RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES by B8V9r47

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									RAJIV GANDHI UNIVERSITY OF HEALTH

 SCIENCES, BANGALORE,KARNATAKA.




PROFORMA FOR REGISTRATION OF SUBJECTS

         FOR   DISSERTATION




               MS.V.JEYANTHI
            I YEAR M. Sc NURSING,
   OBSTETRIC AND GYNAECOLOGICAL NURSING
               (2008 –10 BATCH)




      VARALAKSHMI COLLEGE OF NURSING ,
       # 19, KIADB ROAD, CHOKKASANDRA,
                 T. DASARAHALLI,
                BANGALORE -560057
        RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

                    BANGALORE, KARNATAKA

     SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECT FOR

                         DISSERTATION


                           MS.V.JAYANTHI
                           I YEAR M.Sc NURSING
    NAME OF THE            VARALAKSHMI COLLEGE OF NURSING
1   CANDIDATE AND          NO19,KIADB ROAD,CHOKKASANDRA
    ADDRESS                T.DASARAHALLI
                           BANGALORE -560057


                           VARALAKSHMI COLLEGE OF NURSING
    NAME OF THE            NO19,KIADB ROAD,CHOKKASANDRA
2
     INSTITUTION           T.DASARAHALLI
                           BANGALORE -560057

                        MASTER DEGREE OF NURSING,
3   COURSE OF STUDY AND OBSTETRIC AND GYNAECOLOGICAL
    SUBJECT             NURSING


    DATE OF ADMISSION
4   TO COURSE                    30-06-2008


                           ASSESS THE EFFECTIVENESS OF NEEM
                           EXTRACT SITZ BATH VERSUS
5   TITLE OF THE TOPIC
                           BETADINE SITZ BATH ON EPISIOTOMY
                           WOUND HEALING.
6. BRIEF RESUME OF THE INTENDED WORK

INTRODUCTION


         An episiotomy is a surgical cut in the perineum, the muscular area between the

vagina and the back passage. A local anaesthetic to numb the perineum is given before

the episiotomy is carried out. Having an episiotomy is no longer a routine part of labour.

Your midwife might suggest one if your baby is becoming distressed and needs to be

born quickly, or if she thinks that you may tear very badly unless the opening from the

vagina is carefully enlarged.1 Some health professionals believe that an episiotomy heals

better than a tear, although the research doesn't bear out this assumption. Spontaneous

tears are less painful or at least no more painful for women in the days after the birth than

episiotomies. Various studies have concluded that women who have an episiotomy,

women who tear, and women who have no damage to the perineum during childbirth

have equally strong pelvic floor muscles three months after giving birth.2


       Puerperium is the period following childbirth during which the body tissues,

specially the pelvic organs revert back approximately to the pre-pregnant state both

anatomically and physiologically. The retrogressive changes are mostly confined to the

reproductive organs with the exception of the mammary gland which in fact shows

features of activity. Involution the process whereby the genital organs revert back

approximately to the state as they were before pregnancy. The woman is termed as a

puerpera. The period is arbitrarily divided into a) immediate-within 24 hours; b)early- up

to 7 days and c)remote- up to 6 weeks.3
6.1 NEED FOR STUDY


       The Sanskrit name of neem tree is arishtha meaning 'reliever of sickness' and

hence is considered as sarbaroganibarini. The tree is still regarded as 'village dispensary'

in India. The importance of the neem tree has been recognized by US National Academy

of Sciences, which published a report in 1992 entitled 'Neem – a tree for solving global

problems.For thousands of years the beneficial properties of Neem (A Azadirachta

indica. Juss) have been recognized in the Indian tradition. Each part of the neem tree has

some medicinal property.4 Neem is regarded the holy plant of India. One of its vast uses

in medicine is for skin conditions. It is very rich in nutritients that preserve skin elasticity

like omega 3-6-9. All parts of the herb exhibit properties as, antiviral, anti-inflammatory,

immuno-modulatory, antibacterial, and antifungal. More than 140 compounds were

isolated from different parts of the herb.


