Pasien Ny

Beni-Suef University Journal of Basic and Applied Sciences 7 (2018) 198–203

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Effect of health teaching on post partum minor discomfort Heba Talla El Ashmawy Shabaan ⇑, Yousria Ahmed El Sayed, Gehan Ghonemy Nursing Obstetric Department, Faculty of Nursing, Cairo University, Egypt

a r t i c l e

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Article history: Received 23 July 2017 Received in revised form 17 October 2017 Accepted 18 October 2017 Available online 10 January 2018 Keywords: Postpartum Minor discomfort Health teaching

a b s t r a c t Background: Postpartum period is a time of vast change for women both physically and psychologically. During this period, women needed to information regarding minor discomforts and how to deal with them. Aim: Evaluate the effect of health teaching on women experience of minor discomfort during postpartum period. Design: Quesi experimental (pre and posttest one group) design was selected for this study. Sample: A convenience sample of 150 subjects was selected according to certain criteria. Setting: Postpartum unit at Maternity University Hospital, Cairo Governorate. Tool: Semi-structured Interviewing sheet, maternal knowledge regarding postpartum minor discomforts follow up tool. Results: Subjects age ranged from 20 to 40 years with 44% completed secondary school education, 9.3% reached high level of education, also, the study conveyed a level of improvement regarding breast engorgement, after pain, urinary retention, constipation and episiotomy pain. Sixty-four point seven of subjects mention that they weren’t aware of expected minor discomforts during postpartum period before health teaching was given. After the teaching, only 0.7% of subjects were not aware of postpartum minor discomforts. Conclusion: Teaching helped to improve the women’s knowledge regarding postpartum discomforts. Recommendations: Health educational package on postpartum discomforts should be given on discharge should be written in clear and comprehensive explanation supported by drawing pamphlets especially for illiterate one. Ó 2017 Beni-Suef University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

1. Introduction Postpartum period is the time from the delivery of the placenta through the six weeks after the delivery. Most of the changes of pregnancy, labor, and delivery have resolved and the body has reverted to the non-pregnant state and it is a very special phase in the life of a newly delivered subject and her newborn. It is the most critical, transition and life changing event which filled with strong emotions, physical changes, new and changed relationships, assumptions and adjustments into the mother role (Abd el-Razek, 2013). Maternal and newborn physiological adjustments and important psychosocial and emotional diversifications for all family members. The nurse plays an essential role in promoting and improving post partum outcomes, not only as a health care provider but also as an administrator, manager, educator, researcher

⇑ Corresponding author. E-mail address: [email protected] (Heba Talla El Ashmawy Shabaan).

and counselor. Nurse will need to have the appropriate knowledge and skills to determine when to be proactive with regard to undertaking specific observations where these might be required. Therefore, the nurse must be able to identify signs of morbidity that require further investigations and discuss the future management of these with the women. Nurses will never know the quality of care they offer until if it is being assessed through patient satisfaction. But also for providing vast teaching to women after delivery and before they discharged from the hospital based on bio- psychosocial needs further provide anticipatory assistance and counseling (Abd el-razek, 2013). Postpartum minor discomforts may occur resulting from all systems adaptation. Common postpartum minor discomfort includes after pain, perineal pain, constipation, urinary distention, lactation problems. Immediate and effective care during and after birth for these problems can make the differences in postpartum adaptation. From the research investigator at El Manial University Hospital over the period of two years, there is no one provide health teaching related to minor discomfort which post-partum subject

https://doi.org/10.1016/j.bjbas.2017.10.004 2314-8535/Ó 2017 Beni-Suef University. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Heba Talla El Ashmawy Shabaan et al. / Beni-Suef Univ. J. Basic Appl. Sci. 7 (2018) 198–203

