RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

Ms. REENA P JOHN

NAME OF THE
I YEAR M.Sc NURSING
1 CANDIDATE AND
N.D.R.K COLLEGE OF NURSING
ADDRESS
B.M. ROAD, HASSAN.

NAME OF THE
2 N.D.R.K COLLEGE OF NURSING
INSTITUTION
B.M. ROAD, HASSAN.

COURSE OF STUDY AND MASTER IN NURSING

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SUBJECT OBSTETRICS AND GYNAECOLOGICAL
NURSING

4 DATE OF ADMISSION TO 15-05-2007

THE COURSE

THE EFFECTIVENESS OF SELF

INSTRUCTIONAL MODULE REGARDING
5 TITLE OF THE TOPIC MANAGEMENT OF PREGNANCY INDUCED
HYPERTENSION ON KNOWLEDGE OF STAFF
NURSES IN SELECTED HOSPITALS AT
HASSAN, KARNATAKA.

A STUDY TO EVALUATE THE EFFECTIVENESS

OF SELF INSTRUCTIONAL MODULE
STATEMENT OF THE
5.1 REGARDING MANAGEMENT OF PREGNANCY
PROBLEM
INDUCED HYPERTENSION ON KNOWLEDGE
OF STAFF NURSES IN SELECTED HOSPITALS
AT HASSAN, KARNATAKA.

6. BRIEF RESUME OF THE INTENDED WORK

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6.1 INTRODUCTION

Child birth is a unique and powerful human experience that has physiological,
psychological and social importance. Pregnancy is profound and life changing event. During
this time the mother adapt physically, socially and psychologically to the forthcoming birth
of the child. So proper antenatal care given to a pregnant woman from the time that
conception is confirmed until the beginning of labour.1

During pregnancy complications may occur there is a high probability of poor

maternal and prenatal outcome. Hypertensive disorders of pregnancy are one of the major
cause of maternal and fetal / neonatal morbidity and mortality. Its incidence is
approximately between 6-10% of pregnant women. 2

Pregnancy induced hypertension is hypertension that develops as a consequence of

pregnancy and regresses after delivery. Preeclampsia is a type of pregnancy induced
hypertension characterized by progressive hypertension and pathological edema, is
clinically defined as a blood pressure greater than 140/90 mm of Hg after 20 weeks
gestation plus proteinuria. Eclampsia is the occurrence of convulsions or coma unrelated to
other cerebral conditions with signs and symptoms of preeclampsia. Preeclampsia and
eclampsia may be complicated by the onset of the HELLP syndrome. (hemolysis, elevated
liver enzymes and low platelet count) 3

Preeclampsia complicating 3-5% of all pregnancies in the world and can have a
significant impact on health for both mother and fetus. Risk factors including socio
demographical factors, (extremes of reproductive age, socioeconomic status, ethnic group)
genetic factors, pregnancy factors (multiple pregnancies, primigravidae, previous
preeclampsia) or personal medical history (obesity, chronic renal disease, chronic
hypertension, diabetes mellitus, thrombophilia). Treatment is still prenatal care, timely
diagnosis, proper management and timely delivery. 4

Pregnancy induced hypertension is variable and can change quickly. We need to be

aware of symptoms changing from mild to worse. The exact cause is unknown. Severe
forms of these conditions can play a role in prenatal developmental issues of the fetus or
even death for both the mother and fetus. So nurses currently monitor the condition as an

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outpatient basis by checking in regularly with their patients. The establishment of an
adequate prenatal care is the only effective way to reduce the incidence of preeclampsia
especially in women at high risk pregnancy. The challenge for the maternal nurse is to help
the women with high risk pregnancies maintain a human perspective, while at the same time
comprehending the value of technology innovations that increase options and improve
outcomes. 6

6.2 NEED FOR THE STUDY.

Hypertension induced by pregnancy is one of the most common complications of

pregnancy, occurring in about 10% of all pregnancies. Pregnancy induced hypertension;
preeclampsia and eclampsia are parts of hypertensive syndrome which is a life threatening
condition both for mother and fetus. It remains a leading causes of maternal and fetal
morbidity and mortality worldwide. Maternal mortality due to pregnancy induced
hypertension is 15-33% out of the total number of maternal deaths. 2

