The Effect of Relaxation Techniques on Blood Pressure and Stress among Pregnant Women with Mild Pregnancy Induced Hypertension

 

Gehan. H.Soliman¹, Seham Mohamed Abd Elalem², Samah Mohamed Elhomosy³

¹Assist Prof. of Medical Surgical Nursing, Faculty of Nursing, Menoufia University, Egypt

²Lecturer of Medical Surgical Nursing, Faculty of Nursing, Menoufia University, Egypt

³Maternal and Newborn Health Nursing, Faculty of Nursing, Menoufia University, Egypt

*Corresponding Author Email:

ABSTRACT:

Pregnancy induced hypertension is one of the most common causes of both maternal and neonatal morbidity. This study aimed to evaluate the effect of implementing an educational program about relaxation techniques on blood pressure and stress level among pregnant women with mild pregnancy induced hypertension. Subjects and methods: A quasi-experimental research design was conducted to meet the aim of the study. The study was conducted in maternal and child health center in Kebly at Shebin Elkom, Menoufia governorate, Egypt. Purposive samples of 60 pregnant women with mild pregnancy induced hypertension were randomly assigned into control and study group of 30 patients each. Study group received a structured educational program and planned clinical supervision about relaxation techniques which include deep breathing, progressive muscle relaxation and guided imagery in addition to routine antenatal care. Control group received only routine antenatal care. The data gathering instruments: were Bio sociodemographic and knowledge assessment form, Physiological measurements and Perceived stress scale. The main findings of the study were that, there was statistically significant improvement in knowledge, physiological parameters, also reducing in blood pressure and stress level in study group more than their control (P<0.001).The study concluded that educational program about relaxation techniques have shown beneficial improvement of knowledge and physiological parameters and reduction of blood pressure and stress level among pregnant women with mild pregnancy induced hypertension. The study recommended that practicing relaxation techniques should form an important component and should be included routinely in the management of pregnancy induced hypertension

 

 

 

INTRODUCTION:

Pregnancy is the pleasant situation in a woman's life, but it is sometimes accompanied with diseases such as increasing blood pressure (BP) ⁽¹⁾ pregnancy-induced hypertension is defined as systolic BP is 140 mmHg or more and diastolic BP is 90 mmHg or more ⁽²⁾.

 

BP increases after 20 weeks of pregnancy in gestational hypertension, but is differentiated from preeclampsia by the absence of proteinuria⁽³⁾ These disorders are considered the main cause of morbidity and mortality of fetus and mother across the world⁽⁴⁾. Incidence of pregnancy hypertension is 6–7% in primiparous and 2–4% in multiparous women. ⁽⁵⁾. The main risk factors for pregnancy induced hypertension are First pregnancy, aging, high Body Mass Index before pregnancy ⁽⁶⁾ multiple pregnancies, race,⁽⁷⁾ diabetes, history of hypertension, physical activity at the beginning of the pregnancy , poor socio-economic status and additional factors as life style factor and stress ⁽⁸⁾ High blood pressure during pregnancy can cause significant problems such as decreased blood flow to the placenta, placental abruption, premature delivery and increased chances for developing preeclampsia and cardiovascular disease ⁽⁹⁾.

 

Although, early treatment is very effective in management of hypertension crisis and neonatal complications, in some cases treatment does not alter the progression of disease ⁽¹⁰⁾. Stressors that influence women during their lives especially during pregnancy can effect on their physical, spiritual and emotional status ⁽¹¹⁾. Relaxation techniques such as breathing exercises or yoga can lower stress levels and help to stabilize blood pressure. Breathing techniques similar to those used in Lamaze classes can be effective in reducing anxiety or stress ⁽¹²⁾

 

Nurses have an important role to play in health promotion for the pregnant women who suffer from hypertension. Lifestyle modification and coping mechanism are the most important factors that nurses should give knowledge about it. Relaxation techniques are the most important item that nurses teach to women during child birth preparation ⁽¹³⁾.

