“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON KNOWLEDGE AND

PRACTICE REGARDING MANAGEMENT OF
MINOR DISORDERS OF PREGNANCY
AMONG PRIMIGRAVIDA MOTHERS
IN DISTRICT HOPSPITAL
TUMKUR”.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

MAGI THOMAS
OBSTETRICS AND GYNECOLOGICAL NURSING

Aruna College of Nursing

Ring Road, Maralur,
Tumkur.
2009-10

0
 RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATKA.

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of The Candidate : MAGI THOMAS

and Address First year M.sc .Nursing
Ring road,Maralur
Tumkur.

2. Name of The Institute : Aruna College Of Nursing

Ring Road, Maralur,
Tumkur-572105

3. Course of Study And Subject : 1ST Year, M.SC Nursing

Obstetrics and Gynecological
Nursing

4. Date of Admission : 10-06-2009

5. Title of The Topic : “A study to assess the effectiveness

of structured teaching programme
on knowledge and practice regarding
management of minor disorders of

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 pregnancy among primigravida
mothers in district hospital, Tumkur.”

6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION

“Thousands of women could be saved each year if they had access to

skilled care during pregnancy and child birth, and access to emergency obstetric
care. Most of the interventions they need are simple, affordable and highly
effective”
“Dr.Lee Jong Wook”

Pregnancy is the vital event in the life of a women, it need special attention
from the time of conception to the postnatal stage, every pregnancy is a unique
experience for that women and each pregnancy the women experience will be new and
adequately different. This is why it is so important that the midwife has knowledge and
understanding of the common disorders of pregnancy in order to advice the women on
strategies that will help her to hope with the condition and minimize the effect she
experiences1.

The prenatal period is a time of physical and psychological preparation of birth

and parent hood. Prenatal health supervision permit the diagnosis and treatment of pre-
existing maternal disorder or disorder that may develop during pregnancy in India most
of the mothers have poor knowledge about antenatal and intranatal care available to them.
Illiteracy, poverty and lack of communication and transportation facility make them
vulnerable to serious consequences, even though they are prominent care providers with

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the family the fundamental right health is denied to them in most part of the world . The
death of the mother increase the risk to the survival of her young child and family can’t
substitute a maternal role.2

Minor disorders are common in pregnant mothers like, nausea, vomiting, back
ache, leg cramps and constipation and also the pregnancy is a period of drastic change in
the women’s body these minor disorders are the signs that the body is naturally preparing
itself for new life.3

Women pregnant for the first time are confronted with symptom that would be
considered abnormal in the non pregnant state, much of the prenatal care requested by
such women is prompted by the need for explanation of the causes of minor disorders and
for advice on ways to relieve the discomfort Nurses can do much to allay a first time
mother’s anxiety about such symptom by telling her about them in advance using
terminology that the woman can understood such women who understood physical
discomforts of pregnancy are less able to become very anxious about their health in
addition to understanding the rationale for treatment promotes their participation in their
care.4

In India the morbidity among women may also increase with the decreasing
consumption of food and increasing work burden, Chezhumen has remarked that
women’s minor disorders ahead with or without medication. Good understanding of both
traditional and modern medical view will go along the way in minimizing the disorders
associated with pregnancy.5

One of the important strategies in the care of pregnant women is impairing

knowledge. It is essential to give advice to specific problem which the women is
experiencing .Minor disorders which are related to pregnancy can cause sleeplessness,
interfere with good nutrition, and results in much discomforts and the response of the
disorders depending upon the severity of symptoms.6

Promoting health behaviors in women and increasing knowledge about

pregnancy and its complication among women, their family are always important they

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 become life saving mothers can be encouraged to begin antenatal care early in pregnancy
and should be aware of the available services like Folic acid therapy, and tetanus toxoid.8

6.1 NEED FOR THE STUDY

Problems of pregnancy range from the mildly irritating to life threatening

condition regular antenatal checks beginning early in the pregnancy are undoubtedly
valuable they help to prevent many complication and their ensuring problems, contribute
t timely diagnosis and treatment.1

