A STUDY TO ASSESS THE EFFECTIVENESS OF

STRUCTURED TEACHING PROGRAMME ON

PREGNANCY INDUCED HYPERTENSION
AMONG ANTENATAL MOTHERS IN
SELECTED AREAS OF RAICHUR.

PROFORMA FOR REGISTRATION OF

SUBJECTS FOR DISSERTATION

D.PARIMALA PARANJYOTHI

NAVODAYA COLLEGE OF NURSING

RAICHUR, 2007
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS FOR
DESSERTATION

1. Name of the candidate : Miss. D. Parimala ParanJyothi

and address M.Sc Nursing, I Year
Navodaya College Of Nursing
Navodaya Nagar
Mantralayam Road
Raichur

2. Name of the Institution : Navodaya College of Nursing

3. Course of study : M.Sc Nursing, I year

and subject Obstetrics and Gynaecological
Nursing

4. Date of admission in to : 09-06-2007

the course

5. Title of the Topic :

“A Study to Assess the Effectiveness of Structured

Teaching Programme on Pregnancy
Induced Hypertension Among
Antenatal Mothers in Selected
Areas of Raichur.”
6. Brief Resume of the Intended works

6.1 Need for the study

“It is believed that giving birth to an off-spring is the most beautiful

experience for a woman”.

However, across the world today, for millions of woman, pregnancy

and child-birth remain rather life-taking risk1. Each year an estimated
4,00,000 women in the developing world die in child-birth. Maternal
mortality has been called a “tracer condition” for the health systems, because
if countries can ensure the three basic conditions of adequate access to
antenatal care, medical attendance at delivery, and a health referral system
that ensures prompt treatment of emergency at adequately equipped clinics,
deaths during child-birth can be virtually eliminated. The maternal mortality
rate is the highest in the world which is 2000 maternal deaths per 1,00,000
live births2.

“Maternal mortality is said to be the indicator of social inequity and

discrimination against woman”. It is neglected tragedy because the majority
of these deaths that is 50 to 80% are prevented. Among various causes that
lead to maternal deaths, hypertension is one of the commonest medical
condition as well as a complication encountered in pregnancy and
contributes significantly to maternal and perinatal morbidity and mortality. It
is complicating approximately 10% of all pregnancies 3. Hypertension is a
sign of underlying pathology, which may be pre-existing or appears for the
first time during the pregnancy4.
 “In its most severe form, the condition is associating with
convulsions, proteinuria and edema may lead to maternal death 5. The
triennial report of maternal deaths in the UK identified that the hypertensive
disorders of pregnancy were the second most common cause of maternal
death with 5.2 deaths per million maternities for pre-eclampsia and 2.4 per
million maternities from eclampsia”. Careful observation of this condition
worldwide has identified that the incidence varies with geographical location
and race3.

Apart from being associated with unpredictable onset, it is incurable,

except by ending the pregnancy. The incidence is approximately between 6
to 10% of pregnant women. Risks of pregnancy-induced hypertension
include placental abruption, intracranial hemorrhage, liver lesions, acute
renal disorders and disseminated intravascular coagulation (DIC), adult
respiratory distress syndrome (ARDS), hypervolemia and inhalation of
gastric content due to deep sedation6.

Department of International Development Annual Report 2006

estimated that maternal mortality rate to be 407 per 1,00,000 live births in
India and infant mortality rate to be 70 per 1000 live births. Maternal
mortality due to pregnancy-induced hypetension is 15 to 33% out of the total
number of maternal death in India. Newborn infants of mothers with
pregnancy-induced hypetension present with intra-uterine growth
retardation, pre maturity, dysmaturity and necrotizing are one of the major
causes of maternal and fetal or neonatal morbidity and mortality6.

Health maintenance is an important aspect of prenatal care.

Participation of the mother in the care ensures the prompt reporting of the
possible problems. Prenatal care is one of the models of primary and
secondary prevention of disease. In order to reduce the increasing maternal
mortality rates, women with hypertensive disorders in pregnancy should be
inform of their disease and satisfactory medical information should be
provided by their health care providers. The developed countries have
reduced maternal mortality not only by medical improvements, but also due
to advanced general health, education and social position of the women1.