 

SIGNIFICANCE OF THE STUDY:

Hypertension is the most common medical problem that affecting pregnancy and remains an important cause of maternal and fetal morbidity and mortality in United States. It complicates 10% of all pregnancies ⁽⁹⁾. ⁽¹⁴⁾ Reported that "In Egypt, pregnancy induced hypertension is considered a major cause of maternal death, associated with 27% of direct obstetric death and 22% of all maternal deaths" Pregnancy induced hypertension are associated with adverse fetal, neonatal an maternal outcomes complications, including preterm birth, intrauterine growth restriction (IUGR), perinatal death, acute renal or hepatic failure, antepartum hemorrhage, postpartum hemorrhage and maternal death ⁽¹⁰⁾. Although pregnancy induced hypertension is the major problem, there are no definitive effective treatments. In addition to some treatments are not desirable for use during pregnancy also in most cases the delivery is recommended because of unexpected deterioration.⁽¹⁵⁾. Nowadays, the stress management approaches are used for essential hypertension ⁽¹⁶⁾ Previous research concerned with the positive effects of relaxation techniques on women with pregnancy induced hypertension during the intra - partum period, but little study is known about the combined effect of progressive muscle relaxation, guided imagery and deep breathing exercises on mild hypertension during pregnancy. ⁽¹⁷⁾. So that, this study aimed to study the effect of relaxation technique on stress and blood pressure among pregnant women with mild pregnancy induced hypertension.

 

AIM OF THE STUDY:

This study aimed to evaluate the effect of implementing an educational program about relaxation techniques on blood pressure and stress level among pregnant women with mild pregnancy induced hypertension.

 

RESEARCH HYPOTHESIS:

The following research hypothesis has been formulated in an attempt to fulfill the aim of the study. The pregnant women with mild pregnancy induced hypertension who practice relaxation techniques (study group) will exhibit:

1. Improvement of knowledge and physiological parameters as (weight, physiological edema, headache and sleep) for study group than control group.

2. A reduction of blood pressure and stress level for study group than control group.

 

METHODOLOGY:

Research design:

Subjects:

A purposive sample of [60] pregnant women with mild pregnancy induced hypertension were selected randomly and divided alternatively into two equal groups. The total number to be selected was estimated using the following equation: n = (z2×p × q)/ D2. A sample of 60 patients was recruited based on 10 %

 

Study group [1]:

Was comprised of 30 pregnant women with mild pregnancy induced hypertension received antenatal care which include (history taking, physical examination, special investigations, instructions and reassurance) and they were received also a structured educational program and planned clinical supervision about relaxation techniques which include deep breathing, progressive muscle relaxation and guided imagery in addition to routine antenatal care.  

 

Control group [II]:

Was comprised of 30 pregnant women with mild pregnancy induced hypertension and received antenatal care only.

 

Sampling criteria:

The samples were selected on the following criteria:

The Inclusion Criteria:

·        Conscious, able to cooperate and communicate to participate in the study.

·        Pregnant women above 20 weeks of gestation.

·        Free from proteinuria, pathological edema, systolic blood pressure from (140 -150) and diastolic blood pressure from (90-100).

 

The exclusion criteria:

·        Antenatal mothers less than 20 weeks of gestation.

·        Antenatal mothers with complications such as diabetes mellitus, heart disease or renal diseases, bleeding disorders and multiple pregnancies.

 

Variables:

The independent variable was relaxation techniques, while the dependent variable was blood pressure and stress level.

 

Instruments of the study:

Three instruments were utilized on this study:

Based on the review of the related literature, three tools were utilized by the researcher as the following:

 

Tool (I):

Structured Interview questionnaire:

It was developed by the researcher after reviewing of the related literature. It was used to assess patient's knowledge about menopause, hypertension and comprised of three parts.

 

Part I: Sociodemographic data:

It was include information about women's age, level of education, and level of husband education, occupation, income and residence.

