https://doi.org/10.33698/NRF0284-Manimegalai S, Laishram Dabashini Devi
Background: Pelvic oor dysfunction refers to a wide range of issues that occur when muscles of the pelvic oor are weak, tight or there is an impairment of the sacro iliac joint, lower back coccyx, or hip joint. It may include urinary incontinence, faecal incontinence, pelvic organ prolapse, and sexual dysfunction. Objectives. To determine the effect of structured teaching programme on pelvic oor dysfunction knowledge scores of postnatal mothers. Methodology: The research approach was evaluative. 50 postnatal mothers from Jaya Nagar General Hospital was selected by non-probability purposive sampling technique. Data collection tools was self-administered structured questionnaire including a)socio demographic variables b)Multiple choice questions regarding pelvic oor dysfunction. The tool was validated by experts from the eld of nursing and obstetrics. Structure teaching programme was administered by one to one basis after assessing baseline knowledge score and posttest was done after 7 days by administering same questionnaire. Data was analysed using descriptive and inferential statistics. Results: The result revealed that the overall post-test mean score was 33.78+2.85 (85.11%) and the respondents’ knowledge were signicantly higher than, the overall mean pre-test knowledge scores 13.84+3.99 (36.42%) (P<0.001as per paired t test). Conclusion: The structured teaching programme was effective in improving the knowledge of postnatal mothers on pelvic oor dysfunction.
Key words: Structured teaching programme, pelvic oor dysfunction, post natal mothers
Correspondence at
Manimegalai. S Assistant Professor,
College of Nursing Sciences Dayananda Sagar University
Shavige Malleshwara Hills,Kumaraswamy layout,
Bangalore. Phone no: 9632503541 Email: megalaprabhur@gmail.com
Introduction
Currently pelvic oor dysfunction is becoming major problem during post-natal period. Pelvic oor dysfunction is a condition where pelvic oor muscles loose its control and relaxes completely following childbirth which alter the normal bladder and bowel functions during the post-natal period. A study was conducted and shows that the overall prevalence of post-natal urinary incontinence ranged from 6% to 32% and faecal incontinence ranged from 13% to 25%. Pelvic oor dysfunction is becoming major problem during the whole process of childbirth which can have a devastating effect on women’s life. It may cause mental changes along with physical changes among women. Since prevention is better than cure, maintaining a healthy pelvic oor muscles by doing pelvic oor muscle exercise will prevent the risk of disease.2 Nurses play an important role in helping the women in improving the quality of life by offering conservative management and prophylactic measures to prevent complications. Although a puerperium is a natural physiological process, but it should be recognized as a challenge to prevent the complications during puerperium. Nurses and other health care workers help the w o m a n t o a d a p t w i t h h o m e c a r e management to prevent pelvic oor dysfunction.
Aim: To determine the effect of structured teaching programme on pelvic oor dysfunction knowledge scores of postnatal mothers.
Methodology: A quasi experimental study was carried out at Jayanagar General Hospital. By non-probability purposive sampling technique all the postnatal mothers during data collection period were selected and enrolled in study and sample constituted 50 post-natal mothers. Study was approved by the Institute Ethics Committee and written permission was taken from Medical Superintendent of Jayanagar General Hospital Bangalore. The tools used in the study included self- administered structured questionnaire consists of demographic data of 8 items and knowledge questionnaire , included 40 items to assess the knowledge level of post- natal mothers related to pelvic oor dysfunction and scoring sheet consisted maximum 40 score and for each item was scored from 0 to1. Further the total score was divided into 3 categories based on the percentage gained by postnatal mothers such as inadequate knowledge less than 50%, moderate knowledge 51-75% and adequate knowledge more than 75%. The tools and the structured teaching program plan of the study were developed after reviewing the literature and validated by experts in the eld of nursing, obstetrics and gynaecology. To check the feasibility of study a pilot study on 10 subjects was done and necessary changes were made in tools. T h e r e l i a b i l i t y o f t h e s t r u c t u r e d questionnaire was estimated by spearman- brown prophecy formula and it was found to be r=0.94, which indicated that the tool was highly reliable. Data collection was done on 50 subjects in post-natal period. A Written consent was signed by each participant before taking part in study. The knowledge of postnatal mothers regarding pelvic oor dysfunction was assessed by conducting pre-test by using structured questionnaire. After assessing the knowledge level, on same day each participant was administered Structure Teaching Program on pelvic oor d y s f u n c t i o n , i t s p r e v e n t i o n a n d management by using PPT, ash card, charts, roller board, etc. After seven days post test was conducted by using that same structured questionnaire. The data was analyzed using descriptive and inferential statistics. The various statistical measures used such as frequencies, percentage, mean, standard deviation and parametric tests i.e. paired t test and chi-square test.
