A Study to Assess the Effectiveness of Planned
Teaching Module on Practice of Episiotomy Care among Post Natal Mothers with
Episiotomy in Selected Hospital at Salem.
Padmavathi P.*
Dhanvantri College of Nursing, Pallakkapalyam, Namakkal (Dt) - 637303
E-mail:
ABSTRACT:
Episiotomy is one the most common surgical procedure in
the world. Episiotomy wound care is an important aspect of post
natal period. If the episiotomy care is not done properly it leads to
complications like infections, discharge from the site, redness, echymosis and approximation of suture line. Midwives have
an important role to play in the care of perineal
wound following child birth in order to minimize pain, discomfort, to maximize
healing and sense of well-being in the post natal mothers. Objectives: To assess the effectiveness of planned teaching module
on practice of episiotomy care among post natal mothers with episiotomy. Design: Quasi experimental design was
selected for the study. Setting: K.N.
Rao Hospital, Salem. Participants: 100 post natal mothers with episiotomy (50 control
group and 50 experimental group) fulfilling the
inclusion criteria were selected by purposive sampling. Methods: Experimental group mothers received planned teaching
module on episiotomy care. Participants completed a semi structured interview
questionnaires at post-test. Collected
data was analyzed by using both descriptive and inferential statistics. Results: In control group, the mean
score of the sample was 12.02 (SD = 1.94) and the experimental group mean score
was 26.9 (SD=2.83) with unpaired ‘t’ value of 22.05.
This showed that the planned teaching module was effective in enhancing the
practice of the sample regarding episiotomy care. There was a statistically
significant association found between the post test practice scores of the
sample with their demographic variables. Conclusion:
In control group nearly three fourth of the sample had partially adopting
practice (72% ) where as in experimental group most of them had fully adopting
practice ( 86% ) . The effective patient teaching bridges the gap between the
health information and health practice results in altering the patient’s
behavior in a desired manner. Enhancing patients’ participation in their own
nursing care providing them with necessary information on episiotomy,
encouraging self care, teaching and promoting daily assessment of the wound and
implementing universal precautions’ to prevent wound infection.
KEY WORDS: Effectiveness,
Planned teaching module, episiotomy care, postnatal mothers.
INTRODUCTION:
Background of
the study
Episiotomy is one the most common surgical procedure in
the world. In the United States its use is estimated at about 62.5% of
deliveries, mean while in Europe these figures appear to be around 30%, except
for a rate of 56% in Denmark. Episiotomy was seen as a routine intervention in
all nalliparous and primiparous
deliveries. Midline episiotomy is more widely used in North American, whereas a
medio-lateral incision is used in Europe and Latin
America.
In India, the practice of episiotomy is commonly
observed in hospital labour room. The higher birth
rates indicate that a large number of episiotomies are being performed every
day. In some hospitals there is 100% incidence of episiotomies in primi gravid women.
Episiotomy wound is in vicinity of vagina and rectum,
which are highly colonized by bacteria, especially the anaerobic bacteria. Thus
there is a high chance of infection, which can lead to gaping of wound and rarely
necrotizing fasciitis and thereby causing an increase in morbidity and the
extent of hospital stay.
Episiotomy wound care is an important aspect of post
natal period. The area is conducive to the group of the pathogenic organisms,
because it is warm, moist and is not well ventilated. If the episiotomy care is
not done properly it leads to complications like infections, discharge from the
site, redness, echymosis and approximation of suture
line.
The women should do perineal
care after each time she urinates or bowel movement, it helps to reduce the
risk of carrying fecal organisms from the rectum to the vagina. Clean the perineal area from front to back to avoid spreading germs.
Change the perineal pad when soaked / every 4 hours /
after voiding.
Cold sitz bath for relieving perineal pain in the postpartum period after an episiotomy
was evaluated. It showed that cold sitz bath were
significantly more effective in relieving perineal
pain. The greatest amount of pain relief was experienced immediately after the
cold sitz bath.
Midwives have an important role to play in the care of perineal wound following child birth in order to minimize
pain, discomfort, to maximize healing and sense of well being in the post natal
mothers. The effective patient teaching bridges the gap between the health
information and health practice results in altering the patient’s behavior in a
desired manner. Enhancing patients’ participation in their own nursing care
providing them with necessary information on episiotomy, encouraging self care
, teaching and promoting daily assessment of the wound and implementing
universal precautions’ to prevent wound infection
Objectives:
o
To assess the
practice of episiotomy care among control and experimental group of post natal
mothers with episiotomy after implementation of planned teaching module.
o
To determine the
effectiveness of planned teaching module on practice of episiotomy care among
control and experimental group of post natal mothers with episiotomy.
o
To find out the
association between post test scores of episiotomy care among control and
experimental group of post natal mothers with episiotomy and their demographic
variables.