The practical nurse can play a significant role in the process of providing
patient education during pregnancy. The prenatal patient especially the first time mother,
may have many questions and concerns about this period in her life, much of the
information she may have is probably inaccurate and complete information about self
care concerns, diet need, management of common disorders and the dangers with in the
environment which may effect the health of the unborn infant.7

The goal of the maternity care is a healthy pregnancy with a physically

safe and emotionally satisfying out come for the mother, infant and family. How ever
may maternal adaptations are unfamiliar to pregnant women and their families, helping
the pregnant women to recognize the relationship between her physical status and the
plan for her care, assist her in making decisions and encourages her to participate in her
own care.2

Minor disorders are common during pregnancy may lead to serious

complication like morning sickness that develop into the hyper emesis gravidarum a
condition that begins as a minor disorder and become life threatening abnormality. So
make the mother as alert as possible to any complication and referral is important, For
that she must always educate when the changes of pregnancy are understood and it is
easier to tolerate and avoid unnecessary anxiety.2

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 There is a close relationship between the physical and psychological
reactions to pregnancy although it is a physiological process. It must also be accepted that
some women undergo profound psychological changes during pregnancy. To understand
what is happening during pregnancy is half way towards enjoying a happy successful
pregnancy, but it is important that the husband or family members need to appreciate the
pregnant women. The importance of information is paramount. If the women understand
about her pregnancy and what is happening to her body and mind, she will have more
confident in herself and in her pregnancy.9

The cost of educating management of minor disorders is minimal, and the

results are great. It enhances the mother to progress on health status health education of
management of minor disorders is also with in the scope of nursing practice so it is
mandatory for the mother to gain the knowledge to equip herself to cope with the
experience of pregnancy and also gain specific knowledge, when she presents with a
worrying symptom or discomfort. 6

Health education is one of the helping roles of the nursing care, one of the
first responsibility of personnel involved in the care of the pregnant women is to alert
them on the signs and symptoms that indicate a potential complication of pregnancy.
WHO (1994) reported that antenatal mother need to know why and how report such
warning signs, for the specific problem immediate medical help is required.4

Today nurses and midwives have an important role in health promotion,

being the health care manufactures, the mid wife is passed to a unique function of
identifying and providing high standard of antenatal care that contribute to the
maintenance of good health and minimize the severity of disease one of the factor that
contribute maternal mortality and morbidity is lack of recognition of danger signals by
women.7
The researcher during her clinical experience found that primigravida
mothers had poor knowledge regarding management of minor disorders, personal
interview with the mothers in various hospital found that there was lack of knowledge

5
 regarding management of minor disorders of pregnancy so the investigator felt that there
is a need to give sufficient health education regarding management of minor disorders of
pregnancy.
6.2 REVIEW OF LITERATURE

A Review of literature is a body of text that aims to review the critical points of
current knowledge and methodological approaches on a particular topic, the role of the
literature review is to formulate and clarify the research problems, to ascertain what is
already known in relation to problem of interest, for developing a broad conceptual
context, facilitate cumulating of scientific knowledge for interpreting the result of the
study.

Review of literature is the reading and organizing of previously written

materials relevant to specific problem to be investigated frame work and methods
appropriate to perform the study10

A study was conducted to assess the women’s awareness of minor

disorders of pregnancy and danger sings of obstetric complication in a rural district in
Tanzania (2009). A total 1118 women were interviewed, result reveals that more than
98% of women attend antenatal care at least once half of the women knew about at least
one obstetric danger sign and few women knew one or two minor disorders. It shows that
the women had low awareness of danger signs of obstetric complication and minor
disorders of pregnancy. 11

A study was conducted to assess the practice of pregnant women regarding

directory intake of fibre in Southern Brazil(2009). A cross sectional cohort study was
conducted in eighteen general practices in among 578 pregnant women. The mean energy
intake was 2776 kcal/d. The mean fibre intake is 30.2 g/d, was slightly above the
recommended. Yet 50% of the women failed to meet the recommendation. The study
concluded that practices regarding dietary fibre intake of pregnant women is in
adequate.12