 

Part II: Previous Obstetric History:

It was contain questions about frequency of pregnancy and delivery, abortion, type of delivery, complications with pregnancy and type of these complications,

 

Part III: Knowledge Assessment:

It was contain questions to assess women's knowledge about pregnancy induced hypertension and relaxation techniques as definition, signs and symptoms, risk factors, complications, management, schedule of antenatal visit, definition of relaxation techniques, benefits, performance of relaxation techniques that consists of nine questions.

 

Scoring System:

The answer was classified as completely correct, incompletely correct, and incorrect answer. Each item in the sheet was given a score of two marks for complete correct answer, one mark for incomplete correct answer and zero mark for incorrect answer. Then the score will be summed up and illustrated into three categories: a score range from 65% to 100% (from 11.7 to 18) illustrated that patients have good knowledge; while a score from 50% to less than 65% (from 9 to 11.7) illustrated satisfactory and a score less than 50% ( less than 9) illustrated that women have poor knowledge.

 

Tool II: Physiological Measurements:

It was include assessment of blood pressure (systole and diastole) and other physiological parameters as weight, physiological edema, and headache and sleep before and after relaxation techniques.

 

Tool III: Perceived Stress Scale:

It was developed by⁽¹⁸⁾ and was utilized by the researcher to assess the degree to which women perceive their lives as stressful. Subjects indicate how often they have found their lives unpredictable, uncontrollable, and overloaded in the last month. It consists of 10 items, each item is rated on a 5-point scale ranging from never (0), almost never (1), sometimes (2), fairly often (3) and very often (4), in this scale there were reverse scores for questions 4, 5, 7 and 8, change the score like this 0=4, 1=3, 2=2, 3=1 and 4=0 and the ratings are summed across all 10 items. Scores ranging from 0-13 would be considered low stress, 14-26 would be considered moderate stress, and 27-40 would be considered high perceived stress.

 

Reliability:

All tools used in this study were tested for its reliability using test retest reliability and all tools proved to be strongly reliable.

 

Validity of the tools:

All the tools for data collection were tested for its content validity by a panel of experts in medical and psychiatric health nursing specialty to ascertain to its relevance and completeness and required modification was carried out accordingly.

 

METHOD:

Written Approval:

Permission to carry out the study was taken from responsible authorities after explanation of the purpose of the study.

 

Protection of Human Rights:

At the initial interview each woman was informed about the purpose and benefits of the study and informed that their participation is voluntary. Also confidentiality and anonymity of the participants were assured. Finally formal consent for participants has been obtained.

 

Tools Development:

All tools were developed by the researcher after extensive review of the relevant literature. All tools were tested for its content validity and reliability.

 

 

Pilot Study:

A pilot study was conducted on 10% of study sample to evaluate the developed tools for clarity and applicability then necessary modification was carried out.

 

Data Collection:

·        Data collection was extended from June 2015 to January 2016.

·        Each woman who agreed to participate in the study and fulfilling the inclusion criteria has been interviewed individually by the researcher at maternal and child health center (MCH), Kebly at Shebin Elkom, Menofia governorate, Egypt.

·        A purposive sample of [60] antenatal mothers with mild pregnancy induced hypertension were selected randomly and divided alternatively into two equal groups.

 

Study Group [1]:

Was comprised of 30 pregnant women with mild pregnancy induced hypertension received antenatal care which include (history taking, physical examination, special investigations, instructions and reassurance)  and they were received also teaching related to relaxation techniques which  include deep breathing, progressive muscle relaxation and guided imagery.

 

Control Group [II]:

Was comprised of 30 antenatal mothers with mild pregnancy induced hypertension and received antenatal care only. The researcher deal with control group (II) first then the study group (I) to avoid contamination of data collection.

·     The study was conducted in four phases namely: assessment, planning (for study group I), implementation and evaluation.

 

·        Assessment Phase:

The aim of this phase was to assess patient's sociodemographic data, medical and obstetrical history, knowledge related to hypertension and relaxation techniques, physiological measurements and perceived stress scale by using tools I, II and III.

