Effectiveness of Video Assisted Teaching Program on knowledge regarding Kegel exercise on Episiotomy pain and wound healing among nursing students of Durg District Chhattisgarh
Monika1, Veena Rajput2, Lija Prince3
1M.Sc. NSG (Obs and Gynae), Shri Shankaracharya College of Nursing, Amdi Nagar,
HUDCO, Bhilai (C.G.) Bhilai, Chhattisgarh 490009, India.
2Professor Cum Principal (OBG), Shri Shankaracharya College of Nursing, Amdi Nagar,
HUDCO, Bhilai (C.G.) Bhilai, Chhattisgarh 490009, India.
3HOD Obstetric and Gynecological Nursing, Shri Shankaracharya College of Nursing, Amdi Nagar,
HUDCO, Bhilai (C.G.) Bhilai, Chhattisgarh 490009, India.
*Corresponding Author Email: 1203veena@gmail.com
ABSTRACT:
Introduction: Globally, approximately 140 million births occur every year. In India the incidence of Institutional normal vaginal deliveries 61.5% with 58.4% of normal vaginal delivery with episiotomy. Maternal mortality Worldwide nearly 6 Lakh mothers between the age of 15-49 years die every year due to complication arising from pregnancy and childbirth.Kegel exercises are the most popular method of reinforcing pelvic floor muscles. They were first described in 1948 by the American gynecologist Arnold Kegel. The squeeze and hold vaginal exercises known as Kegel’s were specifically designed to target pelvic floor strengthening which damage due to vaginal delivery. Material and Methods: A Pre-experimental one group Pre-test post-test research design was adopted to conduct the study. Target population was B.Sc. Nursing 3rd year students. A purposive sampling technique was utilized for selecting a sample of 60 B.Sc. Nursing 3rd year students. Section A: - Deals with the socio-demographic variables such as Age, Residence, types of family, period of exposure in Clinical area, Previous knowledge about Kegel exercise and Source of knowledge. Section B: - Deals with self-structured knowledge questionnaire to assess the knowledge regardingKegel exercise on episiotomy pain and wound healing among B.Sc. Nursing 3rd year students. Result: Analysis of pre-test and post-test knowledge score using frequency, percentage and total score indicates that out of 60 B.Sc. Nursing 3rd year students in pre-test majority 3.33% (02) were in good, 63.33% (38) were in averageand 33.33% (20) sample were in need to improve on knowledge regardingKegel exercise on episiotomy pain and wound healingand in post-test majority 76.66% (46) sample were in good, 23.33% (14) were average and 0% (0) were in need to improve.which proves the effectiveness of the video assisted teaching programme.Chi-square analysis shows significant association between knowledge and previous knowledge of subjects, source of information of subjects. Conclusion: A study that conducted the use of video assisted teaching programmeregardingKegel exercise on episiotomy pain and wound healingwas effective in increase knowledge among B.Sc. Nursing 3rd year students.
KEYWORDS: Effectiveness, video teaching program, Kegel exercise, episiotomy pain, episiotomy wound healing.