experienced during this period which may affect their health status that interfere in their family relations and dealing with her baby. In Egypt, there are scattered published studies about importance of health teaching about improving of minor discomfort during postpartum period and indirectly improving subject quality of life. Accordingly this proposed study adds to data base knowledge of researches about most common problems which faced subject during this period. Mirzaee et al. (2013) reported in their study that 91.6%, 90.3% and 83.5% of women had at least one problem at one week, six weeks and twelve months following delivery, respectively. Many of these problems could be resolved through education and raising awareness. Another study conducted in health care centers of Iran by Mirzaee et al. (2015) to assess the maternal knowledge on submit postpartum care. They discovered that most of women had slight expertise about four dimensions of health, breastfeeding and nutrition, contraceptive methods, infant care and they reported that inadequate information, low awareness, loss of skilled personnel at healthcare centers, monetary problems, lack of access to healthcare services and low quality of services are among factors stopping women use of postpartum care. Accordingly this study adds to data base knowledge of researches about most common problems which faced subject during this period. Those, The Egyptian Demographic and Health Survey (2014) reported that Subject spend a little time in health facilities following births. One-third of subjects are in the health facility for less than five hours after birth. Overall, 57% of subjects spend less than a day in the health facility after the birth 2. Aim of the research The aim of this research was to evaluate the effect of health teaching on subject’s knowledge regarding postpartum period minor discomfort.

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4.3. Setting The study was conducted at the postpartum unit at Maternity university hospital, Giza Governorate affiliated hospital providing free health care for the mothers during antenatal, natal and postnatal period as well as gynecological patients. 4.4. Tools for data collection 1- Personal background Semi-structured Interviewing sheet. This tool was designed by the researcher & it was included data about a) Demographic data such as age, place of residence, income, educational level, occupation, b) Obstetric profile such as number of gravida and abortion. 2- Maternal knowledge regarding minor discomfort tool (pre and posttest): to determine level of subjects’ knowledge regarding minor discomfort during early partum period. It included questions about minor discomfort during postpartum period. Tool was include three scores, score three means correct answer, score two for false result and score one for unknown. The results of that responses were statistically analyzed. 3- Postpartum minor discomfort follow up tool (Fahmy, 2004): This tool was designed by the researcher through an extensive review of recent literatures. This tool included only (5) items from minor discomfort during postpartum period which included in present study as breast engorgement, perineal discomfort, urinary retention, constipation and after pain. The scoring system as form of Likert scale for improving symptoms from 3 scale (score 3 means relived discomfort, score 2 means not detected discomfort and score one means become worth). The researcher was followed up each subject every week through period of 3 weeks postpartum through phone calls.

3. Research hypothesis

5. Ethical consideration

Subject who will receive health teaching will reported a decrease of postpartum minor discomfort.

A primary approval was granted from the Ethical Research Committee at faculty of nursing Cairo University to undergo the current research on June 2015. Informed written consent was taken from each postpartum subject who was willing to participate in the research and the researcher emphasized that, their participation in the research is entirely voluntary, and that she has the right to withdraw at any time without giving any reason and without affecting her care. At the same time, pregnant subject were informed that, the research posed no risks or hazards on their health. Measures were taken to assure confidentiality as coding of data and participants were ensured that the collected data will be used only for the purpose of the research.

4. Material and computation 4.1. Design Quesi experimental (pre and posttest one group) design was adopted in this study to achieve the stated aim. This is one type of experimental design, often described as non randomized, prepost intervention studies which used to evaluate the benefits of specific interventions. 4.2. Sample

6. Procedures A convenient sample of 150 postpartum subjects was recruited for the study based on hospital statistics (2015) which revealed that the hospital received approximately 8500 VD postpartum subjects per year; so the sample size was calculated by the following formula:

Yamanes formula :
n ¼ N=1 þ NðeÞ2 n = sample size & N = Population size & e = Margin of errors which is ±5% & Confidence level = 95%. Inclusion criteria: Postpartum primi women, full term pregnancy, vaginal deliveries with or without episiotomy, free from any medical and obstetrics complications and at least can read and write.

