A STUDY TO ASSESS THE EFFECTIVENESS OF

PLANNED TEACHING PROGRAMME ON SELECTED

WARNING SIGNS IN PREGNANCY AMONG PRIMI-

GRAVIDA WOMEN IN SELECTED HOSPITAL,

BANGALORE.

PROFORMA FOR REGISTRATION OF SUBJECT FOR

DISSERTATION

Ms. DELLA K C

IST YEAR M.Sc. (N) NURSING

OBSTETRICS AND GYNECOLOGICAL NURSING

2011-2013

HARSHA COLLEGE OF NURSING

HARSHA HOSPITAL CAMPUS

193/4, NELAMANGALA BYPASS,

BANGALORE-561223

1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKAPROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

MS.DELLA K CHARSHA COLLEGE OF NURSING HARSHA HOSPITAL CAMPUS193/4, NELAMANGALA BYPASS,BANGALORE-561223

2. NAME OF INSTITUTION Harsha College Of Nursing

Bangalore

3. COURSE OF STUDY AND

SUBJECT

I year M.Sc. Nursing Obstetrics And Gynecological Nursing

4. DATE OF ADMISSION TO

COURSE06/05/2011

5. TITLE OF THE STUDY

To Assess The Effectiveness Of Planned

Teaching Programme On Selected

Warning Signs In Pregnancy Among

Primi-Gravida Women

2

6. 0 BRIEF RESUME OF THE INTENDED WORK:INTRODUCTION:

“ Prevention is better than cure”

World Health Organization stated that the pregnancy and childbirth are

special events in woman’s lives and indeed in the lives of their families. This can be a

time of great hope and joyful anticipation. It can also be a time of fear, suffering and

even death. Although pregnancy is not a disease but a normal physiological process, it

is associated with certain risks to health and survival both for the woman and for the

infant she bears. These risks are present in every society and in every setting. In

developed countries they have been largely overcome because every pregnant woman

has to take special care during pregnancy and childbirth. In developing countries

where each pregnancy represents a journey into the unknown from which all too

many woman never return, due to lack of care provision.1

A research study mentioned that nature has bestowed a woman with the

capability of producing children, the process that makes her mother. But sad part is

that, this normal life furthering process of procreation can lead to as grim a situation

as death. At least 40% of all pregnant women will experience some type of

complications during their pregnancies. For about 15%, these complications will be

potentially life threatening, and will require immediate obstetric care. Maternal death

also compromises the health and survival of infants and children they have behind.

The death of a woman during pregnancy and childbirth is not only a health issue but

also a matter of social injustice. 2

World Health Organization stated that Worldwide, there are 430 maternal

deaths

for every 100,000 live births. In developing countries, the figure is 480 maternal

deaths for every 100,000 live births. In developed countries, there are 27 maternal

deaths for every 100,000 live births. 3

In India, most of the mothers have poor knowledge regarding antenatal,

intranatal care and postnatal care. Illiteracy, poverty and lack of communication and

3

transport facility make them vulnerable to serious consequences. Though they are the

prominent care providers within the family and key to human development and well

being, the fundamental right health is denied to them in most parts of the world. The

death of mother increases the risk to the survival of her young children, as the

familycannot substitute a maternal role.

According to Text Book of Preventive and Social Medicine, India has very high

maternal mortality rate. It was 20 per 1000 births and declined to 10 per 1000 live

births. Present maternal mortality rate for India was 407 per 1,00,000 live births. This

means more than 1,00,000 women die each year due pregnancy related causes. It is

mainly due to large number of deliveries conducted home at by untrained persons,

lack of adequate referral facilities to provide emergency obstetric care for complicated

cases and contribute to high maternal morbidity and mortality. 4

Maternal Mortality in India is a subject of grave concern. The maternal mortality

rate in Karnataka is 460 per 1,00,000 live births. Important contributing causes are

anemia, poverty, ignorance, malnutrition, inter current infections,

haemoglobinopathies. Hemorrhage (25.6%) ranks first as the cause of maternal death,

followed by sepsis (13%), toxemia of pregnancy (11.9%), abortions (8%), obstructed

labour (6.2%), while other causes together total 35.3%.5

Though health departments create awareness both central and state level through

mass media for planned MCH programme. Still most the mothers living in remote

areas are not aware of this due to lack of literacy, ignorance and social cultural

factors.