INTRODUCTION:
A postpartum or postnatal period begins immediately after the birth of a child as the mother's body, including hormone levels and uterus size, returns to a non-pregnant state.3 Postpartum period is the period during which the woman adjusts, physically and psychologically post pregnancy and birth. It is the period after the end of labor during which the attendance of a midwife upon the woman and baby is required, being not less than 10 days and for a longer period if the midwife considers it necessary.4
The postnatal period is defined as the first six weeks after birth which is critical to the health and survival of a mother and her new born. The World Health Organization (WHO) describes the postnatal care as the most critical and most neglected phase of the life of the mothers and babies as most of the death occur during the postnatal period.5 Maternal mortality is a tragedy for individual women, for family and for their community. Worldwide nearly 600000 mothers between the age of 15-49 years die every year due to complication arising from pregnancy and childbirth. This means almost every minutes of every year maternal death occurs, 99% of which occur in developing countries. In developed countries, the maternal mortality ratio is around 27%/100000 live birth and in developing country the ratio is 20 times higher.6 The postnatal care is especially critical for mother and new-born. It is the time to deliver intervention to improve the health and survival of both mother and new-born.7
A study on natural child birth found that 85% of women experience a variety of perineal traumas. More than 2/3 of such women are in need of repair. Childbirth perineal injuries are short-term or long-term, including bleeding, infection, suturing, urine and fecal incontinence, painful intercourse, persistent perineal pain (this disorder can effect on interaction of child and mother, breastfeeding, sexual intercourse, post-delivery recovery sensation), and weakening of the pelvic floor muscles.8
Wound healing is complex and requires safe and effective treatment modalities. Attention should be afforded to episiotomy wound care as it parallels any other wound. Wound healing involves a complex series of interactions between different cell types, cytokine mediators, and extracellular matrix. The phases of normal wound healing are homeostasis, inflammation, proliferation, and remodeling. Each phase of wound healing is distinct, although the wound healing process is continuous, with each phase overlapping the next. Most of the doctors prescribe pain relieving medications such as paracetamol and antiseptic creams to avoid infections. Besides, one can follow certain small measures that may promote faster healing.9 Today, the expense of medical treatment is rising high and the care of patient with episiotomy can be economically done if the nurse with their competencies and skills provides various remedial measures for wound healing. Self-perineal care is the most cost-effective way for wound healing. Conservative treatments, a nonsurgical therapy, include improving the lifestyle, bladder training, pelvic floor muscle exercises, biofeedback, and the electrical stimulation of pelvic muscles.10
Kegel exercises are the most popular method of reinforcing pelvic floor muscles and are non-invasive treatment such that they do not involve the placement of any vaginal weights/cones. They were first described in 1948 by the American gynecologist Arnold Kegel. The squeeze and hold vaginal exercises known as Kegel’s were specifically designed to target pelvic floor strengthening. Moreover, it is suggested that, since damage due to vaginal delivery occur in supportive pelvic issues and in the nervous structures related to them, the Kegel exercises reduce the laceration rate occurring during vaginal delivery, give vaginal and perineal muscles their previous tones, decrease the edema in perineal region, accelerate the circulation and preventthe stretch of abdominal muscles thereby prolapse and backache,as well as preventing the known stress incontinence.11 They are the most cost-effective treatment and differ from other therapies in that the patients can do them by themselves anytime, anywhere, while doing other work, and without regular hospitalvisits. The patients simply need to be trained in how to contract their pelvic floor muscles. Most studies show that Kegel exercises steadily reinforce the pelvic muscles.12 Exercises of pelvic floor muscles should be applied for the second half of pregnancy, and in postpartum from the second day of giving birth found that the women must contract the pelvic muscles rather than the thigh, abdominal, or buttock muscles. The muscles are contracted for 10 seconds, and then relaxed for 10 seconds within 10 to 15 times tide. Redirection is often necessary, and biofeedback is often helpful.13
Nurses should distribute the knowledge regarding prevention of pelvic floor dysfunction to women, routinely include Kegel exercises in antenatal education programmers, or carry out relevant training in the community so that women can begin actively practicing Kegel exercise in the early maternity period. These will improve the quality of women's lives during both pregnancy and the postpartum period. Prepare the women for performing Kegel exercises should begin to explain the anatomy and function of the pelvic floor muscles. The next stage is learning to hold and relax the pelvic floor muscles. It is essential that the patient does not hold her breath during exercise, which may be increasing stress urinary incontinence symptoms.14
PROBLEM STATEMENT:
A study to assess the effectiveness of video assisted teaching program on knowledge regarding kegel exercise on episiotomy pain and wound healing among nursing students of selected college in durg district chhattisgarh”.
OBJECTIVES:
1. To assess the pre-test and post-test level of knowledge regarding Kegel exercise on episiotomy pain and wound healing among nursing students.
2. To evaluate the effectiveness of video assisted teaching program on knowledge regrading Kegel exercise on episiotomy pain and wound healing among nursing students.
3. To find out the association between knowledge of nursing students regarding Kegel exercise on episiotomy pain and wound healing with selected demographic variables.
HYPOTHESIS:
0.05 Level of Significance:
H0 – There will be no significant difference between pre-test and post-test score of knowledge of nursing students regarding Kegel exercise on episiotomy pain and wound healing.
H1 – There will be significant difference between pre-test and post-test score of knowledge of nursing students regarding Kegel exercise on episiotomy pain and wound healing.
H2 – There will be significant association between level of pre-test knowledge on the Kegel exercise on episiotomy pain and wound healing with selected socio- demographic variables.