The study was conducted through 3 phases: 1- Preparatory Phase: An official permission to conduct the proposed study was obtained from the hospital administrators. As well as, all participants and healthcare providers were informed orally about the purpose, importance and benefits of the study. Additionally, they were aware that the researcher is a master candidate at the Faculty of Nursing; Cairo University. Also, it included review the recent literature to construct and prepare tool for data collection. The researcher met the postpartum subjects at postpartum unit and obtained their acceptance to be recruited in the study,

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Heba Talla El Ashmawy Shabaan et al. / Beni-Suef Univ. J. Basic Appl. Sci. 7 (2018) 198–203

as well as to gain their cooperation; and the researcher explained the nature and aim of the study, its importance, and its benefits to them. 2- Interviewing phase: It was implemented in 2 steps: A) History taking. B) Knowledge assessment. The researcher was introduce herself to the postpartum subjects and explained the purpose and nature of the study to obtain informed written consent as well as to gain their cooperation A. History taking assessment step: Each postpartum woman was interviewed to collect data related to: - Personal and demographical data such as age, place of residence, educational level, occupation, telephone number (for continues follow up). - Obstetric profile such as number of gravida, abortion. B. Knowledge assessment step: The researcher obtained base line assessment to subject knowledge using maternal knowledge regarding minor discomfort tool (pre and posttest). Pre and posttest for each subject take 10–15 min. 3- Implementation phase: The researcher was provide health teaching regarding minor discomfort, one session which was take 30 min in Arabic language, in a group for all available subjects undergoing the inclusion criteria and accept to participate in the study. 4- Postpartum minor discomfort follow-up: Follow up of the subject every week for three consecutive weeks from discharge using post-partum minor discomfort follow up tool by phone calls. The responses monitoring as following: If symptoms present (yes or no), symptoms relived (yes or no), symptoms detected (yes or no), compliance for given data (yes or no) & reason for incompliance.

7. Statistical analysis Data management was done by coding and entering responses into the statistical package for the social sciences (SPSS), version 21 for analysis. The researcher checked all data to avoid any discrepancies. Data were examined for coding and entering errors. Frequency and percentage were used for numerical data as well as mean & standard deviation for finding the difference between normally distributed numeric data. Wilcoxon test and Friedman test were used. For finding the difference between categorical data non-parametric contingency coefficient test was used. Probability (p-value) less than .05 was considered significant and less than .001 considered as highly significant.

8. Limitation of the study During the field work of the study some obstacles were raised as:

1. Some subjects didn’t answer my phone calls. 2. Some subjects developed risk factors not a minor discomforts as HIN, PPH. 3. Time allowed in the selected area to discuss most of the elements mothers was not enough.

9. Results Demographic characteristics: The study subjects’ age ranged from 20 to 40 years with mean age 25.78 ± 4.233 years. Slightly more than half (52%) of them were in the age group 20–24 years while few (3.3%) of them were in the age group 35–40 years. As regards subjects’ education level, the table reveals that less than half (46.7%) subjects can read and write, while few (9.3%) of them reached to high level of education. Also, less than half (42.7%) of them lived in rural areas. The age at marriage was from 20 to 35 years with mean of 21.16 ± 4.148. In addition, the majority (86%) of subjects were married in the age range of 20 < 25 compared to 13.3% were married in the age range of 30 < 35. The majority of the subjects (98%) were housewives. Most (80%) of the study subjects reported that they hadn’t enough family income. Furthermore, more than half (60%) of them lived in a family house rather than a private one. Only about one-third (30%) of them had health insurance. More than half (64.7%) of the study subjects mentioned that they didn’t aware of expected minor discomfort during postpartum period before health teaching compared to very few (0.7%) of them still didn’t have knowledge after session was given. Level of raising knowledge of postpartum minor discomfort was in the group 20and there was highly a significant correlation between the age group & postpartum minor discomforts (p-value = .009). In relation to subjects’ knowledge; Table 1 revealed that the subjects reported in the pretest that they had colic, fatigue, breast engorgement, hemorrhoid, episiotomy pain, retention of urine, vaginal (71.7%, 18.9%, 15.1%, 13.2%, 9.4%, 9.4%, and 7.5% receptively). After health education session, the table revealed that the subjects had colic, hemorrhoid, retention of urine, breast engorgement, cracked nipple, episiotomy pain (84.9%, 75.7%, 71.4%, 62.3%, 56.6%, 55.3%, 54.7%, 47.2%, and 28.3%, respectively). These results showed a highly significant difference between the pretest & posttest (p = .000). Postpartum Minor discomfort follow up. Table 2 demonstrated that there was a significance improvement of subjects’ knowledge related to breast engorgement after conducting the health teaching session during three consecutive weeks of assessment as reported by 13.1% in the first week, 28.2% in the second week and 74.5% in the third week. Results reported a significant effect of health teaching on subjects’ knowledge regarding breast engorgement given with the progress of time follow up (p = .000).