6
 A study was conducted to determine the effect of ginger in nausea and
vomiting of pregnancy in Isfahan (2009). It was a single blind clinical trial study. The
subject included sixty seven pregnant women who complained of nausea and vomiting
from Isfahan city hospital. The participants were randomly assigned to two groups an
experimental group and a control group. The experimental group received ginger 250 mg
capsules for four days and the control group received placebo with the same prescription
form. The gingers was demonstrated a high rate of improvement than the placebo users
(85% versus 56% :P<0.01). The result shows that ginger is an effective herbal remedy for
decreasing nausea and vomiting during pregnancy.13

A study was conducted regarding Gastro esophageal reflux disease and

management in advanced pregnancy in Germany (2009). A prospective study was
conducted to determine the prevalence of Gastro esophageal reflux disease, the frequency
and severity of typical gastro esophageal reflux disease symptom,and their impact on
quality of life and therapeutic management in advanced pregnancy. 135 consecutive
pregnant women in the third trimester were included in the study. Result reveals that the
prevalence for gastro esophageal reflux disease in this unselected population was 56.3%.
Among symptom regurgitation was the most frequent with 47.3%, where as heart burn
was graded as the most severe symptom. The impact of Gastro esophageal reflux disease
on the quality of life of the pregnant women was significant (P<0.001). 22.9% of the
gastro esophageal reflux disease population required medication. It shows that, gastro
esophageal reflux is common in late pregnancy with an important negative impact on the
quality of life. Gastro esophageal reflux disease in advance pregnancy requires more
attention and better therapeutic management. 14

A study was conducted to determine whether decreasing iron exposure can

mitigate nausea and vomiting symptom in pregnancy in Tornato (2009). Data collected
from a prospective cohort at the mother sick programme in Tornato, 97 women seeking
advice on managing severe nausea and vomiting were advised to discontinue prenatal
multivitamin administration and switch to folic acid. Two thirds (63 out of 97)(P<0.001)
of those women qualitatively reported an improvement in nausea and vomiting symptom
after discontinuation of iron-containing prenatal multivitamins. These data suggest that

7
avoiding iron-containing prenatal multivitamins in the first trimester is effective in
improving morning sickness. 15

A study was conducted to explore knowledge of primigravida mothers

regarding minor disorders of pregnancy and obstetric complication in pregnancy in an
urban health centre in Malawi (2007). A descriptive study was conducted participants
were selected by means of purposive sampling, 45 primigravida from the urban settings
were interviewed. The findings showed that 60% of the participants were knowledgeable
about minor disorders and obstetrics complication in pregnancy, but participants had
limited knowledge of complication that may need immediate treatment during pregnancy.
The findings suggest there is a critical need for giving sufficient information to the
mothers, regarding obstetric complication and minor disorders.16

A study was conducted to assess the effect of treatment to relieve the

symptom associated with varicosity in pregnancy and to reduce leg edema in South
Africa (2006). Four trails of three different treatments were included. In one trail, women
give rutoside capsules in the last 3 months of pregnancy noted an improvement in
symptoms compared with placebo (relative risk 0.54%, 95%, CI 0.32, 0.89). In other trail
women were treated with external pneumatic intermittent compression for 30 minutes to
reduce leg edema in another trail compression stocking prophylatically reduced the
emergencies of leg symptoms (relative risk 0.74 95% CI 0.59, 0.93). Thus the result
shows rutosides appear to relieve symptoms of venous insufficiency in late pregnancy,
external pneumatic compression appears to reduce ankle swelling and compression
stocking reduce leg symptoms. 17

A study was conducted to assess the preventive intervention and treatment

for back pain in pregnancy (2001), randomized trials of any treatment to reduce the
incidence and severity of back pain in pregnancy was selected. Trail quality was assessed
and data were extracted independently by two reviewers. On trails of 109 women was
included. This cross over trail compared the use of a special shaped pillow to fit under the
women’s abdomen (ozzlo pillow) with a standard pillow, women experienced less pain in
the week when they used the ozzlo pillow than in the week with the standard pillow (odds