MATERIAL AND METHODS:
A Pre-experimental one group Pre-test post-test research design was adopted to conduct the study.Target population was B.Sc. Nursing 3rd year students. A purposive sampling technique was utilized for selecting a sample of 60 B.Sc. Nursing 3rd year students. A self-structured knowledge questionnaire was used to assess the knowledge regardingKegel exercise on episiotomy pain and wound healing among B.Sc. Nursing 3rd year students of Shri Shankaracharya College of Nursing, Bhilai, (C.G).
STUDY VARIABLES:
1. DEPENDENT VARIABLE: In this study dependent variable refers to the knowledge of the nursing students towards the Kegel exercise on episiotomy pain and wound healing.
2. INDEPENDENT VARIABLE: In this study independent variable refers to video assisted teaching program.
INCLUSIVE CRITERIA:
a) Students who are studying in B.Sc. nursing 3rd year.
b) Students those who are willing to participate in the study.
c) Student who are in good network zone.
EXCLUSIVE CRITERIA:
a) Students who have child.
b) Student who are absent at the time of data collection.
DEVELOPMENT AND DESCRIPTION OF RESEARCH TOOL:
The multiple choice self-structured knowledge questionnaires were used to assess the effectiveness of video assisted teaching programme on knowledge regarding Kegel exercise on episiotomy pain and wound healing among nursing students of selected college in durg district Chhattisgarh”. A review of the published as well as unpublished literature concerning the effect of video assisted teaching programme on knowledge regarding Kegel exercise on episiotomy pain and wound healing among nursing students and its relation with selected sociodemographic variables were undertaken to get cues for the development of scientific instrument. Tool was finalizing after testing of reliability and validity from different expert.
The tool used for the study comprises of two sections: -.
Section A: Deals with the socio-demographic variables such as Age, Residence, types of family, period of exposure in Clinical area, Previous knowledge about Kegel exercise and Source of knowledge.
Section B: Deals with self-structured knowledge questionnaire to assess the knowledge regardingKegel exercise on episiotomy pain and wound healing among B.Sc. Nursing 3rd year students.
CRITERIAN MEASURES:
There was total 30 questions to evaluate the knowledgeregarding Kegel exercise on episiotomy pain and wound healing among nursing students. Each correct answer score 1 mark and incorrect answer gives 0. The maximum score was 30 and minimum score was 0.
Score was categorized in 3 levels-
· Good
· Average
· Need to improvement
DATA ANALYSIS:
The data obtained from study were analyzed and interpreted in terms of objective. Descriptive and inferential statistics used for data analysis, socio demographic data was analyzed in frequency and percentage. Analysis of the knowledgeregardingKegel exercise on episiotomy pain and wound healingamong B.Sc. Nursing 3rd year studentswas done in frequency and percentage. Chi square analysis was used for the association between Pre-test knowledge score with selected socio-demographic variables among B.Sc. nursing students. T-test analysis was used to find out the effectiveness video assisted teaching programme on knowledge regardingKegel exercise on episiotomy pain and wound healing among B.Sc. Nursing 3rd year students.
MAJOR FINDINGS OF THE STUDY:
SECTION I: Description of Socio-Demographic Variables in Frequency and Percentage:
AGE – Majority 55 % (33) student nurses belong to 22-23 year of age group, 40% (24) students belong to 18-21 year of age group and 5% (3) belongs to above 23 year of age group.
RELIGION: Majority 80% (48) students are Hindu, 16.70% (10) students are Christian and 3.40% (2) students are Muslim.
RESIDENCE: Majority of residence 70% (42) is from urban, and 30% (18) is from rural.
TYPES OF FAMILY: Majority 63.4% (38) were nuclear family, 31.7% (19) were joint family and 5% (3) were extended family.
WORK EXPOSURE OF CLINICAL AREA: Majority of subject’s 63.30% (38) had work in pediatric ward, 30% (18) had work in medical surgical nursing, 6.70% (4) had work in gynecological ward.
ACCORDING TO PREVIOUS KNOWLEDGE: Majority of subject’s 70% (42) had no previous knowledge, 30% (18) subject’s had previous knowledge.
