RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

A STUDY TO EVALUATE THE EFFECTIVENESS OF STRUCTURED

TEACHING PROGRAMME ON SELECTED ASPECTS OF

POST OPERATIVE CARE AMONG PRIMIMOTHERS

UNDERGOING ELECTIVE CAESAREAN

SECTION IN SELECTED HOSPITALS

AT KOLAR DISTRICT.

SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT

FOR DISSERTATION

Ms.POONGODI.V

AE & CS PAVAN COLLEGE OF NURSING

KOLAR - 563101 (KARNATAKA)

RAJIVGANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. NAME OF THE CANDIDATE

AND ADDRESS

Ms. POONGODI. V1ST YEAR MS.c NURSINGAE & CS PAVAN COLLEGE OF NURSING, KOLAR - 563101KARNATAKA.

2. NAME OF INSTITUTION AE & CS PAVAN COLLEGE OF

NURSING, KOLAR - 563101

KARNATAKA.

3. COURSE OF STUDY AND THE

SUBJECT

M.Sc. (NURSING)

OBSTETRICS&

GYNACOLOGICAL

NURSING.

4. DATE OF ADMISSION TO

COURSE

03-06-2008

5. TITLE OF THE TOPIC:A STUDY TO EVALUATE THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON SELECTED ASPECTS

OF POST OPERATIVE CARE AMONG PRIMIMOTHERS

UNDERGOING ELECTIVE CAESAREAN SECTION IN SELECTED

HOSPITALS AT KOLAR DISTRICT.

2

6. BRIEF RESUME OF INTENDED WORK

Introduction:

‘The most successful man in life is the man who has the best information the

only thing more expensive than education is ignorance”.

- K. Park

The word "Caesarean" is derived from the Latin word "Caedore" which means

"to cut". French obstetrician, Francois Mauriceau first reported casearean section in

1668. It was Max Sanger in 1882, first sutured the uterine wall.1

Caesarean section is described as being an operative procedure that is carried

out under anesthesia where by the fetus, placenta and membranes are delivered

through an incision in the abdominal wall and the uterus. This is usually carried out

after viability has been reached (24 weeks of gestation onwards). 2

There are two types of caesarean section. Elective and emergency. In elective

caesarean section when the operation is done at a pre arranged time during pregnancy

to ensure the best quality of obstetrics, an aesthesia, neonatal resuscitation and nursing

services.1

The world health organization estimates that the rate of caesarean

section between 10% and 15% of all births in developed countries. In 2004, the

caesarean section rate was 20% in the United Kingdom, while the Canadian rate was

22.5% in 2001-2002. In the United States the caesarean section rate has risen to 46%.

Since 1996, reaching level of 30.2% in 2005.3

A study was conducted to estimate the population caesarean section rate in

urban India. Total population caesarean section rate was 32.6% (95% CI 27-38) and

primary caesarean section rate was 25 %( 95%CI 20-30). Total caesarean section rate

in the public, charitable and private sector were 20%, 38% and 47%. Private sector

deliveries had an odds ratio of 2.4 (95%CI 1.5,3.8) of a primary caesarean section

delivery in comparison with the public sector after adjustment for parity, age at

delivery of mothers and educational status.4

3

In Jordan, caesarean sections increased consistently from 8.5% in 1990, to

12.9% in 1997 to 17.8% in 2002. The rate of increase in cesarean section delivery

was slightly higher in private hospitals than in public one.5

Currently the incidence is nearly 18% for first time mothers, over 70%

for repeat procedures (DHHS 2000). This rates results from the combination of the

increased safety of caesarean birth and the use of fetal monitors, which provide for

early detection of fetal problems (Grumble and Greedy 2000) . Caesarean section rate

increase may also be related to the phenomenon that physicians skilled in doing

caesarean sections have less experience with other methods.6

Over the last 20 Years there has been increasing in the rate of caesarean

section in India. A collaborative study done by the Indian council of medical research

(ICMR), in 1980’s showed a caesareans section rate was 13.8% in teaching hospitals.