Pregnancy induced hypertension syndrome can cause placental abruption,

intracranial hemorrhage, liver lesions, acute renal disorders, preterm labour and
disseminated intravascular coagulation. Maternal hypertension is also associated with
reduced blood flow to the fetus resulting in intrauterine growth retardation (IUGR),
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premature birth and dysmaturity. Delivery of proper health care system and emergency
obstetrical care facilities are vital for prevention, early detection, proper management and
hence to save the mothers and their babies from a such dreadful disease. 7

Developing countries have had persistently higher rates of maternal and child
mortality due to preeclampsia in comparison with developed countries. In Europe and other
developed countries eclampsia complicates approximately 1 in 2000 deliveries, while in
developing countries estimates vary between 1 in 100 to 1 in 1700. Eclampsia probably
accounts for 50,000 maternal deaths a year world wide. 8

A retrospective study of 27 prenatal deaths associated with 61 cases of eclampsia to

determine prenatal mortality rate associated with eclampsia was conducted in Nigeria. The
results shows that prenatal mortality rate associated with eclampsia was 409/1000 births. It
was highest among women in the age group of 35 years and above. The study suggested that
prenatal mortality rate associated with eclampsia is very high 9

A 5 years retrospective descriptive study was conducted in Ethiopia to measure the

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magnitude of eclampsia and its maternal and prenatal outcome. The result shows that 35741
deliveries making the incidence of eclampsia 7.1/1000 deliveries. Convulsions occurred
antepartum in 133 (61.6%) intrapartum in 49 (22.7%) and post partum in 34 (15.7%)
mothers. The study concluded that eclampsia is a common complication still associated with
high level of maternal and prenatal mortality as well as morbidity. ANC coverage should be
strengthened to detect preeclampsia and prevent eclampsia. 10

Key principles underpin the good midwifery care of every pregnant women
including a sound knowledge base, meeting the women’s needs and enhancing care. Normal
antenatal care with regular measurement of blood pressure remains the mainstay of
screening for hypertension in pregnancy. The midwife’s role is that of accurate assessment
and communication when detecting the first sign of hypertension. The midwife will play a
major role in the ongoing monitoring of the condition, liaison with the medical team and
education of the woman and her family. 11

In the present settings as the student investigator posted in maternity wards, the
student investigator felt that staff nurses need to be provided with additional knowledge
regarding management of pregnancy induced hypertension. So the student investigator felt
that there is a need for the development of an information booklet regarding management
pregnancy induced hypertension and to test its effectiveness on the staff nurses knowledge
about management of pregnancy induced hypertension.

6.3 STATEMENT OF THE PROBLEM

“A study to evaluate the effectiveness of self instructional module regarding
management of pregnancy induced hypertension on knowledge of staff nurses
in selected hospitals at Hassan, Karnataka.”

6.4 OBJECTIVES OF THE STUDY

1. To assess the pretest and post test knowledge regarding management of pregnancy
induced hypertension among staff nurses in experimental and control group.
2. To assess the post test knowledge regarding management of pregnancy induced
hypertension among staff nurses after administration of self instructional module in
experimental group.
3. To identify the effectiveness of self instructional module regarding management of
pregnancy induced hypertension among staff nurses.

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4. To find out the association between the post test knowledge scores with demographic
variables of staff nurses.
6.5 HYPOTHESES

1. There will be a significant difference between pretest knowledge score and post test
knowledge score regarding management of pregnancy induced hypertension.

6.6 ASSUMPTIONS

1. The staff nurses are willing to participate in the study to enhance their knowledge
regarding management of pregnancy induced hypertension.

6.7 OPERATIONAL DEFINITIONS

1. Evaluate: - Refers to a process of valuing the effectiveness of self instructional module

regarding management of pregnancy induced hypertension.
2. Effectiveness: - Refers to gain in knowledge scores regarding management of pregnancy
induced hypertension.
3 Self Instructional module: - Refers to information booklet involving information about
risk factors, complication, identification and management of pregnancy induced
hypertension.
4. Pregnancy induced hypertension: - It is the hypertension that develops as a direct result
of the gravid state.
5. Knowledge: - Refers to number of correct responses from staff nurses to the knowledge
items in the closed ended questionnaire regarding management of pregnancy induced
hypertension.
6. Staff nurses :- Refers to a registered nurse who has completed the basic education in
nursing and working in selected hospitals, Hassan

6.8 INCLUSION AND EXCLUSION CRITERIA

INCLUSION CRITERIA
This study will include staff nurses, who are :-
1. working in selected hospitals, Hassan .
2. willing to participate in the study.
3. present during the period of data collection.
4. having minimum one year of experience.
EXCLUSION CRITERIA

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 The study will not include staff nurses, who are not :-
1. willing to participate in the study.
2. present at the period of data collection.
3. having minimum one year of experience.