6.1 NEED FOR THE STUDY

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“An ounce of prevention is equal to an ocean of care”.

Women; the word sounds so powerful. Since eternity, women have played a

role more important than men and that is no exaggeration. The world would not have

been the same lovely adorable and livable place without wonderful contribution so

selflessly made by women. It has been said that, you teach a female and you build up

a nation and truth can’t be closer than that. Women have always carried the burden of

being a wife, mother, sister etc. Hence, the study is conducted on “assessing the

knowledge of primi gravida women and giving health education on selected warning

signs in pregnancy”.6

Globally, woman that die each year due to pregnancy and childbirth are

Africans (53%), while the rest are Asians (42%) and to a lesser extent Latin

Americans (4%). Less than 1% of maternal deaths occur in developed countries. It is

estimated that 99% maternal deaths occur in the developing world every year.

The World Health Organization estimates that 150 million pregnancies occur

annually.

1. Worldwide, every minute of every day, one-woman dies of pregnancy related

complications. Nearly 6,00,000 women die each year, of these 99% of death occurs in

developing countries.

2. Every single woman who dies, 30 women develop life long illness and injuries

related to pregnancy and childbirth.

3. In India, every five minutes, one woman dies from complications related to

pregnancy and childbirth. This adds up to a total of 1,21,000 woman per year.

4. 15% of the woman develops life-threatening complications.

A study stated that in India, the maternal mortality ranks at 420 per 100,000

live births. Most maternal deaths in India are caused by complications such as

haemorrhage (29%), anemia (19%), sepsis (16%), obstructed labour (10%), unsafe

abortion (9%) and (8%) hypertensive disorders of pregnancy. All these are potentially

avoidable. Maternal death is not a vaccine preventable disease and there is no one

short remedy for reducing maternal mortality. Maternal mortality is disease of

5

poverty, affecting woman and their children, restricted by national borders and of

little interest to anyone else. 7

An awareness study revealed that the studies dealing the knowledge and

awareness about the danger signs of pregnancy at the country level are very rare. The

available studies show that the knowledge and awareness about the danger signs of

pregnancy among men and woman is far less from universal. Because of this lack of

awareness on the part of men and woman, many woman fail to seek care for life

threatening complications of pregnancy and childbirth. Without universal awareness

about danger signs of pregnancy and awareness about what to do in case of a

complication, is it realistic to think of reducing fatalities from pregnancy when it is

clearly known that many complications during pregnancy are unpredictable. 8

A descriptive study was conducted to know the maternal morbidity among

selected women at Hyderabad, AP. The study findings revealed that 67.5% of women

suffered with pregnancy related problems during antenatal period and pre-eclampsia

was the major leading cause. 9

Health Action stated that Safe motherhood is a state of well being in which a

woman approaches childbirth with confidence in her abilities to give birth and nurture

her new born. 10

National Population Policy 2000 and National Health Policy 2002 aim at

reducing the Maternal Mortality Rate to 100 per 100,000 live births from the current

level of MMR of 400 to 500s. 11

Though pregnancy is a natural physiological phenomenon, complications do

arise even with best of antenatal care. The important danger signs during pregnancy

are bleeding, loss of foetal movement, poor weight gain, high blood pressure, swelling

of face, arms and legs etc. It is important to know that hemorrhage is the common

cause of maternal deaths in India and it can cause death of the woman within 2hours if

immediate care is not provided. 12

A study was conducted on teaching Primi-Gravida woman about warning signs in

pregnancy using a specially designed information booklet. A group of 33 pregnant

women were selected and used one group pretest and post test design. The findings

revealed that the mean post test score of 88.79% was significantly higher than the

mean pretest score of 25.58%. The post test score were significantly higher in

6

individual areas of knowledge. This indicated that the information booklet was

effective in raising knowledge regarding warning signs. 13

A prospective study was conducted a sixteen year review on Maternal mortality

in a hospital of Northern India and concluded that there were 116 maternal deaths

among the 126,083 live births, that indicate the maternal mortality rate of 445 per