This has risen significantly. The overall rate showed to increase from 21.8% in 1993-

94 to 25.4% in 1998-1999. In that 42.4% were primigravidas and 31% had come from

rural areas.7

Caesarean section delivery related complications have been increasing

worldwide. Specially in 18 selected states. In India According to National Family

Health Survey in 1992-93 Goa (15.3%) and Kerala (13.7%) were the two states with

relatively higher caesarean section rates. There is reason to believe that current rates

are Part of a rising trend. In Andhra Pradesh, Bihar, Gujarat, Karnataka, Punjab and

Uttar Pradesh the risk of undergoing caesarean section in private sector institutions is

four or more times that in the public sector.8

Caesarean births are not without complications both for mother and

fetus. Maternal complications occur in 25% of births. Proper post operative care will

reduce the incidence.9

A retrospective analysis of maternal deaths following caesarean section,

sepsis was the single most important cause of maternal death (81.5%).10

Currently, caesarean section delivery as a prophylactic measure, to

alleviate problems of birth conditions such as cephalopelvic disproportion, failed

induction or failure to progress in labour and obstructive, benign or malignant tumor.6

4

There are two types of indications for elective caesarean section, namely

definite indications such as cephalopelvic disproportion, major degree of placenta

praevia and high order multiple pregnancy and possible indications such as breech

presentation, moderate to severe pre-eclampsia, a medical condition that warrants the

exclusion of maternal effort, diabetes mellitus, intrauterine growth restriction,

antepartum haemorrhage and certain fetal abnormalities (hydrocephalus).2

Child birth is considered a multidimensional experience. Labour and

child birth includes intense physical, emotional, social, cultural and spiritual elements

that may be critical to an individual women experience of this major life events11.

Post operative caesarean section complications are postpartum

hemorrhage, Shock, an aesthetic hazards, infections, intestinal obstruction,

thromboembolic disorders, wound complications, (wound sepsis, frank pus,

haematoma, and dehiscence) secondary postpartum hemorrhage.1

Before beginning teaching, assess how much the woman already knows

about the caesarean section surgery. Answer all specific questions and fill in gaps in

knowledge. Explain preoperative measures that will be necessary such as surgical

skin preparations, eating nothing before the time of surgery, premeditations and

method of transport, throughout teaching, use visual aids as necessary.6

The post-operative period extends from the time the Patient leaves the

operating room until the follow-up visit with the surgeon. This period may be as short

as one week or as long as several months. During the post-operative period, nursing

care is directed at re-establishing the patients physiological equilibrium, alleviating

pain, preventing complications and teaching the patients self care.12

6.1 NEED FOR THE STUDY:-

5

A 2008, United States report found that fully one third of babies born in

Massachesetts in 2006 were delivered by caesarean section. Among developing

countries, Brazil has one of the highest rates of caesarean section in the world. In

public health network, the rate reaches 35% while in private hospitals the rate

approaches 80%.3

Rates of caesarean section are of concern in both developed and

developing countries. They estimate the proportion of births by caesarean section at

national, regional and global levels. The analysed nationally representative data

available from surveys or vital registration systems on the proportion of births by

caesarean section. They used local non-parametric regression techniques to correlate

caesarean section with maternal mortality ration, infant and neonatal mortality rates,

and the proportion of births attended by skilled health personnel. 15% of births world

wide occurs by caesarean section. Latin America and the caesarean section shows the

highest rate (29.2%) and Africa shows the lowest (3.5%).13

A study was conducted to examine etiology and preventability of maternal

death and the causal relationship of caesarean delivery. Ninety Five maternal deaths

occurred in 1,461,270 pregnancies (6.5 per 1.00,000 pregnancies). The rate of

maternal death causally related to mode of delivery was 0.2 per 1,00,000 for vaginal

birth and 2.2 per 1,00,000 for caesarean delivery.14

A study was conducted to determine the prevalence and correlates of

caesarean deliveries. The rate of caesarean section was 26.4% and correlated with

socio-demographic, obstetrical and provider related variables. This study showed

an increased caesarean section rate in a middle income country and identifies the

correlates of women delivering by the abdominal route.15

A study was conducted on the voice of patients for improving caesarean

delivery care methods the women who had received caesarean section filled out

questionnaire survey few days after caesarean section. This study results showed that

all pregnant women and family, the medical staff should offer correct information

concerning caesarean section at the early stage.16

A study was conducted to analyze the frequency of post operative

complications following elective and emergency caesarean delivery. In 574 planned

6

caesarean section case post operative complication was 1.4% while in 292 emergency

caesarean section it was 2.05% (P>0.05). It is a major surgical procedure

characterized with morbidity even if performed as a planned procedure. The risk of

complications seems to be higher in cases of repeated caesarean section.17

A study was conducted to estimate the relative risk of post-partum

complication by type of delivery. The results indicate that the incidence of major

puerperal infection, thromboembolic events, anesthetic complications and obstetrical

surgical wound infection was higher among women undergoing a caesarean section as

compared to those with vaginal delivery. These findings are of particular relevance in

light of the substantial proportion of repeat caesarean sections performed on an

elective basis.18

Maternal deaths from caesarean sections was exceptionally high and

result from avoidable causes such as hemorrhagic shock, sepsis and hypertensive

disorders in pregnancy. Increased involvement of specialists in the care and improved

intra and post-operative management of cases was advocated to reduce the higher

maternal mortality rate.19

A study was conducted to examine the annual incidence and secular

trend of caesarean births. The results from 1987 to 1999 the over all annual caesarean

section rate rise steadily from 16.6 to 27.4 per 100 hospital deliveries, resulting in a