6.9 DELIMITATIONS OF THE STUDY

1. The study is limited to selected hospitals of Hassan.
2. Sample size is limited to 60 staff nurses .
3. Prescribed data collection period is only 4 to 6 weeks .

6.10 SINGNIFICANCE OF THE STUDY

The study signifies the importance of self instructional module in increasing
knowledge of staff nurses regarding management of pregnancy induced hypertension and
this helps in the prevention of further complications.

6.11 CONCEPTUAL FRAMEWORK :-

Hall's Core, Care And Cure Model
6.12 REVIEW OF LITERATURE
Review of literature is a standard requisition to scientific research. It means reading
and writing the pertinent information of the attempt in research topic to understand better
about the proposed topic. It is essential for researcher to analyze the existing knowledge
before going into a new area of study.

A study conducted in Iran determined the prevalence of hypertension disorders of

pregnancy (HDP) and evaluate their effects on the mothers and fetuses on 2300 pregnant
women. The result shows that 3.3% having HDP and the maternal mortality rate was 1.3 per
10,000 and prenatal mortality rate was 53 per 1000 births. Low birth weight neonates were
observed 20% of cases. Thus study concluded that HDP commonly complicates pregnancy
and have great influence on maternal and neonatal morbidity at mortality rates and more
attention and precision is needed to evaluate the pregnant women for detecting and
preventing the complications . 12

A study was conducted in Peshawar to observe pregnancy outcome in a eclamptics

and to explore the avoidable factors contributing to the adverse outcome. The results shows

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that 71 patients developed a eclampsia and the prenatal mortality was 41.6% . The study
concluded that to decrease the adverse outcome associated with eclampsia a community
based approach is needed to improve community health education, socioeconomics status
and prenatal care. 7

A study conducted in USA reported the incidence of severe maternal morbidity

associated with hypertensive disorders of pregnancy. The results show that the overall
incidence of HDP was 5.9%. Eclampsia was reported at 1 per 1000 deliveries. Women with
preeclampsia and eclampsia had a 3to 25 fold increased risk of severe complications.
Preeclampsia and eclampsia carry a high risk for severe maternal morbidity. 13

A study was conducted on 64 multiparous women in Turkey to evaluate the impact

of preeclampsia recurrence on prenatal outcome. The result shows that fatal loss was higher
in women with recurrent eclampsia (19.0%) than in women with preeclampsia who had a
normotensive pregnancy history (4.71). Study concluded that women with recurrent
preeclampsia had a higher rate of prenatal loss compared to women with preeclampsia who
were normotensive in their prior pregnancies. 14

A study conducted in China determined the influence of pre pregnant body mass
index (BMI) and weight gain during pregnancy on the occurrence of pregnancy induced
hypertension ( PIH) and birth weight on 769 primi mothers giving full term birth to a single
baby. The result shows that the incidence of PIH and fetal macrosomia was significantly
higher the overweight group. The study concluded that pre pregnant BMI and weight gain
during pregnancy can be important factors influencing the occurrence of PIH and the
neonates birth weight. 15

A study was conducted in Pittsburgh to estimate the population attributable

fractions of severe or early preeclampsia associated with pre-existing conditions among
70924 nulliparous and multiparous women. The result shows that pre-existing hypertension,
diabeted obesity or multiple gestations were associated with 22.3% of all preeclampsia cases
among nulliparous women. Prior preelamptic pregnancy was associated with 52.2% of
preelampsia among multiparous women. The study concluded that pre-existing maternal
& obstetric condition are associated with a high proportion of severe or early cases of
preeclampsia. 16