 

·        Planning phase (for group I only):

The researcher prepared a plan of intervention for applying relaxation techniques for 30 minutes daily for 6 weeks in women with mild induced hypertension based on assessment of data collected to identify patient's need.

 

·        Implementation phase (for the study group):

In this phase subjects were interviewed at maternal and child health center. The researcher teaching them how to apply relaxation techniques for 30 minutes daily for 6 weeks. The duration of this session completed within (20 – 30 minutes) according to women level of education and understanding. The researcher took the telephone number from the subjects for following up them and knowing the time for the second interview.

·        Evaluation phase:

Each woman of the study and control group was evaluated two times: The first evaluation is in the assessment phase using tool I, II and III. The second evaluation was done 6 weeks post implementation of the program of relaxation techniques using tool I part III, II and III.

 

Statistical analysis:

Data were collected, tabulated, statistically analyzed using an IBM personal computer with Statistical Package of Social Science (SPSS) version 20  where the following statistics were applied.

 

1. Descriptive statistics: in which quantitative data were presented in the form of mean (), standard deviation (SD), range, and qualitative data were presented in the form numbers and percentages.

 

2. Analytical statistics: used to find out the possible association between studied factors and the targeted disease. The used tests of significance included:

*Chi-square test (χ²): was used to study association between two qualitative variables.

*Fischer exact test: for 2 x 2 tables when expected cell count of more than 25% of cases were less than 5.

*Student t-test: is a test of significance used for comparison between two groups having quantitative variables.

 

RESULTS:

The data collected from the antenatal mothers with mild pregnancy induced hypertension is organized and presented under the following section:

 

Section I: Subjects’ Characteristics (Table 1 and 2):

Table (1) reveals comparison between study and control groups regarding sociodemographic data. There was no statistically significant difference between study and control groups regarding age, residence, and wife education, level of husband education, wife occupation and family income. As noted from this table, most of women in both study and control groups were at 25 – 33 age group with the mean age (26.70±4.21) and (27.36±4.93) respectively. Moreover, the majority of both study and control groups coming from urban regions (53.3% and 56.7% respectively). In relation to educational level, the highest frequency of both study and control groups had secondary education (43.3% and 53.3% respectively). As regards occupation, higher percentages (56.7% and 73.3% respectively) were housewife. In addition to family income the majority of both study and control groups had insufficient family income (60.0% and 53.3% respectively).

Table (1): Socio demographic characteristics of study and control group  at pre intervention (N=60):

Socio demographic Characteristics	study (N=30)		Control(N=30)		χ2 p value
	No.	%	No.	%
·                  Age: -                   17- 25 -                   25 – 33 -                   33 – 41	14 15 1	46.7 50.0 3.3	10 18 2	33.3 60.0 6.7	1.273 0.529 (NS)
·                  Age / years ( ±SD):	26.70±4.21		27.36±4.93		0.563 0.576 (NS)
·                  Residence: ·                  Urban ·                  rural	16 14	53.3 46.7	17 13	56.7 43.3	0.067 0.795 (NS)
·                  Level of education: ·                  Illiterate ·                  Read and write ·                  Secondary education ·                  Higher education	1 8 13 8	3.3 26.7 43.3 26.7	3 6 16 5	10.0 20.0 53.3 16.7	2.288 0.515(NS)
·                  Level of husband education: ·                   Illiterate ·                  Read and write ·                  Secondary education ·                  Higher education	4 5 15 6	13.3 16.7 50.0 20.0	5 7 13 5	16.7 23.3 43.3 16.7	0.678 0.878(NS)
·         Occupation: ·                  Manual work ·                  Administrative ·                  Housewife	0 13 17	0.00 43.3 56.7	2 6 22	6.7 20.0 73.3	5.220 0.074(NS)
·         Income: -                   Sufficient -                   Insufficient	12 18	40.0 60.0	14 16	46.7 53.3	0.271 0.602 (NS)

Significance P value<0.05      NS: non-significant             

 

Table (2): Percentage distribution of  previous obstetric history  of study and control group at  pre-intervention (N=60).