       Neem or Azadirachta Indica, popularly known as margosa is a large, evergreen

tree. Neem has been used as a tonic and astringent that heartens wound healing. Neem or

Azadirachta Indica traditionally being used because of its detoxifying benefits that help

protects healthy circulatory, digestive, respiratory and urinary systems of the body. It is

widely used for external applications in skin related problems. Neem or Azadirachta

Indica extracts have wonderful effects like anti-diabetic, anti-bacterial, and anti-viral

properties.


       A wound affects the first line, of our body’s defense system, the skin. When such

takes place, a plethora of symptoms may appear like, bleeding, swelling, redness, pain

and tenderness, fever with infection, heat, stiffness, discoloration, scabbing, itching and
scar formation.Wounds on skin and other soft tissues, trigger a self-healing process of our

body which is summarizes to the scientific term “inflammation”. This process increases

collagen production below the skin (dermis). Then, follows the regeneration of the outer

skin layer.5


        The postnatal mothers who had undergone episiotomy, they are more prone to get

puerperal infection during early postnatal period. So the researcher felt that by providing

medicated sitz bath can minimize the puerperal infection and promote episiotomy wound

healing.

6.2 REVIEW OF LITERATUR

            Hur et al. conducted a study to verify the effect of aroma-sitz bath with

aroma- soap application on perineal healing on 100 postpartum mothers. The

effectiveness was assessed by REEDA scale and smear of episiotomy wound. The data

were analyzed by repeated measures of ANOVA,ANCOVA and chi (2) test. The study
                                                     the
related that REEDA scale was significantly low in          experimental group at postpartum

5th and 7th day(P=.0009,P=.003) and few bacteria were observed in the smears of

episiotomy wound. In the study they concluded that aroma-sitz bath is more effective in

healing episiotomy.6

            Anupama conducted a study to assess the effectiveness of moist and dry heat

application on healing of episiotomy wound on 30 postnatal mothers by using REEDA

scale. The subjects were randomly allocated to experimental and control group. The study

concluded that rate of wound healing with of moist heat and dry heat application was

similar.7
       Molkizadeh     et al (1382-83) conducted a study to verify the evaluation of

lavender cream effect on perineal pain and episiotomy wound healing in 100 primiparous

women with term pregnancies requiring surgical repair of episiotomy fiiowing a normal

and spontaneous delivery at Moderre’s hospital in Kashmar. The effectiveness was

assessed for perineal pain by VAS and wound healing by REEDA scale at first 24hrs,3rd ,

5th and 7th day postpartum. The data was analyzed with chi- square, mann-withny u and

t-test and analysis in spss software.There was no significant differences in perineal pain

at first 24hrs postpartum between two group(P=0.78), but perineal pain at :3rd(P=0.035),

5th (p=0.0)and 10th ( P=0.04) days postpartum was less in experimental group.In wound

healing there was no significant difference between two groups at 3rd day postpartum

(P=0.170) but at 5th day (0.002), and 10th day (P=0.0) there was significant difference

between two group.The study concluded that the topical application of lavender creem

was effective in reliving perineal pain and episiotomy wound healing.8

           Tejirian et al. conducted astudy to justify and support the recommendation

of sitz bath in the management of ano-rectal disorders. Thirty six articles were found

which highlighted the physiology,benefits,risks,complications and techniques of sitz

bath. This study conducted that sitz bath induces relaxation of the internal sphincter

muscle and cold sitz bath was reported to decrease perineal edema. This study also

recommended additional studies are needed to investigate the benefits of sitz bath.9
STATEMENT OF THE PROBLEM

A COMPARITIVE STUDY TO ASSESS THE EFFECTIVENESS OF NEEM EXTRACT

SITZ BATH VERSUS BETADINE SITZ BATH ON EPISIOTOMY WOUND HEALING

AMONG POST NATAL MOTHERS AT SELECTED HOSPITAL, BANGALORE.

6.3 OBJECTIVES

      6.3.1 To assess the rate of wound healing in episiotomy after providing neem

              tract sitz bath among postnatal mothers in experimental group.