65% increase over 12 years. The mean difference in rates of surgical delivery

between public (mean (public) = 16.0%) and private (mean (private) =43.4%)

institutions was 27.4% (95% confidence interval (CI) = 24.1, 30.7, P<0.001). 20

The national sentinel caesarean section Audit 2001 show that caesarean

section rates in 2000 were highest in Wales, at 24.2% in 2000 and in Northern Ireland,

at 23.9% in 2000-1.2

There are many reasons for the increase in caesarean section rates.

These may be attributed to both technological and social changes. The expectation is

perhaps that every pregnancy should have a healthy outcome (silverton 1993), perhaps

the more, so because many women work full time and are choosing to delay and

restrict the number of pregnancies they have. (Call Wood and Thomas 2008). Fear of

litigation may be a reason for early recourse to caesarean birth.2

7

Women who deliver by caesarean birth have an additional care concern

in the immediate post partal period, because they are not only post partal patients but

post surgical ones as well. Due to the strain of the unexpected procedure, they may

have increased difficulty bonding with their new infant. There is little time for

teaching because of shortened hospital stays.6

Preoperative teaching is a vital part of nursing care. Studies have shown

that preoperative teaching reduces clients anxiety and postoperative complications and

increases their satisfaction with the surgical experience. Good preoperative teaching

also facilitates the client's return to work and other activities of daily living.21

Based on the review of literatures and personal experience of the

investigator during practice in the field of nursing service found that primimothers

undergoing elective caesarean section they are not having adequate knowledge

regarding post operative care. This gap of knowledge on one side and the growing

risks on the other side necessitates to need to systematically educated the mother's to

adopt healthy life style pattern. So the investigator felt to impart that the structured

teaching programme will facilitate them to know about the selected aspects of post

operative care after caesarean section.

6.2. REVIEW OF LITERATURE:

8

According to Polit and Beck (2006) a broad, comprehensive, in depth,

systematic and critical review of scollerly publications, unpublished materials, audio

visual materials and personal communications is called review of literature.22

An extensive search of literature was done by the investigator to elicit factual

information about selected aspects of post operative care after caesarean section. The

related literatures is organized and presented under the following headings.

1. Literatures related to caesarean section

2. Literatures related to selected aspects of post operative care after

caesarean section.

Related to pain management

Related to prevention of wound complications

Related to maternal nutrition

Related to initiation of breast feeding.

3. Literatures related to effectiveness of structured teaching program on

selected aspects of post operative care after caesarean section.

1. Literatures related to caesarean section.

The caesarean section rate continues with routine access to medical

services, yet this increase is not associated with improvement in prenatal mortality or

morbidity. The women preference for caesarean section varied from 0.3% - 14%.

Caesarean section related to psychological factors, perceptions of safety, or in some

countries was influenced by cultural or social factors.23

2. Literatures related to selected aspects of post operative care after

caesarean section.

Related to pain management.

A study was conducted to assess the analgesic effect of transcutaneous

nerve stimulation (TENS) on caesarean 54 subjects randomly selected. The result of

this study showed that intensity of pain and usage of sedative drug remarkably

reduced after use of transautaneous nerve stimulation (TENS) (P<0.001, P<0.05).

Patient satisfaction was significantly before than the control group (P<0.001) This

9

might lead to better out comes in pain control and facilitating development of bonding

between mother and baby.24

A study was conducted to assess post operative pain and pain relief after

caesarean birth. 60 women underwent caesarean birth. Descriptive patient survey was

carried out and data are collected through a questionnaire and assessment of pain by

visual analog scale (VAS) and women birth experience measured on a seven-point

Likert scale. The results showed that the women experienced high level pain during

the first 24 hours and 78% of the women scored greater than or equal to 4 on the

visual Analog Scale. There was no difference between elective and emergency

caesarean births in the levels of pain. In spite of high levels of pain, women were

pleased with the pain relief. Postoperative pain negatively affected breastfeeding and

infant care. The study concluded that, there is a need for individual with adequate

pain treatment for women undergoing caesarean birth, as high levels of pain interfere