Previous obstetric history	Study (N=30)		Control (N=30)		χ2 p value
	No.	%	No.	%
·             Frequency of pregnancy : -                   Gravida 1 -                   Gravida 2 -                   Gravida 3	22 6 2	73.3 20.0 6.7	23 6 1	76.7 20.0 3.3	0.356 0.837 (NS)
·             Frequency of delivery -                   Para 0 -                   Para 1 -                   Para 2	22 6 2	73.3 20.0 6.7	23 6 1	76.7 20.0 3.3	0.356 0.837 (NS)
·     Abortion -                   yes -                   no	3 27	10.0 90.0	2 28	6.7 93.3	0.218* 0.640 (NS)
·             Types of delivery -                   No parity -                   Normal -                   Cesarean section	25 5 0	83.3 16.7 0.0	25 3 2	83.3 10.0 6.7	2.50 0.287 (NS)
·                  Complication with pregnancy: -                   Yes -                   No	13 17	43.3 56.7	14 16	46.7 53.3	0.067 0.795 (NS)
·             Types of complications: -                   Anemia -                   Diabetes -                   No complication	10 3 17	33.3 10.0 56.7	10 4 16	33.3 13.3 53.3	0.173 0.917 (NS)

*Fisher exact test     significance P value<0.05             NS: non-significant             

 

Table (2) presents comparison between study and control groups regarding previous obstetric history of the studied groups. There was no statistically significant difference between study and control groups regarding gravida, Para, and complications with pregnancy. Regarding to gravida the majority of both study and control groups were Primigravida (73.3% and 76.7 % respectively). in relation to parity The majority of both study and control groups were Para 0 (83.3%, 83.3% respectively). As regards complication with pregnancy the majority of both study and control groups don't have complication in pregnancy (56.7% and 53.3% respectively) and the majority of complication was anemia for both study and control group (33.3% and 33.3% respectively).

 

Section II: knowledge assessment of study and control group (Table 3):

Table (3) presents knowledge assessment about hypertension during pregnancy and relaxation techniques at pre and post intervention among studied groups. There was no statistically significant difference between study and control groups regarding knowledge at pre intervention. In relation to knowledge the majority of both study and control groups presented poor knowledge at pre intervention (96.7% and 93.3% respectively). While at post intervention There was statistically high significant difference between study and control groups regarding knowledge at post intervention (χ² =42.343, P<0.001). Regarding knowledge the majority of the study group presented good knowledge (76.7%) and control group presented poor knowledge (90.0%).

 

 

Table (3): Knowledge assessment pre and post intervention of study group and control group (N=60):

 *Fisher exact test    significance P value<0.05    NS: non-significant      HS: highly significant

 

 

Section III: blood pressure and physiological parameters of antenatal mothers at pre and post intervention of study and control group (Table 4 and 5):

Table (4) reveals blood pressure (systole and diastole) of antenatal mothers at pre and post intervention of both groups. There was no statistically significant difference between study and control groups regarding mean score of blood pressure (systole and diastole) at pre intervention. While at post intervention There was statistically high significant difference between study and control groups regarding mean score of blood pressure at post intervention as (P value<0.001). Table (5) reveals physiological parameters of antenatal mothers at pre and post intervention of both groups. There was no statistically significant difference between study and control groups regarding weight, physiological edema, headache and sleep at pre intervention. While at post intervention There was statistically high significant difference between study and control groups regarding weight, headache and sleep at post intervention as (p value<0.001).

 

Section IV: Perceived stress scores of antenatal mothers at pre and post intervention of study and control group (Table 6):

Table (6) reveals Perceived stress scores of antenatal mothers at pre and post intervention of both groups. There was no statistically significant difference between study and control groups regarding stress score at pre intervention. While at post intervention there was statistically high significant difference between study and control groups regarding stress at post intervention as (p value<0.001).