8
ratio 0.32%, 9.5% confidence interval 0.18 to 0.58 ). This shows that specially shaped
pillow appear to help reduce back pain in late pregnancy and improve sleep.18

A study was conducted to assess the effect of different methods for

treating consumption in pregnancy in United Kingdom (2000). Randomized trail of any
treatment for constipation in pregnancy was selected. Trail quality assessment and data
extraction were done independently by two reviewers one trial of 40 women was
included fibre supplements increased the frequency of defecation (odds ratio 0.18, 95%
confidence interval 0.05 to 0.67) and lead to suffer stools. Thus the dietary supplements
of fibre in the form of bran or wheat fibre are likely to help women experiencing
constipation in pregnancy.19

6.3 STATEMENT OF PROBLEM

9
 “ A study to assess the effectiveness of structured teaching programme on

knowledge and practice regarding management of minor disorders of pregnancy

among primigravida mothers in District Hospital Tumkur.”

6.4 OBJECTIVES OF THE STUDY

 To assess the knowledge of primigravida mothers regarding

management of minor disorders of pregnancy.
 To identify the practice of primigravida mothers regarding management of

minor disorders of pregnancy.

 To educate the primigravida mothers with a structured teaching

programme regarding management of minor disorders of pregnancy.

 To evaluate the effectiveness of structured teaching programme regarding

management of minor disorders of pregnancy among primigravida

mothers.
 To associate the knowledge and practice of prmigravida mothers regarding

management of minor disorders of pregnancy with selected demographic

variables.

6.5 OPERATIONAL DEFINITIONS

 Assess : It is the organized and continous process of

collecting data.

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 Effectiveness : it refers to the extent to which the structured
Teaching programme on management of
Minor disorders of pregnancy has achieved
the desired effect in improving the
knowledge, changing practice of primigravida
mothers ,evident from gain in knowledge
score and change in practice score .

 Structured teaching : it refers to the Systematically developed

Programme information designed to teach the primigravida

mothers regarding management of minor
disorders of pregnancy.

 Knowledge : It denotes the awareness or

information that the

primigravida mothers posses regarding
management of minor disorders of pregnancy .

 Practice : It refers to the actual activities done by the

primigravida mothers .

 Management : Measures taken to relieve the minor disorders of

Pregnancy.

 Minor Disorders : The anatomical and physiological changes in

Pregnancy which disturb the normal functioning
of the body is called as minor diorders of .
pregnancy.
 Pregnancy : The condition from conception to the expulsion
Of the fetus.

 Primigravida : A women who is pregnant for the first time.

Mothers

6.6 ASSUMPTION

 Primigravida mothers may have some knowledge regarding management

of minor disorders of pregnancy.

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  Structured teaching programme will help to improve the knowledge and

practice of Primigravida mothers regarding management of minor

disorders of pregnancy .

6.7 HYPOTHESIS

H1 : There will be significant difference between pre-test and post test

knowledge of primigravida mothers regarding management of

minor disorders of pregnancy after implementation of structured

teaching programme.

H2 : There will be significant relationship between structured

teaching programme and change in knowledge and practice

of management of minor disorders of pregnancy among

Primigravida mothers.

H3 : There will be significant association between the knowledge

and practice with the selected demographic variables of

Primigravida mothers.

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7. MATERIALS AND METHODS

The purpose of this study is to determine the effectiveness of structured

teaching programme on knowledge and practice regarding management of minor

disorders of pregnancy among primigravida mothers in district hospital Tumkur.

7.1 SOURCES OF DATA

 Research approach : pre experimental approach is used for

study

 Research design : one group pretest and post test

Pre experimental Design.

 Setting of the study : District Hospital Tumkur

 Sample Size : 60 Subjects

 Sampling technique : Simple Random Sampling

Selected Variables

 Independent Variable : structured teaching programme

 Dependent Variable : Knowledge and practice of primigravida
mothers with selected demographic
variables such as age, Sex, Education,
Religion.

Sampling Criteria

Inclusion Criteria : Mother who were pregnant for the first time
: Mother who are willing to participate in
the study.

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 : Mother who can understand English and
Kannada.