100,000 live births. Out of these 64 deaths (955.5%) due to direct causes, 50 deaths

(43.1%) due to indirect causes and the remaining two (1.7%) due to unrelated causes. 14

A survey was conducted on assessment of maternal mortality and its causes in

Tamilnadu State and concluded that the maternal causes are haemorrhage, toxaemia,

severe anemia and obstructed labour. 15

A pre experimental study was conducted on the identification of high-risk

pregnancy among 120 antenatal mothers. She observed that among various risk

factors the highest percentage (93.33%) of the women had obstetric risk and 66.7%

had medical risk and 60% had physical risk. So early identification and timely

intervention is verymuch important to prevent or to avoid the complications. 16

During the clinical placement in hospital, the investigator found that most of the

pregnant women are unaware of warning signs and its effect during pregnancy.

Considering the above factors, the investigator felt there is need for assessing the

knowledge regarding warning signs in pregnancy among Primi-Gravida woman. So it

was decided to conduct a study to assess the knowledge of selected warning signs

during pregnancy among Primi-Gravida woman.

6.2 REVIEW OF LITERATURE

Review of literature is a key step in research process refers to the activities

involved in searching for information on a topic and developing a comprehensive

picture of the state of knowledge on that topic .This provides a background for

understanding what has already been learned on a topic and illuminates the significant

of new study. The review is divided into under following sections:

7

Section A: Studies related to Warning signs during pregnancy

Section B: Review of Literature related to severe vaginal bleeding

Section C: Review of Literature related to severe vomiting

Section D: Review of Literature related to unusual swelling

Section A: Studies related to Warning signs during pregnancy.

A study was conducted on detection and management of eating disorders during

pregnancy and stated that eating disorders such as anorexia and nervosa bulimia

nervosa associated with potential negative consequences during pregnancy, including

higher rates of miscarriage, low birth weight, obstetric complications, and post partum

depression. 17

An experimental study was conducted on nausea and vomiting in early pregnancy

and its role in placental development concluded that there may be a positive

relationship between morning sickness and pro conceptional body mass index, such

that women that are under weight will experience less severe symptoms of morning

sickness compared with women with normal proconceptional body mass index’s. 18

A descriptive study was conducted on knowledge of urban mothers about high

risk conditions reported mean knowledge score of mother was 70.62%. Highest

knowledge score (95%), obtained in area of bleeding and pain in abdomen and lowest

50% about pregnancy with fever. Again highest (90) mean % knowledge score was

about fits and lowest (55) mean % knowledge score about fever and headache. 19

Section B: Studies related to Severe vaginal bleeding.

A clinical research was conducted in their study on the predictors of vaginal

bleeding during the first two trimesters of pregnancy. The findings revealed that the

maternal age, race, cigarette smoking, prior spontaneous abortion, prior induced

abortion and prior preterm birth were in relation to vaginal bleeding during the first

two trimesters of pregnancy. 20

8

A study on the vaginal bleeding showed that in the first 20 weeks of pregnancy

revealed that the first and foremost diagnosis to exclude in the pregnant patient

presenting with vaginal bleeding is ectopic pregnancy. 21

A randomized control trial conducted among 1100 pregnant women in USA to

determine the association between first trimester bleeding and preterm birth. It was

found out 60% of women with first trimester bleeding had one or more infections

detected at the initial examination. Preterm birth was increased among women with

first trimester bleeding i.e., 4.4%.22

Section C: Studies related to Excessive vomiting during pregnancy.