ACCORDING TO SOURCE OF KNOWLEDGE: Majority 70 % (42) of subject’s had none source of knowledge, 13% (8) had from health care profession, 10% (6) had from mediaandinternet and 7% (4) had from familyand friends.
Section II: Over all analysis of Pre-test and Post-test score by using, Mean, Mean score, Mean % and Standard deviation:
Revels that knowledge regarding Kegel exercise pre- test mean was 13, mean percentage 43.33% SD was 3.48 where as in post- test mean was 22.6, mean % was 75.33 % and SD was 2.77. The t value of knowledge regarding Kegel exercise on episiotomy pain and wound healing was 14.02 which is highly significant at >0.05 which proves the effectiveness of video assisted teaching programme.
Section III: Criteria Wise Analysis of Pre-Test and Post-Test Knowledge Score.
Analysis of pre-test and post- test knowledge score using frequency, percentage and total score indicates that out of 60 B.Sc. Nursing 4th yr. students in pre-test and post-test knowledge regarding Kegel exercise on episiotomy pain and wound healing 02 (3.33%) were in good , 38 (63.33%) were in average and 20 (33.33%) were in need to improvement in pre test and post test majority 46 (76.66%) were in good, 14 (23.33%) were in average and 0 (0%) were in need to improvement.
Table 1 –Frequency and Percentage distribution of Criteria wise analysis of pre-test and post-test knowledge score
|
|
PRE- TEST |
POST-TEST |
||
|
KNOWLEDGE |
FREQ- UENCY |
% |
FREQ- UENCY |
% |
|
Good 21-30 |
02 |
3.33% |
46 |
76.66% |
|
Average 11-20 |
38 |
63.33% |
14 |
23.33% |
|
Need to improve 0-10 |
20 |
33.33% |
0 |
0% |
|
TOTAL |
60 |
100% |
60 |
100% |
SECTION IV: Paired t test Analysis to assess the effectiveness of Video Assisted Teaching Programme.
There was highly significant difference between the pre – test and post – test knowledge score of video assisted teaching program as calculated value 14.02, (df.59) was greater than table value 2.00 at 0.05 level of significance, hence H1 is accepted.
Table 2- Evaluation of pre-test post-test knowledge score of video assisted teaching program on Kegel exercise using t-test.
|
Video Assisted Teaching Program |
Mean |
SD |
DF |
Paired‘t’Value |
TableValue |
Inference At 0.05 |
|
Pre – Test |
13 |
3.48 |
59 |
14.02 |
2.00 |
Highly Significance |
|
Post – Test |
22.6 |
2.77 |
SECTION V: Chi-square analysis for association between Pre-test knowledge score of B.Sc Nursing 3rd year students with selected Socio demographic variables:
Findings reveals that there was no significant association between knowledge and age, residence, type of family. Only significant association between knowledge and religion, work exposure of clinical area, source of information of subject.
DISCUSSION:
The overall percentage in pre-test knowledge score of knowledge regarding Kegel exercise on episiotomy pain and wound healing 02(3.33%) were in good, 38 (63.33%) were in average and 20(33.33%) were in need to improvement in pre test and post test majority 46 (76.66%) were in good, 14(23.33%) were in average and 0(0%) were in need to improvement. So, the hypothesis (H1) is accepted that means there was a significant difference in the knowledge between pre-test and post- test.
The above finding was supported by a study conducted by D.J. Dini “To evaluate the effectiveness of video assisted teaching on knowledge and attitude regarding Kegel exercise on episiotomy pain and wound healing among staff nurse in selected hospitals at Dindigul District” a quasi-experimental non-equivalent control group pre-test- post-test design was adopted. Purposive sampling technique was used to select 30 samples in experimental and 30 samples in control group. Finding shown that the mean score of knowledge and attitude in the post test were greater than the mean score of the pre-test. The obtained “t-value” was highly significant at P<0.05 level. The relationship between the level of knowledge and attitude were found to have positive correlations (r=0.1767) in the experimental group.