Table 1 Subjects Knowledge Related To Known Postpartum Minor Discomforts (N = 53). Reported Minor Discomfort

Colic Hemorrhoid pain Episiotomy pain Fatigue Breast engorgement Constipation Retention of urine Vulval discomfort Cracked nipple

Pretest

Posttest

No.

%

No.

%

38 7 5 10 8 0 5 4 0

71.7 13.2 9.4 18.9 15.1 0.0 9.4 7.5 0.0

45 40 30 15 33 29 38 25 83

84.9 75.5 56.6 28.3 62.3 54.7 71.7 47.2 55.3

N.B: The numbers are not mutually exclusive & The test Based on negative ranks.

Wilcoxon Test

P value

10.539

.000

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Table 3 disclosed that there was a significance improvement of subjects’ knowledge related to after pain; after conducting the health teaching session during three consecutive weeks of assessment as reported by 25.5% in the first week, 54.5% in the second week and 77.9% in the third week. Results reported a significant effect of health teaching on subjects’ knowledge regarding after pain given with the progress of time follow up (p = .000). Table 4 revealed that there was a significance improvement of subjects’ knowledge related to urinary retention; after conducting health teaching session over three consecutive weeks of assessment as reported by 37.2% in the first week, 58.6% in the second week and 75.9% in the third week. Results reported a significant effect of health teaching on subjects’ knowledge regarding urinary retention given with the progress of time follow up (p = .000). Table 5 shown that there was a significance improvement of subjects’ knowledge related to constipation; after conducting the health teaching session over three consecutive weeks of assessment as reported by 49.7% in the first week, 64.8% in the second week and 74.5% in the third week. Results reported a significant effect of health teaching on subjects knowledge regarding constipation given with the progress of time follow up (p = .000).

Table 6 revealed that there was a significance improvement of subjects’ knowledge related to episiotomy pain; after conducting the health teaching session over three consecutive weeks of assessment as reported by 51.7% in the first week, 59.3% in the second week and 75.9% in the third week. Results reported a significant effect of the health teaching on subjects knowledge regarding episiotomy pain given with the progress of time follow up (p = .000). 10. Discussion The following discussion will focus on the findings related to previously suggested hypothesis: ‘‘Women who will receive health teaching will report a decrease of postpartum minor discomfort”. The current study revealed that fifty-two percent of the study subjects were in the age group (20-) for this reason their knowledge was markedly changed regarding the minor discomfort during postpartum from pretest to the posttest & this change showed a statistically significant difference (p-value = .008). Moreover, Timilsina and Dhakal, (2015) reported in their study ‘‘which conducted in Emirates” that there was a significant association between level of knowledge regarding postpartum minor discom-

Table 2 Health teaching effects on subjects’ knowledge regarding breast engorgement (n = 145*). Responses

Improve Cant not decide Get worse Total *

1st week

2nd week

3rd week

No.

%

No.

%

No.

%

19 96 30 145

13.1 66.2 20.7 100.0

41 91 13 145

28.2 62.8 9.0 100.0

108 35 2 145

74.5 24.1 1.4 100.0

Friedman test

P value

139.9

.000

Friedman test

P value

111.047

.000

Friedman test

P value

70.955

.000

Friedman Test

P value

31.43

.000

Five missed cases in the first, second and third weeks.

Table 3 Health teaching effects on subjects knowledge regarding after pain (n = 145*). Knowledge

Improve Cant not decide Get worse Total *

1st week

2nd week

3rd week

No.