Results: Table1 shows the demographic variables of post-natal mothers Half of post-natal mothers (52%) were in the age group of 21-25 years and 24 (48%) were in the age group of 26-30 years. Education level of 30(60%) post-natal mothers were high school, 17 (34%) had completed middle school education, 3(6%) were graduates. Two third mothers (62%) were Muslims and only 19(38%) were Hindus. Residential area of 32(64%) post-natal mothers was urban area, and 18(36%) were from rural area. Family income of 30(60%) mothers was between Rs 5000-12000, 18 (36%) had family income <Rs. 5000/, 2(4%) had family income between Rs.12001-20000. Two third of the post- natal mothers 30(60%) were multi Para, and 20(40%) were primipara.
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Table – 1: Demographic profile of post- natal mothers N=50
Table 2 shows the comparison between pre- test and post-test area wise knowledge scores. Regarding the pre-test, the overall mean scoreis 13.84 with standard deviation 3.99 and mean percent score was 36.42. About the post-test, the overall mean score is 33.78 with standard deviation 2.85 and mean percent score is 85.11. The overall t- value is 49.12 at 0.1% level of signicance, which is greater than the table value of 2.56 which indicates the effectiveness of structured teaching programme on knowledge regarding pelvic oor dysfunction. Hence the hypothesis H1- There will be signicant differences between pre-test and post-test knowledge scores regarding pelvic oor dysfunction after administering structure teaching program is accepted. There is signicant improvement of post test score as compared to pre test score in each domain.
Table 3 describe the percentage of participants’ correct responses to each statement during pre-test and post-test. During post test all the respondents were able to give correct response to the statement regarding Pelvic oor muscles located in pelvic region and The main function of the pelvic oor is providing support for pelvic organ. More than 90% could correctly tell after post test about Inability to control the pelvic oor muscle is termed as pelvic oor dysfunction, The procedure which can injure the pelvic oor is forceps delivery, Urinary incontinence occurs during the end of pregnancy, Lack of bowel control is known as faecal incontinence, The one of the symptoms of pelvic oor disorder is lower back pain, A measure in which the ability to control
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TABLE-2: Comparison between the pre-test and post-test area wise knowledge level regarding pelvic floor dysfunction.
S: Statistically signicant at P<0.001 t (0.001, 49df) = 2.56
pelvic oor muscles is assessed is known as physical examination, The management of pelvic oor dysfunction includes relaxation technique.
Table 4 shows the association of level of pre- test knowledge with selected demographic variables. It is evident from the above table that there is no signicant association with the variable like age, education, religion, residential area, family income, parity, and previous knowledge.
Discussion:
Pelvic oor dysfunction has lifelong effect for women in the form of urinary incontinence, fecal incontinence, pelvic organ prolapse and sexual dysfunction. Hence prevention and management of pelvic oor dysfunction is essential in order to rectify the complications. Prevention of pelvic oor dysfunction can be achieved by doing pelvic oor muscle exercise in the early post-partum period; thereby it helps women to maintain a healthy pelvic oor. The following conclusions were drawn on the basis of the ndings of the study which revealed that, none of the respondents had adequate knowledge, 35(70%) respondents had inadequate knowledge, and 15(30) respondents had moderate knowledge on pelvic oor dysfunction before the implementation of the structured teaching programme. Similarly, a descriptive study was conducted on women’ s stated knowledge of the term pelvic oor disorder in Hong Kong. The sample of the study was 376 women. The data was collected through structured interview. The study nding reveals that the majority 78.2% had no idea about pelvic oor disorder. Only 20.3% of women knew about pelvic oor disorder. The results of this study revealed inadequate knowledge on pelvic oor disorder. The study concluded that further
Table-3: comparison between number of participants’ correct response during pre-test and post test.