with early infant care and breastfeeding.25

A study was conducted to evaluate the effectiveness of acupressure for

controlling post-caesarean section symptoms such as nausea, vomiting, anxiety

perception and pain perception. A total of 104 eligible participants were recruited by

convenience sampling techniques. The experimental group received three acupressure

treatments before caesarean section and within the first 24 hours after caesarean

section. The results indicated that the experimental group had significantly lower

anxiety and pain perception of caesarean experiences than the control group. The

study concluded that the utilization of acupressure treatment to promote the comfort of

women during caesarean delivery is strongly recommended.26

A quality improvement study of pain management after caesarean

delivery was conducted. The patient subjective report of satification with pain

management was not related to the method or drug used for pain control (P=0.13)

fewer women assigned to morphine thereby stopped breastfeeding (P=0.02) and more

roomed in with their infants (p<0.01). The pain relief was superior with the morphine

regimens used and was positively associated with breast feeding and infant rooming

in.27

Related to Prevention of wound complications

10

A study was conducted on risk factors for surgical site infection after

low transverse caesarean section. Retrospective cast-control study design. Surgical

site infections (5.0%) independent risk factors for surgical site infections 95%. It

should be incorporated into approaches for the prevention and surveillance of surgical

site infection after surgery.28

A study was conducted on caesarean section, surgical site infection and

wound management. Surgical site infections are a common cause of morbidity. The

risk factors for surgical site infections following caesarean section including

prophylaxis antibiotics, type of dressing, approach to wound closure, obesity and

general health.29

A study was conducted to assess the post partum uterine wound

dehiscence is a case for late postpartum hemorrhage following caesarean section. A

partial or complete dehiscence of the lower segment caesarean section is a rare, but

possible cause. Emergency laparotomy revealed a complete dehiscence of the lower

uterine segment incision. A subtotal hysterectomy was performed to control the

bleeding.30

A study was conducted to assess the occurrence of abdominal wall scar

endometroma after caesarean section. A study was undertaken of six patient's in

general surgical clinic, each of whom had presented with a painful mass at a previous

caesarean section site. It is strongly recommended that, at the conclusion of the

procedure of caesarean section, the abdominal wall wound be cleaned thoroughly and

irrigated vigorously with high jet saline solution before closure.31

A study was conducted to assess the risk factors associated with surgical

site infections following caesarean section. 765 samples selected by randomized

sampling techniques. Multiple logistic regression analysis identified four factors:

absence of prophylactics antibiotiic (P=0.001), Surgery time (P=0.04), < 7 prenatal

visits (P=0.001) and hours of ruptured membranes (P=0.04). women's health care

professionals also must continue to encourage pregnant women to start prenatal visits

early in the pregnancy and to maintain scheduled visits throughout the pregnancy to

prevent perinatal complications, including post operative infection. 32

11

A study was conducted to assess the role of prophylaxis antibiotic in

caesarean section for prevention of infections complications during puerperium. Not a

single case with endometritis and only one case with suppuration (13.99%). All these

parturient were with low risk of puerperal infections.33

Related to maternal nutrition:

A study was conducted on the effect of early versus delayed post

caesarean feeding on woman's satisfaction. Women's satisfaction measured with a

visual analogue scale (VAS). The woman's satisfaction was similar in both groups. A

statistically significant difference was observed in mean postoperative pain 29+/-

13mm in the delayed feeding group versus 24+/-11mm in the early feeding group

(P=0.008). Early feeding after uncomplicated caesarean in low risk women is

equivalent in terms of the woman's satisfaction and the reduced perceived pain.34

A study was conducted on early maternal feeding following caesarean

delivery. A prospective, randomized study was design including 179 women

underwent first or repeated caesarean delivery. The received clear fluids and solid

food within 8 hours of surgery maternal satisfaction was significantly higher among

the early fed women. It is not associated with higher rates of post operative

complications.35

A randomized controlled trial study was conducted on beneficial effects

of early feeding post caesarean delivery. Bowel sounds were present immediately

postoperatively in 90.8% (early group) versus 95.5% (control). Maternal satisfaction

rate higher in the early fed group (90 versus 60, on visual analogue scale score 0-100,