MATERIALS AND METHODS:
Research
approach and research design:
An evaluative approach was used as an appropriate
measure to evaluate the effectiveness of planned teaching module on episiotomy
care among postnatal mothers.
A posttest only with control group design was selected
for the study.
Research
setting of the study:
The study was conducted at K.N. Rao
Hospital, Salem
Sample and
Sampling technique:
The sample for the study included 100 postnatal mothers
with episiotomy (out of which 50 were control group and 50 were experimental
group) admitted in K.N. Rao, Hospital, Salem, by non
probability purposive sampling technique.
Development
of tool:
Section A; Demographic variables of sample seize age,
religion, education, occupation, family income, type of family, residence and
parity.
Section B: Semi structured interview schedule
questionnaires regarding episiotomy care.( 30 questions)
Plan for data
analysis:
The data were analyzed by using both
descriptive and inferential statistics.
Back ground information of the subjects
were described by percentage distribution.
Mean, standard deviation, mean percentage
and unpaired‘t’ was used to find the relationship between post test scores on
episiotomy care among postnatal mothers with episiotomy.
Chi –square test was used to find the
relationship between demographic variables of postnatal mothers with their post
test practice scores of both the groups.
RESULTS:
1.
Demographic
variables of experimental and control group samples
In
Control group: Majority of the
postnatal mothers in the age group of 21 -30 years (74%) , 92% were Hindu , 46%
had completed their higher secondary education, half of them housewives, all of
them were high socio economic status, 74% of them were nuclear family, 80% of
them from urban area and 50% of them were multipara.
In
experimental group: 5% of the
postnatal mothers were in the age group of 21 -30 years , 82% were Hindu , 26%
had completed their higher secondary education, half of them daily wages,
90% of them were high socio economic
status, 72% of them were nuclear family, 70% of them from urban area and 50% of
them were primipara.
2.
In control group
nearly three fourth of the sample had partially adopting practice (72% )
whereas in experimental group most of them had fully adopting practice ( 86% )
and 14% had partially adopting practice.
3.
In control group,
the mean score was 12.02 (SD = 1.94) and in experimental group it was 26.9
(SD=2.83) which indicated an improvement in the practice level of the
respondents after intervening planned teaching module.
4.
Unpaired
‘t’ value was computed to evaluate
the effectiveness of planned teaching module on episiotomy care. The obtained
value was 22.05 which was significant at0.05 levels indicating the
effectiveness of planned teaching module.
5.
Chi –square test
was computed to determine the association between post test practice scores of
the postnatal mothers with their demographic variables in both the groups.
DISCUSSION:
Highly significant difference found between control and
experimental group posttest practice scores of postnatal mothers regarding
episiotomy care.
Significant relationship was found between post test
practice scores of the samples with their age (χ2 = 0.403), religion
(χ2 = 0.594), education (χ2 = 1.93), occupation (χ2 = 1.64),
family income (χ2 = 0.58), type of family (χ2 = 0.01), residence
(χ2 = 0.77) and parity (χ2 = 0.15).
RECOMMENDATIONS:
On the basis of the findings of the study it is
recommended that,
1.
An experimental
study could be undertaken without the control group
2.
A large scale
study in community can be carried out to generalize the findings
3.
Comparative study
can be conducted on knowledge and practice of mothers with episiotomy
4.
A similar study
can be conducted by using a SIM for educate mothers
5.
A study may be
carried out to evaluate the various treatment modalities for episiotomy care.
6.
A similar study
may be carried out to evaluate the effectiveness of episiotomy wound healing
REFERENCES:
1.
Lede. Robert L et.al. In routine use of episiotomy
justified. American journal of obstetrics and gynecology. 2006; volume 174 (5).
2.
World health organization report 1998 on episiotomy delivery.
3.
Grundy L. The role of the midwife in perineal
wound care following childbirth. British journal of nursing. 1997; volume 6
(10).
4.
Judith. Effectiveness of perineal care on
episiotomy wound healing. The Indian journal nursing and midwifery. 2003;
volume 6.
5.
Episiotomy care – free download from Encyclopedia.
Received on 21.11.2011 Modified on 09.12.2011
Accepted on 15.12.2011 ©
A&V Publication all right reserved
Asian J. Nur. Edu. and Research 1(3): July-Sept. 2011; Page 76-78