A study on vomiting in pregnancy concluded that antihistamines are safe and

effective for treatment of nausea and vomiting of pregnancy and also metaclopromide

possess a high efficacy and safety profile. 23

A prospective study on nausea and vomiting, its frequency, intensity and patterns

of changes during pregnancy revealed that 74% of women reported nausea. Morning

sickness occurred in only 1.8% of women, whereas 80% reported nausea lasting all

day. Only 50% of women were relieved by 14 weeks gestation; 90% had relief by

week 22. 24

A prospective study of 363 pregnant women and found that 20% had no

symptoms of nausea and vomiting, 28% just felt sick and 52% felt sick and vomited.

Symptoms peak at about the ninth week of pregnancy and often stop suddenly by

about the 14th week. Two-thirds of women may have similar symptoms in successive

pregnancies. 25

Section D: Studies related unusual swelling of face, arms and foot during

pregnancy.

A study results showed that the interval between pregnancies and the risk of pre-

eclampsia revealed that pre-eclampsia occurred during 3.9 percent of first

pregnancies, 1.7 per cent of second pregnancies, and 1.8 percent of third pregnancies

when the women had the same partner. The risk approximated that among nulliparous

women. 26

9

A study was conducted on maternal mortality in pre-eclampsia. The study revealed

that maternal mortality due to eclampsia is very high in developing countries, 93.4%

of the mothers did not have regular antenatal checkup and care and 9.9% were grande

multipara. They concluded that in order to overcome the problem, good antenatal care

should be provided through improving the educational, social and economical status

of the women. 27

6.3 STATEMENT OF THE PROBLEM

A Study to Assess the Effectiveness of Planned Teaching Programme on

selected Warning Signs in Pregnancy among Primi-gravida Women in Selected

Hospital, Bangalore.

6.4 OBJECTIVES:

1. To assess the pretest knowledge of primi gravida women on selected warning

signs in pregnancy.

2. To assess the effectiveness of planned teaching programme on knowledge of

primi gravida women on selected warning signs in pregnancy.

3. To associate the pre test knowledge of primi gravida women on selected

warning signs in pregnancy with that of demographic variables.10

6.5 OPERATIONAL DEFINITIONS

1. Effectiveness : It refers to the extent to which teaching programme, had brought

about the results intended and measured in terms of significant knowledge gained

in the post test. In this study it refers to gain in knowledge score of primi gravid

women after under going planned teaching programme on selected warning signs

in pregnancy.

2. Planned Teaching Programme : It refers to the systematically developed

instruction or information and Visual aids designed to teach selected warning

signs in pregnancy for primi gravida women attending in selected hospital,

Bangalore.

3. Selected Warning Signs in Pregnancy: Giving notice of possible danger

indications during pregnancy regarding complications which includes severe

vaginal bleeding, severe vomiting and unusual swelling.

6.6 HYPOTHESIS OF STUDY

H1 –There will be a significant difference between pre test and post test level of

knowledge of primi gravida women regarding selected warning signs of pregnancy.

H2- There will be a significant association between pre test level of knowledge of

primi gravida women regarding selected warning signs of pregnancy with selected

demographic variables.

6.7 ASSUMPTION

1. Primi gravida women may have inadequate knowledge regarding warning signs of

pregnancy.

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2. Planned teaching programme may improve the knowledge of primi gravida

women regarding selected warning signs of pregnancy.

6.8 DELIMITATION

The study was delimited to

1. Primi gravida women who are attending at selected hospital, Bangalore.

2. 4-6 weeks of duration.

6.9 VARIABLES

Research variables on the concept at various levels of abstraction that are

entered manipulated & collected in a study.

1. Independent variables: Planned teaching programme regarding selected

warning signs of pregnancy

2. Dependent variables: knowledge of primi gravida women regarding selected

warning signs of pregnancy.

3. Demographic variables: It contains demographic variables of primi gravida

women such as age, religion, education, type of family, income of the family,

source of information regarding selected warning signs of pregnancy.

7. MATERIAL AND METHODS

The study is designed to assess the Effectiveness of Planned Teaching

Programme on selected Warning Signs in Pregnancy among Primi-gravida Women in

Selected Hospital, Bangalore.