P.Value is less than 0.001). Early feeding post-caesarean delivery with added benefits

of earlier intravenous cannula removal, ambulation, breast feeding initiation and

potential for shorter hospitalization.36

A comparative study was conducted on early post operative feeding

versus conventional feeding for patients undergoing caesarean section. The rate of

mild ileus symptoms in the early feeding groups was significantly less than the

conventional group (19.6%) versus 31.1% P =0.03). The early feeding after

uncomplicated caesarean section had reduced the rate of ileus symptoms and offer

12

potential benefits associated with shorter interval to bowel movement, IV fluid

administration and length of hospital stays.37

A study was conducted on early oral hydration and its impact on bowel

activity after caesarean section. Bowel sounds appeared in a significantly shorter

duration of time in study group the mean being 7.4h as compared to 11.5h in the

control group. The mean oral fluid intake was much more and return to soft and the

full diet was faster in the study group. The early oral hydration in the post operative

period helps in the faster recovery of the patient by means of quicker return to normal

feeding habits and early ambulation.38

A study was conducted on early compared with delayed oral fluids and

food after caesarean section. The results showed that early oral fluids or food were

associated with reduced time to first food intake (weighted mean difference - 7.20

hours 95% confidence interval 13.26 to 1.14). No complication of withholding oral

fluids after uncomplicated caesarean section.39

A study was conducted on attitudes to oral feeding following caesarean

section. Only 21.5% of units had a departmental policy concerning feeding after

caesarean section. The women could eat or drink in the majority of obstetric units

(78.5%) after without help of guidelines. The period of postoperative starvation was

found to very greatly, from <1hr in some units to >24 hrs in others. They suggest that

all obstetric units should produce guidelines in order to rationalize postoperative

feeding for women following caesarean section.40

A study was conducted to assess on safety and efficacy of early

postoperative solid food consumption after caesarean section. Early solid food

consumption would reduce the need for analgesia. Women will eat solid food very

soon after caesarean section (mean + /-SD 10.2+/-5.2 hours from surgery to onset of

solid food consumption) as compared to women on a traditional dietary expansive

regimen (mean+/-SD 41.5+/-16.0 hours P<.001). There is no evidence of

complications. Early postoperative feeding after caesarean section is a safe and

effective alternative for most women.41

13

Related to initiation of breast feeding

A study was conducted on caesarean section and breastfeeding

initiation. With established determinants for breastfeeding duration, including feeding

exclusively with breast milk in maternity wards, early initiation of breast feeding,

rooming-in and pacifier use, varied according to nationality. The rate in the mothers

country of origin (P<0.001, P=0.04). The study concluded that these differences are

dependant on educational level and on the mothers nationality. The large variation

suggests that different trans-national experiences play some role in health-related

decision-making and access to health care.42

A study was conducted to assess the effects of caesarean section on

breast feeding. There was a significantly lower postpartum prolactin (PRL) level in

the caesarean section group (8.48 nmol/<, 95% CI: 7.80 - 9.21 nmol/L). Caesarean

section was an important hazard for a shorter duration of breastfeeding (RR=1.21;

95% CI; 1.10 - 1.33) with in one year after childbirth. Measures including promoting

the secretion of postpartum prolactin (PRL) such as early contact, early sucking and

analgesic method should be taken to improve the successful breastfeeding rate.43

A study was conducted to assess the policies and practices for maternal

support options during childbirth and breastfeeding initiation after caesarean delivery.

Convenience sample of 154 obstetric nurse manager and nurse representatives 89%

permitted only one support person during non emergent caesareans, and 58.0% of the

nurse representatives believed that mothers should be allowed a second support

person. Less than one third (31.2%) of the hospitals considered a mothers request to

breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in

the recovery room. The study concluded that breastfeeding initiation after caesarean

birth was encouraging, support person options during non emergent caesarean births

and related rationales warrant further examinations.44

3. Literatures related to effectiveness of structured teaching programme

related to post operative care after caesarean section.

A study was conducted on caesarean section and maternal education.

Studies on the association between caesarean section and maternal social background.

This study result showed that the lowest educated had the highest risk of caesarean

14

section. In all deliveries the adjusted relative risk of caesarean section for the lowest

versus the highest educated increased from 1.16 in the 1967-76 period to 1.34 in the

1996-2004 period.45

A study was conducted to evaluate individual or group antenatal

education for childbirth or parenthood, or both. To assess the effects of this education

on knowledge acquisition, anxiety, sense of control, pain, labour and birth support,

breastfeeding, infant-care abilities, and psychological and social adjustment.

Randomized controlled trials of any structured educational programme provided

during pregnancy by an educator to either parent that included information related to

pregnancy, birth or parenthood. No consistent results were found. Sample sizes were

very small to moderate, ranging from 10 to 318. No data were reported concerning

anxiety, breastfeeding success, or general social support. The study concluded that

the effects of general antenatal education for childbirth or parenthood, or both, remain

largely unknown. Individualized prenatal education directed toward avoidance of a

repeat caesarean birth.46

PROBLEM STATEMENT

15

A study to evaluate the effectiveness of structured teaching programme

on selected aspects of post operative care among primimothers undergoing elective

caesarean section in selected hospitals at Kolar district.