      6.3.2   To assess the rate of wound healing in episiotomy after providing betadine

               sitz bath among postnatal mothers in control group.

      6.3.3   To compare the effectiveness of neem extract sitz bath versus betadine sitz

              bath on episiotomy wound healing among postnatal mothers in experimental

              and control group.

      6.3.4   To study the association between effectiveness of neem extract sitz bath

              versus betadine sitz bath on episiotomy wound healing with selected

              demographic variables of postnatal mothers in experimental and control

              group.

6.4 HYPOTHESIS

H1:

         There will be significant difference between neem extract sitz bath versus

betadine sitz bath on episiotomy wound healing.

H2:

         There will be significant correlation between neem extract sitz bath versus

betadine sitz bath on episiotomy wound healing.
H3

        There will be significant association between the episiotomy wound healing with

the selected demographic variables.

6.5 OPERATIONAL DEFINITIONS

     Effectiveness:

        In this study it refers to the wound healing produced in the vaginal introitus by

        providing neem extract sitz bath vs betadine sitz bath.

     Betadine Solution:

        It is the pharmacologically available 10% povidone iodine , topical antiseptics in

     readymade form.

     Neem extract:

        It is a solution in which 20gm of neem paste is added in one litter of boiled water

        then the boiled solution is filtered and called as neem extract.

     Sitz Bath:

        It is a type of bath in which the episiotomy wound is soaked in some

        recommended solutions about 15 to 20 minutes.

     Episiotomy wound:

         An incision made medially or medio-laterally to the vaginal introitus during labor

        process to facilitate delivery of the fetus.

     Healing:

        It refers to the process of returning back towards normal apposition of muscles

        and skin.
  Post natal mothers:

      In this study, it refers to all prime mothers within 24 hours of delivery with

      episiotomy.

6.6 ASSUMPTIONS

  1. Post- natal mothers in experimental group will accept the neem extract sitz bath.

  2. The rate of episiotomy wound healing will be higher in neem extract sitz bath

      compared to betadine sitz bath.

  3. Post-natal mothers in experimental group will have more satisfaction

       than postnatal mothers in control group.

6.7 DELIMITATION:-

  1. Mothers who had undergone episiotomy during study period.

  2. Mothers who have the willing to participate in this study.

  3.The study was delimited to four week period.

6.8 VARIABLES

 Independent Variable: Providing neem extract sitz bath versus betadine sitz bath.

 Dependent Variable: Episiotomy wound healing.

 Demographic Variable: Age, Parity, Education, Occupation and Religion, source of

                           information, previous experience.
7.0. MATERIALS AND METHODS

       This study is designed to compare the effectiveness of neem extract sitz bath

versus betadine sitz bath on episiotomy wound healing among postnatal mother in a

selected hospital, Bangalore.

7.1. SOURCE OF DATA

        Data will be collected from the postnatal mothers with episiotomy wound at

        selected hospital, Bangalore.

7.2 METHODS OF COLLECTION OF DATA

       Structured questionnaire will be collecting the data regarding effectiveness of

       neem extract sitz bath versus betadine sitz bath on episiotomy wound healing.

7.2.1 RESEARCH DESIGN:
               Quasi Experimental research design.

7.2.2 RESEARCH APPROACH:
               An evaluative descriptive approach will be used to assess the effectiveness

       neem extract sitz bath versus bedatine sitz bath through comparing the outcome of

       experimental and control group.

7.2.3 SETTING OF THE STUDY
       The study will be conducted at a selected hospital, Bangalore.

7.2.4 POPULATION

       The population in the study will comprise all postnatal mothers with episiotomy at

selected hospital, Bangalore.
7.2.5 SAMPLE SIZE

       A sample of the study consists of 60 postnatal mothers with episiotomy in a

selected hospital, Bangalore.

7.2.6 SAMPLING TECHNIQUE

       Sample (n=60) will be selected through convenient sampling technique and will

be allotted 30 each in control as well as in experimental group.