7.1. SOURCE OF DATA:

The data will be collected from Primi-gravida Women in Selected Hospital,

Bangalore.

7.1.1 RESEARCH DESIGN:

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Pre experimental one group pre test post test design.

7.1.2 RESEARCH APPROACH:

Evaluative approach

7.1.3 SETTING OF THE STUDY:

This study will be conducted in selected hospital, Bangalore.

7.2 METHODS OF COLLECTION OF DATA:

Structure self administered questionnaire will be used to assess the knowledge of

primi gravida women regarding selected warning signs of pregnancy.

.7.2.1 SAMPLING TECHNIQUE:

Probability sampling technique, Simple random sampling (Lottery method)

7.2.2 SAMPLE SIZE:

The sample of the study consists of 60 primi gravida women.

Duration of study:

4 weeks

7.2.3 SAMPLING CRITERIA:-

Inclusion criteria:

1. Who are attending antenatal O.P.D in selected hospital, Bangalore.

2. Who are willing to participate in the study.

3. Who can understands Kannada and English.

Exclusion criteria:

1. who can not understand English and kannada

2. who are not willing to participate

7.2.4 TOOLS FOR DATA COLLECTION:

Structure self administered questionnaire will be used to assess the knowledge of

primi gravida women regarding selected warning signs of pregnancy.

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Procedure for data collection:

Data collection is the gathering of information needed to address a research problem.

A validated structured questionnaire will be used to collect the data about knowledge

of primi gravida women regarding selected warning signs of pregnancy.

7.2.5 DATA ANALYSIS METHOD:

Descriptive statistics

-Frequency and percentage distribution were used to study the demographic variables

of primi gravida women regarding selected warning signs of pregnancy.

-Mean and standard deviation were used to determine the level of knowledge of primi

gravida women regarding selected warning signs of pregnancy.

Inferential statistics

Paired t test: will be used to assess the relation between pre test and post test level of

knowledge of primi gravida women regarding selected warning signs of pregnancy.

Chi-square test: will be used to bring out the association between the knowledge

with selected demographic variables. Level of significance was fixed at 5% level.

7.3 DOES THE STUDY REQUIRE ANY INTERVENTION OR

INVESTIGATION TO BE CONDUCTED TO THE PATIENTS, OTHER

HUMAN OR ANIMALS?

Yes. Planned teaching programme will be used as an intervention.

7.4 HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Permission will be obtained from:

1. The research committee of the college of Nursing.

2. Authorities of selected hospital, Bangalore.

3. Informed consent will taken from the primi gravida women who are willing

to

Participate in the study.14

8. LIST OF REFERENCE:

1. Gita. R. Being pregnant today, Health Action: February 1998; 17-8.

2. Gupta. N. Maternal Mortality: magnitude, causes and concerns. Journal of obstetrics

& Gynaec today: September 2004; 9: 555-8.

3. Division of Reproductive Health. World Health Organization. Safe motherhood:

Maternal Mortality: Switzerland; 1998(CH-1211)

4. Park. K. Text book of Preventive and Social Medicine. 17th ed. Jabalpur: Banarsidas

Bhanots; 2002.

5. The Journal of Family Welfare; 1997: 42 (1); 2-5.

6. Benett R, Linda K Brown. Myles Text book for Midwives. 12th ed. Edinburgh:

Churchil Living Stone; 1993.15

7. Mathai. M. Improving Maternal and Child survival in India. Indian Journal of

Medical Resident: May 2005; 121: 624-7.

8. Ram. F, Singh A. Safe motherhood and millennium development goals in India. The

Journal of Family Welfare; special issue 2004: 26-30.

9. Swarna. Maternal Morbidity. Nurses of India: September 2004; 11-4. 10. Safe

motherhood. Health Action: April 1998.

10. Department of Health. National Population Policy: Ministry of India; 2000.

11. Department of Family Welfare Service. Safe motherhood: Government of India:

1997-1999; 94-9.