6.3 OBJECTIVES:

To assess the existing knowledge of primimothers undergoing elective

caesarean section regarding selected aspects of post operative care.

To evaluate the effectiveness of structured teaching programme on

selected aspects of post operative care among primimothers undergoing

elective caesarean section.

To find the association between post test knowledge level with their

selected demographic variables.

6.4 OPERATIONAL DEFINITIONS:

Evaluate:

It refers to determine the effectiveness of preoperative teaching on

selected aspects of post operative care among primimothers undergoing elective

caesarean section.

Effectiveness:

It refers to a significant increase in the level of knowledge of

primimothers after structured teaching programme regarding selected aspects of post

operative care.

Structured teaching Programme:

Refers to a system of planned instructional design to impart information

in order to bring the changes in knowledge regarding selected aspects of post

operative care of primimothers undergoing elective caesarean section.

Selected aspects of Post operative care:

16

It refers to selected aspects of care after operation in terms of pain

management, prevention of wound complications, maternal nutrition and initiation of

breast feeding.

Caesarean section (CS):

It refers to an operative procedure helps to deliver the fetus after

viability has been reached (24 weeks of gestation onwards).

Primimothers:

It refers to mothers who are pregnant for the first time.

6.5 HYPOTHESIS:

Ho: There will be no relationship between pretest and post test scores of

primi mothers undergoing elective caesarean section.

6.6 VARIABLES:

6.6.1 Dependent Variables:

Knowledge of Primi mothers regarding selected aspects of post

operative care.

6.6.2 Independent Variables:

Structured teaching programme.

6.6.3 Attributed Variables:

Age, education, occupation, income, religion, type of family,

place of residence and source of information .

7. MATERIAL AND METHOD :

17

7.1 Source of data:

Primi mothers admitted for elective caesarean section in selected

hospitals at Kolar.

7.2 Method of data collection:

7.2.1 Research design:

Pre- experimental design (One group Pre test - post test)

7.2.2 Setting:

The study will be conducted in two hospitals namely, Sri Narasimha

Raja (SNR) hospital Kolar, the incidence rate of caesarean section in 2007 was 986, it

is having 500 bed strength which is 2km away from pavan college of nursing and

R.L. Jalappa hospital and Research center Tamaka, Kolar, the incidence rate of

caesarean section in 2007 was 792, it is having 850 bed strength which is 5km away

from Pavan College of nursing.

7.2.3 Population:

The population for the present study comprises of primimothers who are

undergoing elective caesarean section.

7.2.4 Sample:

Primimothers who are undergoing elective caesearean section, age group

between 20-40 years.

7.2.5 Sample size:

60 Primimothers.

7.2.6 Sampling technique:

Convenient sampling technique will be used to select the sample for the

study.

7.2.7 Sampling Criteria:

Inclusion Criteria:

Primimothers who are admitted for elective caesarean section in Sri

Narasimha Raja (SNR) hospital and R.L. Jalappa hospital and

Research center at Kolar.

Primimothers age group between 20-40 years.

18

Primimothers who can communicate in Kannada or English.

Primimothers who are willing to participate in the study.

Exclusive Criteria:

Mothers who are below 20 years and above 40 years.

Mothers who are admitted for normal vaginal delivery.

Mothers who are undergoing emergency caesarean section.

Mothers who can not communicate Kannada or English.

Mothers who are not willing to participate in the study.

7.2.8 Tool of data collection:

Structured interview schedule will be used for data collection.

The tool consists of two sections.

Section A

Consists of demographic data of the subject which includes age,

education, occupation, income, religion, type of family, place of residence, and source

of information.

Section B

Consists of knowledge questions regarding selected aspects of post

operative care. (Knowledge regarding pain management, prevention of wound

complications, maternal nutrition and initiation of breast feeding).

7.2.9 Method of data collection:

Structured interview schedule will be used to collect the data from the

primimothers who are undergoing elective caesarean section.

The purpose of the study will be explained and consent from the

participant will be obtained to involve in the study.

The tentative period of data collection will be 6 weeks, before that tool

will be developed and after validation by the experts, the further refinement of the tool

will be done. Before the main study the pilot study will be conducted.