%

No.

%

No.

%

37 89 19 145

25.5 61.4 13.1 100.0

79 59 7 145

54.5 40.7 4.8 100.0

113 25 7 145

77.9 17.3 4.8 100.0

Five missed cases in the first, second and third weeks.

Table 4 Health teaching effects on subjects’ knowledge regarding urinary retention (n = 145*). Responses

Improve Cant not decide Get worse Total *

1st week

2nd week

3rd week

No.

%

No.

%

No.

%

54 60 31 145

37.2 41.4 21.4 100.0

84 36 24 145

58.6 24.8 16.6 100.0

110 15 20 145

75.9 10.3 13.8 100.0

Five missed cases in the first, second and third weeks.

Table 5 Health teaching effects on subjects’ knowledge regarding constipation (n = 145*). Responses

Improve Cant not decide Get worse Total *

1st week

2nd week

3rd week

No.

%

No.

%

No.

%

72 41 32 145

49.7 28.3 22.0 100.0

94 23 28 145

64.8 15.9 19.3 100.0

108 11 26 145

74.5 7.6 17.9 100.0

Five missed cases in the first, second and third weeks.

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Table 6 Health teaching effects on subjects’ knowledge regarding episiotomy pain (n = 145*). Responses

Improve Cant not decide Get worse Total *

1st week

2nd week

3rd week

No.

%

No.

%

No.

%

75 37 33 145

51.7 25.5 22.8 100.0

86 31 28 145

59.3 21.4 19.3 100.0

110 10 25 145

75.9 6.9 17.2 100.0

Friedman Test

P value

30.896

.000

Five missed cases in the first, second and third weeks.

forts and selected demographic variables as educational level (v2 = 48.75 & p-value = .00) and occupation (v2 = 5.008 & p-value = .024). Moreover, Namutebi (2013) reported that increased maternal age and having secondary school education were found to be positively associated with knowledge of at least one maternal minor postpartum problem. On the contrary, the study conducted by Tiwari and his colleagues on postnatal mothers in India showed that there was no significant relationship between age in years and knowledge scores of postnatal mother. Besides Mirzaee and his colleagues (2013) showed no significant relationship between age and postnatal mother knowledge (P > .05. Finally Timilsina and Dhakal (2015) reported that there was no association between postnatal mother knowledge and other demographic variables. The present study findings revealed that less than two thirds of studied postpartum women didn’t have any knowledge regarding postpartum minor discomfort .This finding was in agreement with Kumbani and Mclnerney, (2010) who found that the majority of the participants (73%) didn’t know any problems that could occur during and after the birth in Malawi. Also, Missiriya (2016)who conducted study on postnatal Mothers’ reported that 70% of postnatal mothers had inadequate knowledge and 30% had moderately adequate knowledge and no one had adequate knowledge. In addition to a study conducted by Adam (2015) on ‘‘Assessment of Mother’s Knowledge Regarding Postpartum Self-Care in National Ribat University Hospital” reported that the majority of the participants responded with inadequate knowledge regarding perineal care, breastfeeding, awareness of minor, discomfort danger signs, rest and exercise. But they had good knowledge about suitable diet during puerperium. In relation to episiotomy pain; The present study findings revealed that after conducting health teaching session among three consecutive weeks of assessment, more than three quarters of the subjects reported about improvement in their episiotomy pain. While only, 17.2% of the subjects informed about getting worse. This finding congruent with study findings of Gadiya et al. (2014) who conducted a study about ‘‘Effectiveness of Planed Teaching Program on Episiotomy care” on 60 primipara women; the result of the study indicated that there was a highly significant difference between the pre-test and post-test scores (p-value = .000), this showed that the planned teaching program on episiotomy care was effective. In addition to the present study was in agreement with Mohamed and El-Nagger (2012) who studied effect of self perineal care instructions on episiotomy pain and wound healing of postpartum women conducted on 80 postpartum at El-Minia General Hospital. The results revealed that the instructional guideline had a significant effect on studied mothers by decreasing in the level of perineal pain at 4, 24, & 48 h and seven days postpartum between the two groups. There was a significant differentiation between sample in relation effect of pain with walking, sitting, and urination at 24 & 48 h, and at seven days postpartum. Breast engorgement: The present study findings revealed that after conducting health teaching session, three quarters of the subjects informed about improvement in the breast engorgement. On the other side, 1.4% of the subjects informed about getting worse.