Though many studies are conducted in the area of Pregnancy Induced

Hypertension, the researcher could not find any valid study to assess the
effectiveness of the structured-teaching programme on knowledge regarding
Pregnancy Induced Hypertension. Hence, the researcher felt the need to
assess the effectiveness of structured-teaching programme on Pregnancy
Induced Hypertension among antenatal mothers.

6.2 Review of Literature

Review of Literature refers to the activities involved in identifying
and searching for information on a topic and developing an understanding of
the state of the knowledge on that topic7.

A quasi-experimental study was conducted to determine the

effectiveness of the Problem-Based Learning Package on Pregnancy Induced
Hypertension for BSc Nursing students in selected Institutions at Manipal.
Forty-three students were selected by random method out of which 20
students were in experimental group and 23 were in control group. Data
were collected by using semi-structured questionnaire. The study results
showed that the students in the experimental group gained significantly
higher scores (95.10%) in the post test when compared to the control group
(80.37%). The study concluded that studies may be conducted to compare
the strategy with other instructional strategies8.
 A hospital-based study was conducted to assess the effects of
hypertension during pregnancy in selected hospitals of Varanasi, India.
Eighteen Hundred and two pregnant women were screened for hypertension
between July 2002 to June 2006, out of which 72 patients were selected by
purposive sampling technique. Data were collected by investigatory
findings. The study results showed that perinatal death in 37.5% of
deliveries and low birth weight was seen in 66.66% of births. The study
concluded that hypertension during pregnancy is responsible for high fetal
mortality and low birth weight9.

A descriptive study was conducted to assess the factors affecting the

outcome of pregnancy in hypertensive patients in selected hospitals at
Nigeria. One hundred and twenty seven patients with pre pregnancy chronic
hypertension were selected by purposive sampling for the study. Data were
collected by using questionnaire. The results of the study showed that 6.1%
maternal mortality, 36.4% fetal mortality and 66.7% fetal respiratory
distress. The study concluded with the need for patient education and regular
antenatal clinic attendance10.

A descriptive study was conducted to determine the prevalence of

hypertensive disorders of pregnancy and evaluate their effects among the
mothers and fetuses in selected hospitals at Jahrom. Two thousand three
hundred pregnant women were selected by convenient sampling technique.
Data were collected by semi structured interview schedule. The study results
showed that maternal mortality was 1.3 per 10,000 births, perinatal mortality
was 53 per 1000 births and 20% cases were low birth weight neonates. The
study concluded that hyepertensive disorders of pregnancy have great
influences on maternal and neonatal morbidity and mortality rates11.
 A comparative study was conducted to estimate the incidence and
effect of pregnancy related Hypertensive condition on multiple gestations in
selected area of USA. Thirty four thousand three hundred and seventy four
women with one to four fetuses and women who delivered at more than 28
weeks of gestations were selected by convenient sampling technique. Data
were collected by semi-structured interview schedule. The results of the
study showed that increase incidence of pregnancy-induced hypertension
with 12.7-19.6% for multifetal gestations compared with 6.5% for
singletons. The study concluded that pregnancy related hypertensive disease
increases progressively with advancing fetal number from singleton to
triplets12.

6.3 Statement of the Problem

“A Study to Assess the Effectiveness of Structured Teaching

Programme on Pregnancy Induced Hypertension

Among Antenatal Mothers in Selected

Areas of Raichur”

6.4 Objectives of the Study

1. To assess the knowledge of antenatal mothers regarding

pregnancy induced hypertension.
2. To determine the effectiveness of structured teaching
programme on pregnancy induced hypertension among
antenatal mothers.
3. To find out the relationship between knowledge of antenatal
mothers regarding pregnancy-induced hypertension with
selected demographic variables.
6.5 Operational Definitions

1. Knowledge: It is a verbal response of antenatal mothers to the

items, in the interview schedule regarding pregnancy-induced
hypertension.

2. Effectiveness: It is the significant gain in knowledge of antenatal

mothers with regard to pregnancy-induced hypertension as evident
by the differences in pre and post test scores.

3. Structured teaching Programme: Refers to systematically

developed instructions designed for antenatal mothers to provide
information regarding pregnancy-induced hypertension.

4. Pregnancy Induced Hypertension: It refers to the absolute rise of

blood pressure of at least 140/90 mmHg, if the BP is not known or
a rise in systolic pressure of at least 30 mmHg, or a rise in diastolic
pressure of at least 15 mmHg over the previously known BP.