12. Noronha. J. Teaching Primigravida women about warning signs in pregnancy using a

specially designed information booklet. The Indian Journal of Nursing & Midwifery:

December 1998; 1 (3): 27-34.

13. Anandalakshmy PN, Buckshee K. Maternal Mortality in a referral hospital of northern

India - A sixteen year review. The Journal of Family Welfare: September 1997; 43

(3): 1-4.

14. Ramchandran L, Muthuswamy P. An assessment of maternal mortality and its causes.

The Journal of Family Welfare: September 1994; 40 (3): 51-8.

15. Sarvamangala. To identify the risk factors related to pregnancy among the pregnant

women attending antenatal clinic in a selected hospital. M.Sc(N) Thesis, Rajiv Gandhi

University: 1998.

16. Frabko DL, Spurrell EB. Detection and management of eating disorders during

pregnancy. Journal of Obstetrics and Gynaecology. June 2000; 95 (6): 942-6. (cited

on June 8) Available from URL: http://www.pubmed.com

17. Huxley RR. Nausea and vomiting in early pregnancy: its role in placental

development. Journal of Obstetrics and Gynaecology; May 2000; 95 (5): 779- 82.

(cited on June 8) Available from URL: http://www.pubmed.com

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18. Simrat kaur NJ. Knowledge of urban mothers about high risk conditions during

pregnancy, NJI: May 1998; 89 (5); 290-6.

19. Yang, Savitz DA, Dole N, Hartman KE, Herring AH, Olshan AF et. al. Predictors of

vagina bleeding during the first two trimesters of pregnancy Paediatric Perinatal

Epidemiology: July 2005; 19 (4): 276-3. (cited on August 5) Available from URL:

http://www.pubmed.com.

20. Coppola PT, Coppola M. Vaginal bleeding in the first 20 weeks of pregnancy.

Emergency Medical Clinician North America: August 2003; 21 (3): 667-7. (cited on

June 8) Available from URL: http://www.pubmed.com

21. French. JI et. al. Gestational bleeding bacterial vaginosis and common reproductive

tract infection: risk for preterm birth. Journal of Obstetrics and Gynaecology: 1999;

93 (5): 715-24.

22. Schroder O, Stein J. Vomiting in pregnancy. MMW Fortshr Med (14610862)

December 2002; 144 (50): 32-4. (cited on June 8) Available from URL:

http://www.pubmed.com.

23. Lacriox R, Eason E, Melzack R. Nausea and vomiting during pregnancy. American

Journal of Obstetrics and Gynaecology: April 2000; 182 (4): 981-7. (cited on June 8)

Available from URL: http://www.pubmed.com

24. Gadsy R. Pregnancy sickness and symptoms. Prof. Care mother child: 1994; 4 (1): 16-

7. ( cited on June 8) Available from URL: http://www.pubmed.com

25. Wilson, Watson, Prescott G, Sarah, Doris et al. Hypertensive diseases of pregnancy

and risk of hypertension and stroke in later life. British Medical Journal: April 2003;

326-45.

26. . Jarven, Allen Wilcox and Rolv T. The interval between pregnancies and the risk of

pre-eclampsia. New England Journal of Medicine: January 2002; 346 (1): 33.

27. Pal, Basker. Maternal mortality in pre-eclampsia. The Journal of Obstetric and

Gynaecology of India: 1997; 42 (2): 11-7.

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9. SIGNATURE OF STUDENT :

10. REMARKS OF THE GUIDE :

11. NAME & DESIGNATION OF :

11.1 GUIDE NAME & ADDRESS :

Head of the Department Obstetrics and gynecological Nursing

11.2 SIGNATURE OF GUIDE :

11.3 CO - GUIDE (IF ANY) :

11.4 SIGNATURE :

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11.5 HEAD OF THE DEPARTMENT :

Head of the Department, Obstetrics and gynecological Nursing

11.6 SIGNATURE OF H.O.D :

12.1 REMARK OF PRINCIPAL :

12.2 SIGNATURE OF PRINCIPAL :

19