7.2.10 Data analysis and interpretation:

19

Data will be analysed on the basis of objectives and hypothesis by using

descriptive and inferential statistics. In descriptive statistics the frequency,

percentage, mean and standard deviation will be used for the data analysis. In

inferential statistics the chi-square test will be used to find the association between

post test knowledge level with their selected demographic variables and paired ‘t’ test

will be used to know the effectiveness of structured teaching programme on selected

aspects of post operative care. The results will be presented in the form of tables,

graphs and diagrams.

7.3 Does the studies require any investigation or intervention to be conducted on

patient/sample population or other humans or animals?

Yes. The study will be conducted on the primi mothers undergoing

elective caesarean section. Since it is pre- experimental study, it requires interventions

in the form of teaching regarding pain management, prevention of wound

complications, maternal nutrition and initiation of breast feeding; it will not have any

harm to the mothers.

7.4 Has ethical clearance been obtained from your institutes?

Yes, prior permission will be obtained from the concerned authorities of

SNR hospital and R.L Jallapa hospital in Kolar to conduct a study and also from

research committee of AE & CS Pavan College of nursing at Kolar. The purpose of

the study will be explained to the primi mothers who are undergoing elective

caesarean section in selected hospitals and the scientific objectivity of the study will

be maintained with honesty.

8. List of referances:-

20

1) D.C Dutta. Text book of obstetrics. 6th edition. New central book agency (p)

Ltd. 2004; 588-89,596-97.

2) Myles. Text book for midwives. 14th edition. Published by Elsevier Ltd. 2003;

581, 583-85.

3) Statistics report on World Health Organization, regarding caesarean section.

Wttp: //does google.com.

4) Sreevidya.S. Sathiyasekaran BW. Population –based cross sectional study on

high caesarean rates in Madras (India). 2003 Feb; 110(2):106-11.

5) M.Khawaja and M.Al-Nsour. Trends in the prevalence and determinats of

caesarean section delivery in Jordan. 2002, 17(1):90-98.

6) Adele Pillitteri. Maternal and child health Nursing. Care of the child bearing

and child rearing family.4th edition. Williams Lippincott publication. 2003,

540,549.

7) Gita Arjun. Caesarean section. Evaluation, guidelines and recommendations.

8) US Mishra and Mala Ramanathan. Delivery-related complications and

determinants of caesarean section rates in India.

9) Bobak. Maternity and gynecologic care. 5th edition. Mosby publications. 1066.

10) Ojo VA. Adetoro OO. Okwerekwn FE. Characteristics of maternal deaths

following caesarean section in a developing country. 1988; PMID: 290308.

11) The Nursing Journal of India. LXXXIX, 3 1998; 53.

12) Brunner and Suddhardh. Medical surgical Nursing. 9th edition. WB.Sounders

company. 2001: 347

13) Betran. Ana P etal. Rates of caesarean section analysis of global, regional and

national estimates. 10.111/j.1365-3016.2007.00786.x.

14) Clark SL. Belfort MA. Dildy GA. Herbst MA. Dildy GA. Herbst MA. Mevers

JA. Hankins GD. Maternal deaths in the 21st century: causes, Prevention and

relationship to caesarean delivery. 2008 July: 199(1):36.el-5

15) Tamim H etal. Incidence and correlates of caesarean section in a capital city of

middle-income country. 2007; 35(4):282-8.

21

16)Masui. The voice of patients for improving caesarean delivery care. 2006 July:

55(7):914-9

17) Dimitrova V. Pandeva I. Tsankova M. Pranchev N. Post- operative

complications following elective and emergency caesarean delivery. 2005;

44(7):15-21.

18)Koroukian SM. Relative risk of postpartum complications in the ohio medical

population: vaginal versus caesarean delivery. 2004 June; 61(2):203-24

19) Ozumba BC. Anya SE. Maternal deaths associated with caesarean section in

Enugu, Nigeria. 2002 March; 76(3):307-9.

20) Leung GM. Lam TH. Thach TO. Wan s. Ho LM. Rates of caesarean births in

Hong Kong. 2001 September; 28(3):166-72.

21)Barbara Kozier. Text book of fundamentals of nursing. 7th edition. Published by

Dorling Kindersely (India) Pvt. Ltd. 940.

22) Basavanthappa BT. Nursing Research. 1st edition. Jaypee brothers. New Delhi.

1998: 93.

23) Mc Court C. Weaver J. Statham H. Beake S. Gamble J. Creedy DK. Elective

caesarean section and decision making, a critical review of the literature. 2007

March; 34(1); 65-79.

24) Jaafarpor M. Khani A Javadifar N. Taghinejad H. Mahmoudi R. Saadipour

KH. The analgesic effect of Transcutaneous Elective Nerve Stimulation

(TENS) on caesarean under spinal anaesthesia. 2008 June. Email.