| S. no. | Statements | Percentage of participants gave Correct
response |
|
| Pre test | Post test | ||
| 1 | Pelvic oor muscles located in pelvic region | 70 | 100 |
| 2 | The main function of the pelvic oor is providing support for pelvic organ | 72 | 100 |
| 3 | A weak pelvic oor muscles causes urinary incontinence | 52 | 88 |
| 4 | The leaking of urine while coughing and sneezing is termed as stress incontinence | 46 | 82 |
| 5 | Difculty during sexual intercourse because of pelvic oor muscle weakness is
known as painful intercourse |
36 | 68 |
| 6 | During menopause decreased hormonal level can lead to decreased vaginal
lubrication |
38 | 86 |
| 7 | Inability to control the pelvic oor muscle is termed as pelvic oor dysfunction | 22 | 90 |
| 8 | One of the main causes of pelvic oor dysfunction is child birth | 52 | 80 |
| 9 | The procedure which can injure the pelvic oor is forceps delivery | 56 | 90 |
| 10 | Urinary incontinence occurs during the end of pregnancy | 42 | 92 |
| 11 | The risk of pelvic oor disorder is greater in case of obese women | 32 | 86 |
| 12 | excessive smoking can also leads to increases the risk of pelvic oor dysfunction | 42 | 86 |
| 13 | Frequency in passing motion is one of the conditions of pelvic oor disorder | 36 | 84 |
| 14 | Lack of bowel control is known as fecal incontinence | 20 | 94 |
| 15 | Sudden strong urge to urinate is known as urge incontinence | 40 | 84 |
| 16 | Bulging of the pelvic organ through vagina is known as pelvic organ prolapse | 26 | 86 |
| 17 | A condition in which urinary bladder bulge through the vagina is known as bladder
protrusion |
26 | 82 |
| 18 | The one of the symptoms of pelvic oor disorder is lower back pain | 24 | 90 |
| 19 | The most common symptom of pelvic organ prolapse is feeling of heaviness | 30 | 84 |
| 20 | The symptom which is not included in bladder dysfunction is frequency in passing
motion |
42 | 86 |
| 21 | The conrmatory test for pelvic oor dysfunction is pelvic examination | 24 | 74 |
| 22 | A measure in which the ability to control pelvic oor muscles is assessed is
known as physical examination |
18 | 92 |
| 23 | Pelvic oor dysfunction affects muscles and bones which leads lower back pain | 22 | 82 |
| 24 | Pelvic oor disorder affects emotionally which may lead to the problem such as
depression |
34 | 80 |
| 25 | The Aim of pelvic oor exercise is to improve muscle tone | 24 | 78 |
| 26 | The one of the purpose of pelvic oor exercise is to prevent anal incontinence | 28 | 84 |
| 27 | The One of the preventive measure for pelvic oor dysfunction is pelvic oor
muscle exercise |
24 | 92 |
| 28 | pelvic oor muscle exercise is otherwise known as kegel exercise | 28 | 84 |
| 29 | Pelvic oor muscle exercises involves contracting and relaxing pelvic oor
muscles |
32 | 88 |
| 30 | The rst step while performing pelvic oor exercise is nding the right muscles | 20 | 86 |
| 31 | The exercises should be performed for at least 3 times per day | 36 | 76 |
| 32 | The pelvic oor muscle exercises should not be performed with full bladder | 24 | 82 |
| 33 | The food not be consumed to maintain normal bladder function is caffeine | 20 | 88 |
| 34 | The normal daily uid consumption is 6-8 glasses of water | 26 | 84 |
| 35 | The food stuffs which avoid constipation are bre rich food items | 22 | 84 |
| 36 | pelvic oor dysfunction can be prevented by home management | 28 | 80 |
| 37 | The One of the treatment to control stress related incontinence is pessary
treatment |
20 | 74 |
| 38 | The treatment to control overactive bladder is bladder retraining | 32 | 78 |
| 39 | The drug to manage urinary incontinence is muscle relaxant | 64 | 80 |
| 40 | The management of pelvic oor dysfunction includes relaxation technique | 54 | 94 |
education is needed to improve women’s knowledge about pelvic oor disorder3.
