to a woman skilled in aiding the delivery of babies
6.5 HYPOTHESIS
H1 : There is a significant deference in the knowledge score on pain management during labour in the post test knowledge score than the pretest knowledge score among nurses