7.2.7 SAMPLING CRITERIA

    INCLUSION CRITERIA

       The study includes postnatal mothers

          With episiotomy wound on 0 or 1st post natal day to 3rd postnatal day.

          Admitted at selected hospital, Bangalore.

          Who can able to understand Kannada and English.

          Mother who is accepts this study.



     EXCLUSION CRITERIA

       The study excludes postnatal mother

          Who are not available at the time of intervention

          High risk post natal mothers

          Not willing to participate in the study.



7.2.8 DATA COLLECTION TOOL
       REEDA Scale.
7.2.9 DATA ANALYSIS METHOD
         The collected data will be analyzed by the descriptive and inferential analysis

         Frequency and percent will be used to describe the demographic

          characteristics of post natal mothers of two groups.

         Descriptive measures such as mean, standard deviation will be used assess

          post scores of two groups

         Unpaired t-test will be used to compare the post scores of two groups

         Chi-squre analysis will be carried out to bring out the association between

          rate of episiotomy wound healing of post natal mothers and their demographic

          characters

7.3 Does the study require any investigations or interventions to the

     patients or other human beings or animals?

            Yes, the neem extract sitz bath will be provided for the post natal mothers

   with episiotomy at selected hospital, Bangalore.

7.4 Ethical clearance

   The permission will be obtained from

   -The Research committee of the Varalakshmi college of nursing

   -Authorities of selected Hospital at Bangalore.
8. LIST OF REFERENCE

     1. Aiien,R.E.Hoster,G.L.Smith,A.R.Warrell.Pelvic floor damage and

       childbirth.British journal of obstetrics and gynaecology.1990;97, pp770-9.

     2. Carroli, Blizan.Episiotomy for vaginal birth. Journal of cocharne review, The

        cocharne library. Jan very.2004;3,24-32.

     3. D.C.Dutta.Text book of obstetrics”, 6th edition, published by new central book

        of agency, 2004,p.

     4 .Biswas,Kausik.,Ishita chattopadhyay,Ranajitk,Banerjee, Uday bandyopadhyay.

       Biological activities and medicinal properties of neem.jornal of current

       science.2002;82(11):1336-1345.

     5. Newsfindder,A literary favor to world culture. Established on June 16.2002

     6. Hur.M.H,Han S.H. Clinical trial of aromatherapy on postpartum mothers

      perineal healing. Tachan Kanho Hakhow chi.June 2004.

     7. Anupama Dutta.Evaluate the effectiveness of moist and dry heat application on

     healing of episiotomy wound. Dissertation.RGUHS.2004.

     8. Molkizadeh.M, Khadivzadeh.T, Rakshandeh.H, Khajedaleui.M. Evaluation of

        lavender cream effect on perineal pain and episiotomy wound healing.

     9.Tejirian.T. Abbas M.A.sitz bath.Scientific basis of common practice. Diseases

      of colon rectum. June 2005.
9. SIGNATURE OF THE STUDENT :


10. REMARKS OF THE GUIDE       : The present study help the researcher to
                                 discover the fabulous effects of Neem leaf
                                 extracts sitz bath for episiotomy wound
                                 healing versus Betadine sitz bath;The
                                 researcher can prepare a pamphlet about
                                 proved scientific benefits of Neem leaves
                                 which will be helpful for the mother’s
                                 undergone normal delivery.


11 NAME AND DESIGNATION OF
11.1. GUIDE                     : Mrs. Nisha clament.Msc(N).
                                  Associate Professor,
                                  Department of Obstetric and
                                  Gynaecological Nursing.
                                  Varalakshmi College of Nursing,
                                  Bangalore.
11.2 SIGNATURE:


11.3 HEAD OF THE DEPARTMENT : Mrs. Nisha clament.Msc(N)..
                              Associate Professor,
                              Department of Obstetric and
                              Gynaecological Nursing.
                              Varalakshmi College of Nursing,
                              Bangalore.



11.4 SIGNATURE                 :


12. REMARKS OF PRINCIPAL           : The topic is appropriate for the specialty
                                     chosen.
12.1 SIGNATURE                     :

								
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