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 A study conducted in U.S.A estimated the incidence and effect of pregnancy related
conditions on multiple gestations on 34374 singleton, twin, triplet and quadruplet gestations.
The result shows that the incidence of severe – pregnancy related hypertensive conditions
was significantly increase in twin(1.6%) and triplet (3.1%) gestations as compared with
singletons. Thus study concluded that mild & severe pregnancy related hypertensive disease
increase progressively with advancing fetal number from singleton to triplet but is not
further increased in quadruplet pregnancies. 17

A study was conducted in Sweden to determine whether pregnant women with

chronic hypertensive disease have an independent risk for preeclampsia on 68151 primi
mothers among these 3374 women are diagnosed with chronic hypertensive disease. The
result shows that chronic hypertensive disease is an independent risk factor for
preeclampsia. The study concluded that chronic hypertensive disease is independently
associated with an increased incidence of preeclampsia18
A study was conducted in Varanasi between July 2000 to June 2000 to assess the
hypertension in pregnancy. In this study preeclampsia was seen in 44.44% eclampsia in
40.28% HELLP syndrome in 6.94% Maternal mortality was 5.55% and prenatal death
occurred in 37.5% of deliveries. Low birth weight was seen in 66.66% of births.
Hypertension complicated 5.38% of all pregnancies in this study. The study concluded that
hypertension in pregnancy is responsible for high fetal mortality and low birth weight. 19

A study was conducted in U.K to estimate the national incidence of eclampsia and to
describe the management and associated outcomes since the introduction of magnesium
sulphate. The results shows that the incidence of eclampsia. was 2.7 cases per 10,000 births.
The study concluded that the incidence of eclampsia and its complications have decreased
significantly in the U.K following the introduction of management guidelines for eclampsia
and preeclampsia. 20

07. MATERIALS AND METHODS OF STUDY.

7.1 STUDY DESIGN:-

A Quasi Experimental Research Deign

Group Pretest Treatment Post test

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 Staff nurses Experimental
working in group O1 X O2
selected
hospitals,
Hassan Control group O1 -- O2

Key:-
O1 = Pretest to assess knowledge of staff nurses regarding management of pregnancy
induced hypertension.
X= Administration of SIM regarding management of pregnancy induced hypertension..
O2 = Post test to assess knowledge of staff nurses regarding management of pregnancy
induced hypertension.

7.2 SOURCES OF DATA

The data will be collected from the staff nurses who are working in selected
hospitals, Hassan.

7.3 METHOD OF COLLECTION OF DATA :

Data collection will be done through a closed ended questionnaire regarding
management of pregnancy induced hypertension.

POPULATION
The population selected for the study includes the staff nurses working in selected
hospitals of Hassan.
SAMPLE
Staff nurses who fulfills the inclusion and exclusion criteria formulate the sample of
this study.

SAMPLE SIZE
Sample comprises of 60 staff nurses, who are working in selected hospitals of
Hassan.

SAMPLE TECHNIQUE
Non – probability convenient sampling

SETTING
The study will be conducted in Govt hospital and selected private hospitals of
Hassan. (Bhrathi Nursing Home and Jayashree Nursing Home.)
PILOT STUDY
Pilot study will be planned with 10% of the sample size

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8. VARIABLES

8.1 INDEPENDENT VARIABLE: Self instructional module regarding management of

pregnancy induced hypertension.
8.2 DEPENDENT VARIABLE – Knowledge of staff nurses.
9. PLAN FOR DATA ANALYSIS
It includes descriptive and inferential statistics
Descriptive statistics :
Describe the demographic variables and level of knowledge by number (n),
frequency (f), percentage (%) mean (x) and standard deviation (SD) are planned.
Inferential statistics
1. The paired ‘ t ‘ test will be used to find out the significant difference of both pretest and
post test knowledge score.
2. The chi-square test will be used to find out the association between the demographic
variable and post test knowledge scores.
10. ETHICAL CONSIDERATIONS

10.1 Has ethical clearance being obtained from institution?

Yes

10.2 Has the consent taken from the hospital authorities

Yes.