5. Antenatal Mothers: Refers to all pregnant mothers who are in

first, second and third trimester at the time of data collection.
6.6 Selected Variables:

Dependent Variables:

Knowledge of the antenatal mothers pregnancy induced hypertension.

Independent variables:

Structured teaching programme regarding pregnancy induced

hypertension.
Extraneous Variables:

1) Age: Refers to the chronological age of antenatal mothers. For the

present study age was categorized as

a) Less than 20 years

b) 21-25 years

c) Above 25 years.

2) Gravida : Refers to Pregnancy. For the present study gravida was

categorized as

a) Young Primigravidae

b) Elderly Primigravidae

c) Multigravidae.

3) Weeks of gestation : Refers to the period of Pregnancy in weeks. For

the present study weeks of gestation was categorized as

a) 0 – 12 Weeks
b) 13 – 24 weeks
c) 25 – 36 weeks
d) 37 – 42 weeks.
4) Family History : Refers to presence of P1H within the previous

generation. For the present study family history was categorized as

a) History of P1H in the family

b) No History of P1H in the family.
5) Educational Status : Refers to the ability of the antenatal mothers to

read and write. For the present study two groups are considered

a) Literates – Antenatal mothers who know to read and write

Kannada or English

b) Illiterates – Antenatal mothers who do not know to read and

write Kannada or English.

6) Source of health related information: It refers to the means through

which antenatal mothers get information. For the present study it was

categorized into

a) Television
b) Family members
c) Health team
d) Friends
e) Partner.

7) Monthly family income: It refers to the amount of money earned by

family members every month. For the present study it was categorized

into:

a) Rs. less than 2000

b) Rs. 2001 – 3000

c) Rs. 3001 – 4000

d) Rs. more than 4000

 8) Medical Disorders : Refers to the medical conditions which are

present in the mothers during pregnancy. For the present study the

medical disorders are categorized into

a) Hypertension

b) Diabetes Mellitus

c) Nephritis.

6.7 Hypothesis :

H1 Significant relationship will be there between the age and the

knowledge of antenatal mothers with regard to P1H

H2 There will be significant association between the knowledge of

antenatal Mothers with regard to P1H and their gravidal status.

H3 There will be significant association between the weeks of

gestation and the knowledge of antenatal mothers with regard to P1H.

H4 There will be significant relationship between the family history and

the knowledge of P1H among the antenatal mothers.

H5 There will be significant relationship between knowledge of antenatal

mothers with regard to P1H and their educational status.

H6 Relationship between knowledge of antenatal mothers with regard to

P1H and the sources of health related information will be significant.

H7 There will be significant association between the monthly family

income and the knowledge of antenatal mothers regarding P1H.

H8 There will be significant association between the medical disorders

during pregnancy and the knowledge of antenatal mothers regarding

P1H.

6.8 Limitations:

The study is limited to

a) the women who are pregnant.

b) the women who are willing to participate in the study.
c) the women who are available at the time of data collection.
d) women who are residing in selected urban slum areas of
Raichur.
e) those women who know to read and write Kannada or English.

6.9 Projected Outcome: The results of the study throws a light on

effectiveness of structured teaching programme on pregnancy induced

hypertension among antenatal mothers. It helps the future researchers to

adopt other innovative strategies to enhance the knowledge of antenatal

mothers.

7. Material and Methods

7.1. Sources of Data

 Design: Pre – experimental design of one group pre test and post test

method is chosen for the present study.

 Setting of the Study: Raichur is one of the Back ward District

situated in North – Eastern Karnataka. It has an area of 60 Sq. km and

comprises of 5 towns, 300 villages and 35 wards. The study will be

conducted at Kulusumbi Colony, an Urban Slum area of Raichur

District with a population of 6,860.

 Population: The Population of the Study comprised of all the

antenatal mothers in urban slum areas of Raichur who are in first,

second and third trimester of pregnancy.

 Sample: Sample for the present study consists of 40 antenatal mothers

from the urban slum area.

 Sampling Technique: Convenient sampling technique will be used to

select the subjects for the study. A convenient sampling is a Non

Probability Sampling Technique, which entails of use of most

convenient available people or subjects in a study. The Antenatal

mothers who will be at first, second and third trimesters of pregnancy

and willing to participate in the study will be selected, by going door

to door till the selection of 40 subjects.