Exclusion Criteria : Mothers who are multigravida.

: Mother who are not available at the time

of data collection .

7.2 METHOD OF DATA COLLECTION

 Tool for data collection : Structured Questionnaire

Tool 1

Part A : Porforma for collecting demographic Data

Part B : Structured Questionnaire to assess

knowledge and Practice on Management

of minor disorders of pregnancy

Tool 2 : Structured teaching Programme regarding

Management of minor disorders of

Pregnancy.

 Method of data analysis. : Data will be analyzed according to the

and interpretation objectives of the study and by using

appropriate statistical techniques

and will be present in the form of tables,

graphs and diagrams.

 Duration of the study : 6 weeks

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7.3 :Does the study the require any investigation or intervention to be conducted

on the patient or human beings or animal? so please describe briefly

No

7.4 : Has ethical clearance been obtained from your institution?

Yes, Ethical clearance been obtained from the institutions ethical committee

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8.LIST OF REFERENCES

1. Myles. Textbook For midwives.14th edition .London ;Churchill Livingstone P.13,217.

2. B.T Basavantappa .Midwifery And Reproductive Health Nursing. Ist edition.Jaypee

brothers; P. 171,232,254.
3. Richard Sea. Problem Pregnancies; health action September 1993.
4. Bobak and Jenson.Maternity And Gynecologic Care. 5th edition. 1993. p.118,120-122.
5. Francis C.M . Antenatal care ,The Guide line of health worker and Expectant

mothers; Health action 1994, 13-17.

6. Katharine, A May, Lavrar, Mahimeister. Maternal And Neonatal Nursing. 3 rd edition.

p. 270-1994.
7. Women’s health Care Topics: http://www.womenshealthcaretopic.com .
8. Message from the Director General of WHO ,Health Action 1998 ,71(4): 41.
9. Markatz .Thomson and Kesingston. Prenatal care. Journal of obstetric Gynecologic

and neonatal Nursing, 1993 June; 22(3): 242.

10. Polit D.F and B.F Hungler .Text book of Nursing Research Principles and methods

,Lipping Cott Publication, p:57.

11. Pembe A.B ,Urassa D.P ,Carlsted .A . Women’s awareness of Minor Disorders and

obstetric complication. BMC Pregnancy child birth, 2009; 9-12.

12. Bussc, Nunes MA, Cameys, Manzolli P. Dietary Fibre Intake of the Pregnant

Women ,Public health Nutr .2009 Sep. 12(9) : 1392-8.

13. Ozgoli G, Goli m, Simbar M. Effects of Ginger capsules on pregnancy nausea and

vomiting, J.Altern.complement Med 2009 mar; 15(3): 243-6.

14. Fill Malfertheiners, Monice Muller K, Rohi FW . Gastro Esophageal Reflux disease

and management in advanced pregnancy .Digestion, 2009; 79(2):115-20.

15. Gill SK Maltepc, Koren G. The Effectivness of Discontinuing iron Containing

prenatal multivitamins on reducing the severity of nausea and vomiting of Pregnancy.

J.obstet Gynaecol, 2009 Jan; 29(1):13-6.

16. Kumbani LC, Mclnerney. Knowledge of minor disorder and Obstetric complication

among primigravida. Curations, 2007 August ; 29(3) :41-93.

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17. Bamigboy. AA, Hotmegr G.J . Intervention for leg oedema and varicosities in

pregnancy ,European Journal of obstetrics and Gyneacology ,2006 November 129 (1)

: 3-8.
18. Young G, Jewell D. Intervention for preventing and treating back ache in pregnancy,

Cochrane data base systematic review ,2001 April; (2).

19. Jewell D, Young G. Intervention for treating constipation in pregnancy ,2000

January ; (2).

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9. Signature of the Candidates :

10. Remarks of the Guide

11. Name of the Designation Of :

11.1. Guide :

11.2. Signature :

11.3. Co-Guide(if Any) :

11.4. Signature :

11.5. Head of Department :

11.6. Signature :

12.

12.1. Remarks of the Principal :

12.2. Signature :

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