 

 

 

Table (4): Total mean score of blood pressure at pre and post intervention of study and control group (N=60):

Blood Pressure	Study (N=30) (Mean ±SD)	Control (N=30) (Mean ±SD)	t-test	p value
Systolic Blood pressure: ·  Pre-intervention ·  Pos-tintervention	141.50 ± 8.11 126.97 ± 4.42	140.00 ± 7.31 138.83± 9.53	0.752 5.865	0.455(NS) 0.000(HS)
Diastolic blood pressure: ·  Pre-intervention ·  Pos-tintervention	91.87 ± 2.01 81.93 ± 1.89	90.50 ± 2.95 87.10 ± 3.90	0.970 6.519	0.336(NS) 0.000(HS)

Significance P value<0.05   NS: non-significant HS: highly significant

 

 

 

 

 

 

 

Table (5): Physiological parameters at pre and post intervention of study and control group (N=60):

* t-test             Significance P value<0.05      NS: non-significant        HS: highly significant

 

Table (6): Perceived stress scores pre and post intervention of study and control group (N=60):

*t-test  Significance P value<0.05  NS: non-significant HS: highly significant

 

 

DISCUSSION:

The result of this study verifying the hypotheses and showed that there was a significant improvement of knowledge, a reduction of blood pressure and stress level among pregnant women with mild pregnancy induced hypertension who practice relaxation techniques for study group than control group.

 

Regarding sociodemographic characteristic and medical data of study and control group:

The current study findings showed that the most of women in both study and control groups were at 25 – 33 age group with the mean age (26.70±4.21) and (27.36±4.93) respectively. This finding is consistent with El-Bahy, et al, 2013 they stated that the majority of the studied samples were regard age; half of the studied subjects were in the age group ranging between 20 to less than 30 years. Also ⁽¹⁹⁾ concluded that most of mothers in the study sample were in the age group of 26 – 30 years. As regards occupation, higher percentages were housewife. This finding is consistent with; ⁽²⁰⁾ they found that pregnancy induced hypertension and its complications were higher among house wife and manual workers. Also, In relation to family income ⁽²¹⁾ stated that lower socioeconomic class is reported to have a higher incidence of pregnancy induced hypertension and preeclampsia due to Poor ante-natal care, improper nutrition and increased incidence of concealed pregnancies are confounding factors .this i s agree with our study as the majority of both study and control groups had insufficient family income. As regards obestetrical history, the majority of both study and control groups were Primigravida this agree with ⁽¹⁰⁾ they stated that Preeclampsia is a disease of first pregnancy.

 

 

Regarding knowledge about hypertension during pregnancy among study and control group:

The current study showed that there was statistically significant difference between study and control group regarding their knowledge about pregnancy induced hypertension and using relaxation techniques for reducing blood pressure and stress among pregnant women. This finding is consistent with ⁽²³⁾, stated that antenatal care is very important for pregnant women to detect any abnormalities especially hypertension that leading to maternal and fetal complications, so that the health care providers especially nurse should implement the health education programs that improve knowledge for pregnant women about pregnancy induced hypertension during the women 's antenatal visit by using  a simplified booklet which include basic information about pregnancy induced hypertension with some illustration pictures. Also ⁽²⁴⁾ they stated that; The primary prevention and the management of prenatal care requires that the nurse should be knowledgeable and competent to detect the initial signs and symptoms of pregnancy induced hypertension and initiate patient education and reevaluation for improving patient awareness and prevent complications. In relation to ⁽²⁵⁾ they noted that improving mother’s knowledge about pregnancy induced hypertension through education and health promotion that given by health care providers to ensure successful pregnancy outcomes. ⁽²⁶⁾ Noted that improving mother's knowledge about methods for controlling hypertension during pregnancy helping for protection of herself and her baby. In relation to ⁽²⁷⁾ observed that most of the complications related to pregnancy induced hypertension are occurring due to maternal negligence or unawareness on the management of pregnancy induced hypertension.