This result in congruence with Eapen, Sara Fernandes and Philomena (2013) who reported that information booklet was highly effective in improving knowledge of the postnatal mothers by providing an information booklet on home remedial measures for breast engorgement and there was a significant difference between pretest and posttest knowledge (p < .05). Similarly, Pavithra et al., (2015)reported that the structured teaching was effective in improving the level of knowledge on the prevention and management of breast engorgement among the postnatal mothers and the difference between the pre and post test scores was highly significant at p-value < .05 level. In relation to urinary retention, the present study findings revealed that after conducting health teaching session, more than three quarters of the subjects reported an improvement in the urinary retention; while, 13.8% of the subjects informed getting worse. This result in congruence with Anger and Mehta (2012) who conducted a study about ‘‘Evaluation and Management of Postpartum Urinary Retention” and reported that practice measures consist of oral analgesia, namely NSAIDS aimed at reducing perineal and periurethral edema, early ambulation, providing the mother with privacy, warm baths. These measures alone have been shown to resolve temporary urinary retention in 60% of postpartum post-operative women. Similarly, Wan and his colleagues (2016) reported that continuous primary nursing care increased satisfaction with nursing care and reduced postpartum problems for hospitalized women and showed a significantly lower occurrence of postpartum urinary retention. In relation to after pain .The present study findings revealed that after conducting health teaching session, more than three quarters of the subjects informed about improvement in the after pain; while, 4.8% of the subjects informed about getting worse. Danasu and Praimathi (2016) who conducted a study about ‘‘Assessment the effectiveness of nursing care on reduction of after pains among postnatal mothers in Iran”; the results revealed that nursing care like fundal massage, and alternative leg raising exercise was an effective intervention to reduce the after pains among post natal mothers. Bouhours et al. (2011) reported in their study about ‘‘Effect of Postnatal Home Visits on Maternal/Infant Outcomes in Syria” that the intervention consisting of home visits aimed to educate, support, and counsel women who had recently given birth has effective effects to manage postpartum minor discomfort especially after pain and constipation. The present study findings revealed that three quarters of the subjects informed about improvement in the constipation; while on the other side there was 17.9% of the subjects informed about getting worse. This result in congruence with Dukas et al. (2013) who conducted study about ‘‘Association between Physical Activity, Fiber Intake and other Lifestyle variables and constipation in a study of women‘‘ and reported that moderate physical activity and increasing fiber intake were associated with substantial reduction in the prevalence of constipation in women. Finally, the results of the current study reported that the health teaching which aiming to educate, support, and counsel women

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who had recently given birth had effective effects to manage postpartum minor discomfort as after pain, constipation, urinary retention, breast engorgement and episiotomy pain.

3. Policy makers must enrolled health teaching about postpartum minor discomforts into their system of care.

11. Conclusion

References

The results of the current study revealed that 64.7% of the postnatal subjects had inadequate knowledge regarding postpartum minor discomfort and their management; however one time teaching helped to improve their knowledge by different levels. The knowledge gained was supported the postnatal subjects for early identification of discomforts and preventing further complications. Health teaching aimed to educate, support, and counsel subjects who had recently given birth had effective effects to manage postpartum minor discomforts as after pain, constipation, urinary retention, breast engorgement and episiotomy pain. 12. Recommendations 1. Increasing maternal knowledge awareness related to physiological changes and minor discomforts during natal, antenatal and postnatal to control this discomfort is recommended. 2. Health educational package on postpartum discomforts should be given on discharge and should written in clear, simplified and comprehensive explanation about methods of reducing minor discomforts supported by drawing pamphlets especially for illiterate one.

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