Saadipour_kh@yahoo.com.

25) Karlstrom A. Engstrom-Olofasson R. Norbergh KG. Sjoling M. Hildingsson I.

Postoperative pain after caesarean birth affects breast feeding and infant care.

2007 September; 36(5); 430-40.

26) Chen HM. Chang FY. Hsu CT. Effect of acupressure on nausea, Vomiting,

anxiety and pain among post-caesarean section women in Taiwan. 2005

August; 21(8); 341-50.

27)Yost NP. Bloom SL. Sibley MK. Lo Jy. Mdntire DD. Leveno KJ. A

hospital- sponsored quality imptovement study of pain management after

caesarean delivery. 2004 May; 190(5):1341-6. PMID: 15167840.

22

28) Olsen MA. Butler AM. Willers DM. Devkota P. Cross GA .Fraser VJ.

Risk factors for surgical site infection after low transverse caesarean

Section.2008 June; 29(6); 477-84.PMID:18510455.

29) Gould D. Caesarean section, surgical site infection and wound management.

2007 April .PMID 17479790.

30) Wagner MS. Bedard MJ. Postpartum uterine wound dehiscence, a case report.

2006 Aug; 28(8); 713-5.PMID 17022911.

31) Wasfie T. Gome ZE. Seon S. Zado B. Abdominal wall endometrioma after

caesarean section, a preventable complication. 2002 July; 87(3):175-7.

32) Killian CA. Graffunder EM. Vinciguerra TJ. Venezia RA. Risk factors for

surgical-site infections following caesarean section. 2001 Oct; 22(10); 613-7.

33) Bozhinova S. Ignatov P. Bogdanova A. the role of antibiotic Prophylaxis in

caesarean section. 1998.

34) Izbizky GH. Minig L. Sebastiani MA. Otano L. The effect of

early versus delayed post caesarean feeding on women’s satisfaction: a

randomized controlled trial. 2008 Feb; 115(3):332-8.PMID 18190369.

35) Bar G. Sheiner E. Lezerovizt A. Lazer T. Hallak M. Early maternal feeding

following caesarean delivery; a prospective randomized study. 2008; 87(1);

68-71.

36) Teoh WH. Shah MK. Mah CL. A randomized controlled trial on beneficial

effects of early feeding post-caesarean delivery under regional anesthesia.

2007 February; 48(2); 152-7. Teohwendy @yahoo.com.

37) Chantarasorn V. Tannirandorn Y. A comparative study of early post-operative

feeding versus conventional feeding for patents undergoing ceasarean section;

a randomized controlled trial. 2006 October; 89suppl 4; s 11-6.

varies@loxinfo.co.th.

38) Malhotra N. Khannas. pasrija S . Jain M. Agarwala RB. Early oral

hydration and its impact on bowel activity after elective caesarean section.

2005 may; 120(1); 53-6.

39) Mangesi L. Hofmevr GJ. Early compared with delayed oral fluids and

food after caesarean section . 2002 ;( 3); CD003516.

23

40) Worthington L M . Mulcaby AJ. White S . Flvnn P J. Attitudes to

oral feeding following caesarean section. 1999 July; 54(7); 719-20.

41) Burrows W R etal. Safety and efficacy of early postoperative solid

food Consumption after caesarean section. 1995 June; 40(6); 463-7.

42) Merten S. Wyss C. Ackermann – Liebrich U. Caesarean sections and

Breast feeding initiation among migrants in Switzerland 2007; 52(4):210-22.

43) Wang BS . Zhou LF . zhu LP . Gao XL . Gao ES . Prospective

Observational study on the effects of caesarean section on breastfeeding. 2006

April; 41(4); 246-8.

44) Spear H. Policies and practices for maternal support options

during childbirth and breast feeding initiation after caesarean in Southeaster

Hospitals. 2006 September; 35(5):634-43.

45) Tollanes MC. Thompson JM. Daltveit AK. Irgens LM. Caesarean

section and maternal education. 2007; 86(7); 840-8.

46) Gagnon AJ. Sandall J. Individual or group antenatal education for

childbirth or parenthood, or for both. 2007 July 18 ;( 3)-CD002869.

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9. SIGNATURE OF THE

CANDIDATE

10. REMARKS OF THE GUIDE

11. NAME AND DESIGNATION OF

1. GUIDE

2. SIGNATURE

3. CO-GUIDE

4. SIGNATURE

5. HEAD OF THE

DEPARTMENT

6. SIGNATURE

12. REMARKS OF CHAIRMAN OR

PRINCIPAL

1. SIGNATURE

25