11. LIST OF REFERENCES:

1. Franune H Nichols, Elaine Zwelling: “ Maternal and newborn nursing” Page No. XI
643 -4
2. Grujic I, Milasinovic.L. “ Hypertension, pre-eclampsia and eclampsia monitoring
and outcome of pregnancy, Med Preg 1. 2006 Nov – Dec; 59 (11-12) : 556-9
3. Lt col Elizabeth J Bridges, Cap shannon wamble Ca.. Marline Wallace, Cap. Terry
Mc. Cartney “ Hemodynamic Alterations Associated with Pregnancy – Induced
Hypertension, Preeclampsia and Eclampsia. Crit-care nurse 2003 oct ; 23(5) : 52-57
4. Smith RA, Baker P N Risk factors, prevention and treatment of hypertension in
pregnancy. Minerva Ginecol. 2005 Aug ; 57(4) : 379 -88
5. Kathleen Black. Pregnancy induced hypertension Journal of obstetric, Gynecologic
and Neonatal nursing. Vol 36 Issues 5 page 419 -429, Sep/ Oct 2007

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6. Lopez – Jaramillo, Patricio a, Garcia, Ronald G et. al preventing pregnancy induced
hypertension : are there regional difference for this global problem ? Journal of
hyper tension 23(6): 1121 -1129, June 2005.
7. Shabeen B, Hassan L, Obaid M. Eclampsia, a major cause of maternal and perinatal
mortality. J Pak Med Assoc. 2003 Aug; 53(8) : 346 – 50
8. Reingardience D. Preeclampsia and Eclampsia Article in Lithuanian. Medicina
( Kaunas) 2003;39(12) 1244-52
9. Onwuhafua PI, Oguntaya A. Perinatal Mortality associated with eclampsia in
Kaduna, Nothem Nigena Niger J Med 2006 Oct – Dec; 15(4) : 397 – 400.
10. Abate M. Lakew Z Eclampsia a 5 year retrospective view of cases manged in two
teaching hospitals. Ethiop Med J. 2006 Jan ; 44 (1) : 27-31
11. Cheyne H. Mc. Queen J. Care of the women with hypertension in pregnancy: the
viewpoint of the midwife. Baillieres Best pract Res clin obstet Gynaecol. 1999 Mar;
13(1) : 107-13
12. Zareian Z. Hypertensive disorders of pregnancy. Int. J. Gynaecol obstet. 2004 No;
87(2) 194-8
13. Z hang J, Meikles Trumble A “Severe maternal morbidity associated with
hypertensive disorders in pregnancy in the united states. Hyper tens prengnancy.
2003;22(2) : 203-12
14. Mendikoioglu I, Trak B, Uner M, Umit . S etal recurrent preeclampsia and perinatal
outcome Acta obstet Gynecol scand 2004 Nov; 83(II) 1044-8
15. Yin Yz, Cherxw, Lixm, Hou, Hy etal Relations of pre-pregnant weight and weight
gain during pregnancy with pregnancy induced hypertension and birth weight Di Yi
Jun Yi Da Xue Xue Bao 2005 Feb; 25(2); 226-8
16. Catov JM, Ness RB, Kip KE, Olsen J. Risk of early or severe preeclampsia related to
pre – existing conditions int. J Epidemiol 2007 Apr; 36(2): 420-1
17. Day Mc, Barton JR, O’ Brien Jm, Istwan NB et-al The effect of fetal number on the
development of hypertensive conditions of pregnancy. Obstet Gynecol. 2005 Nov;
106( 5 pt 1) : 927-31
18. Zetterstiam K, Lindeberg SN Haglund B , Hassan U Maternal complications in
women with chronic hypertension. Acta obstet Gynecol scand 2005 May 84(5) :
419-24
19. Praksh J. Pandey LK, Singh AK , Kar B Hypertension in pregnancy J. Assoc
Physians India 2006 Apr; 54 : 269-70

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 20. Knight M; UKOSS. “ Eclampsia in the United Kingdom 2005” BJOG. 2007 Sep;
114(9) : 1072-8 Epuh 2007 Jul

Ms REENA P JOHN
12 SIGNATURE OF THE CANDIDATE

13 REMARKS OF THE GUIDE FEASIBLE TO CARRY OUT

THE STUDY

14 NAME AND DESIGNATION OF

Prof. JASMINE KARTHIK
HOD OBG DEPARTMENT
14.1 GUIDE

14.2 SIGNATURE

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 14.3 HEAD OF THE DEPT Prof. JASMINE KARTHIK

14.4 SIGNATURE

15 REMARKS OF THE CHAIRMAN & PRINCIPAL FORWADED FOR APPROVAL

15.1 SIGNATURE

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