 

Considering relaxation techniques and its influence on blood pressure, physiological parameters and stress among study and control group:

The current study revealed that There was statistically high significant difference between study and control groups regarding mean score of blood pressure at post intervention after performing relaxation techniques (deep breathing, progressive muscle relaxation and guided imagery) for 6 weeks. On the same line study by⁽²⁸⁾ they noted that both study groups that perform breathing exercise and progressive muscle relaxation for 4 weeks showed a significant decrease in systolic and diastolic blood pressure than control group that receive antenatal care only. Also ⁽²⁹⁾ stated findings similar to the present study. They studied the effects of mental relaxation and slow breathing on essential hypertension and observed that both methods decreased systolic BP effectively, while mental relaxation could not decrease diastolic BP. They found that slow breathing was more effective on decreasing BP, compared to mental relaxation. In addition to ⁽³⁰⁾ showed that slow breathing could decrease systolic and diastolic BPs more than spontaneous breathing. Findings of the present study are not consistent with the study of ⁽³¹⁾ they compared immediate effects of two techniques of progressive muscular relaxation and mental imaging on mental secretive and cardiac functions of pregnant women. No significant change was observed in the intervention and control groups. Although they utilized a rapid method and one session of muscular relaxation, in our study, significant decreases were observed in systolic BP at the first session and in diastolic BP in some sessions.

 

The current study showed that there was statistically high significant difference between study and control groups regarding stress at post intervention. This finding is consistent with ⁽³¹⁾ they studied the effect of different types of relaxation techniques on psychobiological wellbeing among pregnant women. They indicate that different types of relaxation techniques had differential effect on various psychological and biological stresses while at the same time reducing cardiovascular activity. In addition to ⁽³²⁾ they concluded that using of Benson's relaxation therapy leading to improve psychological health and reduce stress by enhancing coping in high risk mothers during pregnancy. Also the nurse play an important role in education and encouragement for pregnant women to practice relaxation therapy so that continuing nursing education programs could be conducted to improve nurse's knowledge and skill in providing competent care for those women who experience stress due to various causes and decreased coping ability at hospitals and in the community settings. In relation to physiological parameters as (weight, headache, and sleep) there was statistically high significant difference between study and control groups regarding weight, headache and sleep at post intervention after applying relaxation techniques. This finding is consistent with ⁽³²⁾ they concluded that there was a statistically significant positive change in mean score of weight, headache, edema, Epigastric pain and sleep for study group at post intervention than pre intervention. The reason for these finding from our opinion as performing relaxation techniques leading to reducing stress that result on an improvement of sleep, maintain normal weight, reducing headache. From this study we can concluded that there is a need for educating women with mild pregnancy induced hypertension relaxation techniques in antenatal care to improve knowledge, physiological parameters and reduce blood pressure and stress level which result in improvement of the pregnancy outcome and prevent complications associated with pregnancy induced hypertension. 

 

 

 

CONCLUSIONS:

The overall findings in the present study revealed that educational program about Practicing relaxation techniques was effective and have a significant improvement of knowledge, physiological parameters and a reduction of blood pressure and stress among women with mild pregnancy induced hypertension.

 

RECOMMENDATIONS FOR PRACTICE AND RESEARCH:

1.      Supervised health teaching program should be carried out for pregnant women in antenatal care about the importance of practicing relaxation techniques for reducing blood pressure and stress. 

2.      The presence of nurse educator to improve women's' knowledge about pregnancy induced hypertension, causes and how to perform relaxation techniques for reducing blood pressure and stress to prevent complications is essential for the pregnant women.

3.      A simplified and comprehensive booklet should be available for all pregnant women with mild pregnancy induced hypertension. This booklet should include a clear, brief and simple explanation about relaxation techniques for reducing blood pressure and stress.

4.      Replication of the study using a larger probability sample from different geographical areas to help for generalization of the results.

 

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Accepted on 08.10.2016                © A&V Publications all right reserved