After the structured teaching programme, the post test knowledge level showed that, 26(52%) respondents had moderate knowledge and 24(48%) respondents had adequate knowledge 47 (94%) had adequate knowledge on pelvic oor dysfunction. The area wise mean post-test knowledge scores are higher than the mean pre-test knowledge scores. The post-test mean score for the rst area was 5.24 (87.33%) with standard deviation 0.55, mean score for the second area is 9.34 (84.91%) with standard deviation 0.69, mean score for the third area is 4.26 (85.2%) with standard deviation 0.49 and mean score for fourth area is 14.94 (83%) with standard deviation 1.12 and the overall mean score is 33.78(85.11%) with standard deviation 2.85 were signicantly higher than the mean pre-test knowledge scores 3.14(52.33%) with standard deviation 0.87 , mean score for second area is 3.94( 35.89%) with standard deviation 0.96, mean score for third area is 1.38 (27.6%) with standard deviation 0.69 and mean for the fourth area is 5.38(29.89%) with standard deviation 1.47 and the overall mean score is 13.84 (36.42%) with standard deviation 3.99 which implies that the structured teaching programme on pelvic oor dysfunction was effective and statistically highly signicant at P<0.001 level. The present study reveals that there is n o a s s o c i a t i o n b e t w e e n s e l e c t e d demographic variables like age, education, religion, residential area, family income, parity and previous knowledge in relation with pre-test knowledge scores of post- natal mothers at P>0.05 level
The result shows that the post-natal mother’s knowledge level improved after implementation of the structured teaching programme on pelvic oor dysfunction. The study concludes that the structured teaching programme is an effective method in providing moderate to adequate level of knowledge regarding reproductive health issues to the post-natal mothers to promote and to maintain their optimum level of health. Similarly, a study was conducted to evaluate the effectiveness of educational intervention programme on improving mother’s knowledge on pelvic oor dysfunction and anatomy in Belgium. The sample of the study was 43 post-natal mothers. The data was collected through questionnaire. The study nding reveals that the pre intervention knowledge mean score was 6.2. and the post intervention knowledge mean score was 15.6. Hence, the educational programme was effective in improving the knowledge of post-natal mothers4.
Hence Nurses working in the hospital and community, play a vital role in providing post-natal care to the post-natal mothers. The midwife can provide knowledge about pelvic oor dysfunction and pelvic oor exercises during their hospital stay after the delivery and provide health information to the post-natal mothers during their hospital visit. Nurses can help the post-natal mothers to follow pelvic oor muscle exercises to prevent complications in future and to get the best level of management to maintaining their pelvic oor health.
TABLE-4: Association between pre-test knowledge score with selected demographic variables
| Demographic variables | Categories | Pre-test knowledge scores on pelvic floor dysfunction | Chi-square value (df) p value | |
| Inadequate n(%) | Moderate n(%) | |||
| Age
21-25 26-30 |
18(69.2)
17(70.8) |
8(30.8)
7(29.2) |
0.014 (1) >0.05 | |
| Educational qualification
middle school High school |
10(58.8) 25(75.8) |
7(41.2) 8(24.2) |
1.53(1) >0.05 |
|
| Religion
Hindu Muslim |
14(73.7)
21(67.7) |
5(26.3)
10(32.3) |
0.19(1)>0.05 |
|
| Residential area
Rural Urban |
11(61.1)
24(75.0) |
7(38.9)
8(25.0) |
1.05(1)>0.05 | |
| Family income
<5000 5001-12000 |
15(75.0)
20(66.7) |
5(25.0)
10(33.3) |
0.40(1)>0.05 | |
| Parity
primi multi |
12(60.0)
23(76.7) |
8(40.0)
7(23.3) |
1.59(1)>0.05 | |
References:
- Noble D. Seasons of women. Available from: http://dianenoble.wordpress.com [Accessed on 4th Nov 2011].
- Shriver EK. National institute of child health and human development. Available from: http://www.nich.nih.gov/health/topics/pregnancy.cfm [Accessed on 7th Nov 2011] χ2 (0.05, 1 df) =3.841
- Palmer J. The post natal women: what do expect. Available from: http://www.pregnancy.com.au/resourc es/topics-of-interest/post natal/the- post natal -women-what-to- expect.shtml [Accessed on 8th Nov 2011].
- Child birth connection. Preventing pelvic oor dysfunction. Available from: http://www. Child birth connection.org [Accessed on 11th Nov 2011].