 Inclusion Criteria: The Study includes antenatal mothers who are:

a) Pregnant.

b) Willing to Participate in the study.

c) Available at the time of data collection

  Exclusion Criteria: The Study excludes the mothers who are:

a) Not Pregnant.

b) Not willing to Participate in the Study.

c) Not available at the time of data collection.

7.2 Methods of Collection of Data

 Data collection Instrument

A structured interview schedule will be developed and used for

collecting the data. The interview schedule contains of two sections, namely

part – I and Part – II. Part – I consists of demographic data and part – II

consists of questions on knowledge regarding pregnancy-induced

hypertension.

 Data Collection Method

Prior permission will be obtained by the significant authorities and the

subjects, then face to face interviews with subjects will be conduced by the

investigator personally by using the structural interview schedule before and

after the implementation of structured teaching programme.

7.3 Plan for Data Analysis

The following statistical methods will be used to analyze the data.

1) Frequency and percentages will be used to summarize the

sample characteristics and for item wise analysis.

 2) Mean and standard deviation will be used to assess the

knowledge of women on PIH.

3) Chi-square and ‘t’-test values will be computed to find out the

relationship between the knowledge with selected variables.

7.4 Does the study require an Investigation or Interventions to be

conducted on patients or others Humans or Animals? If So, Please

Describe Briefly?

The Study requires intervention in the form of imparting knowledge to

antenatal mothers on pregnancy-induced hypertension, by using a structured

teaching programme.

7.5 Has Ethical Clearance been obtained from your Institution, in case

of 7.4?

Ethical Clearance has been obtained from the institutional ethical committee.
8. List of References:

1) Maternal HH. www.ceeindia.org/mdgs/goal2005-5hmt-18k.

2) Global Monitoring Report. By World Bank; 2007 hhp://web;world

Bank.org/2007/0.com

3) Diane M.Fraser and Margaret A Cooper. Textbook for Midwives. 14th

Ed. Churchill: Elsevier Limited; 2003; 357.

4) D.C. Dutta. Textbook of Obstetrics 5th Ed. New central book. Agency

(P) Ltd ; Calcutta ; 1983 ; 234.

5) BT Basavanthappa. Text book of Midwifery and Reproductive, Health

Nursing. 1st Ed. Jaypee Brothers Medical Publishers (P) Ltd

New Delhi; 2006 ; 540.

6) Guruji A. Hypertension, Pre – eclampsia and Eclampsia – Monitoring

and Outcome of Pregnancy. Med Preg. 2006, Nov – Dec ; 59 (11 – 12)

; 556 – 9.

7) -Denise F.Poli Nursing Research – Principles & Methods. 16th Ed.

Philadelphia, Lippincott Publishers; 1999;79.

8) Mrs. Jutiana Linnethe D’sa. Evaluation of a Problem – Based

Learning Package on Pregnancy – Induced Hypertension for B.Sc.

Nursing students. The Nursing Journal of India, November 2002 Vol,

LXXXXIII, No. 11; 261.

9) Prakash J. Hypertension in pregnancy; Hospital based study J Assoc

Physicians India 2006, Apr ; 54 ; 273 – 8.

10) Familoni OB. Pattern and factors affecting the outcome of

pregnancy in hypertensive patients. J Natl Med Assoc 2004 Dec ;

96 (12) ; 1626 – 31.

11) Zareian Z. Hypertensive Disorders of Pregnancy. Int J Gynaecol

Obstet. 2004, Nov ; 87 (2) ; 194 – 8.

12) Day M C. The effect of fetal number on the development of

hypertensive conditions of pregnancy. Obstet. Gynecol . 2005 No ;

106 (5 pt 1) ; 927 – 31.

9. Signature of the Candidate :

10. Remarks of the Guide :

11. Name and Designation of :

11.1. Guide : Mrs. Sreelekha.C

Asst. Professor,

DEPT. OF OBSTETRICS AND

GYNECOLOGY NURSING

11.2. Signature :

11.3. Co – Guide (If any) :

11.4. Signature :

11.5. Head of the Department : Mrs. Sreelekha.C

Asst. Professor,

DEPT. OF OBSTETRICS AND

GYNECOLOGY NURSING

11.6. Signature :

12.1. Remarks of the Chairman

And Principal :
12.2. Signature :