Another study is conducted by Ms. Kokilapriya.S (2014) “to assess the effectiveness of video assisted teaching program on knowledge regarding Kegel exercise on episiotomy pain and wound healing in selected areas at erode, the quantitative educative and evaluative research approach and the research design was quasi-experimental design. 60 nursing students were selected by using purposive sampling technique. The mean pre-test score is 8.1 and mean post test score is 17.9. The paired ‘t’ test value was 10.11 when compared to table value (2.02) is high. The mean post-test value of control group was 7.4 which is lesser than the post-test value 17.9 of experimental group. The un-paired ‘t’ value was 11.3 When compared to table value (2.02) is high. The findings show there is significant increase in the level of knowledge in experimental group then control group. It indicates the effectiveness of video assisted teaching program is increasing knowledge level regarding effectiveness of Kegel exercise on episiotomy pain and wound healing.
G. Jaya thangaselvi (2015) was designed to assess the knowledge regarding episiotomy wound healing and its primary level prevention by learning module and demonstration on Kegel exercise among nursing students. This was a descriptive design. The data was collected from 30 students through convenience sampling. The tool used for data collection was a structured questionnaire for knowledge and rating scale for attitude developed by the researcher. The findings reveal that the majority of students had 19(64%) inadequate knowledge regarding episiotomy wound healing. And 11(36%) had adequate knowledge. This study it is essential to create awareness in order to improve the knowledge and change the attitude of nursing students in episiotomy wound healing and thereby it helps to improve the quality of life.
Jawaher Hazza Alharbi et.al, (2019) conducted a study related to Knowledge, Attitude and Practices of Kegel Exercise among Postnatal Women, in Al Madinah Al Munawarah, Saudi Arabia This study utilized descriptive quantitative cross-sectional study design. The study was conducted of the postnatal ward in Maternity and Children's Hospital in Al Madinah Al Munawarh, Saudi Arabia. From December 2018 to April 2019. the study carried out among 152 of postpartum mothers. Tools that used in this study; Tool I: An interviewer-administered questionnaire in Arabic language was used in this study, it composed of three parts targeting the research objectives. Tool II: was concerned with knowledge of women regarding Kegel exercises. Tool III: concerned two parts: Part one: This part related to women's attitude towards Kegel exercises. Part two: This part related to women's practices about Kegel exercises. the study found that 44.7% of the sample was in the age group 26-31 years old, 75.0% were multigravida, 85.5% had no miscarriage, 67.1% had vaginal delivery, and 50.0% have 1-3 children. 25% of the sample reported media as their source for information on Kegel exercise. 62.7% of the sample had satisfactory knowledge. 72.4% were categorized as having ‘somewhat favorable’ overall attitudes towards Kegel exercises. 57% of the mothers have not performed Kegel exercise. 38.5% of the participants were correctly practiced Kegel exercise in sitting or standing position. While 29.7% was correctly practiced Kegel exercise in lying down position. Women’s knowledge concerning the Kegel exercise in the postnatal period is reasonable and their attitude was favourable, but the mothers had the poor practice of Kegel exercises.
ETHICAL CONSIDERATION:
The study was accepted by the research committee prior permission was obtained from Principal of Shri Shankaracharya College of Nursing Hudco, Bhilai (C.G.) the permission was also taken from the Mrs. Shailaja Anik, Principal of Shankaraharya Swami Swaroopnanand College of Nursing Junwani, Bhilai to conduct Pilot study. Written consent was taken from the subjects who formed the sample group.
CONCULSION:
The study conducted on video assisted teaching programme on knowledge regarding Kegel exercise on episiotomy pain and wound healingwas effective in increase knowledge among B.Sc. Nursing 3rd year students. findings suggest that need for educating B.Sc. Nursing students on appropriate and effective way of managing the episiotomy wound through Kegel exercise which reduce the laceration rate, give vaginal and perineal muscles their previous tones, decrease the edema in perineal region, accelerate the circulation and prevent the stretch of abdominal muscles thereby prolapse and backache, as well as preventing the known stress incontinence.
ETHICAL APPROVAL:
Research Committee College of Nursing SVIMS approved the study. Informed consent was obtained from participants. They had the freedom to select any option from the question and they can withdraw from the study at any time without giving any reason.
CONFLICT OF INTREST:
Nil.
ACKNOWLEDGEMENT:
Investigators acknowledge the cooperation extended by the B.Sc. Nursing 3rd Yr. students during the time of data collection.
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Received on 15.07.2021 Modified on 30.08.2021
Accepted on 07.10.2021 ©A&V Publications All right reserved
Asian J. Nursing Education and Research. 2022; 12(1):108-113.