RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA

PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1 NAME OF THE CANDIDATE AND ADDRESS

Ms.YASHASWINI,1ST YEAR M.Sc. NURSING STUDENTNISARGA COLLEGE OF NURSING18#, KIADB, INDUSTRIAL AREA,B.KATIHALLI,HASSAN,KARNATAKA.

2 NAME OF THE INSTITUTION

NISARGA COLLEGE OF NURSING,HASSAN,KARNATAKA.

3 COURSE OF THE STUDY AND SUBJECT

MASTER OF SCIENCE IN NURSING,OBSTETRIC AND GYNAECOLOGY NURSING.

4 DATE OF ADMISSION TO COURSE

15/06 /2012

5 TITLE OF THE STUDY

KNOWLEDGE REGARDING CARE OF MOTHERS WITH SELECTED HIGH RISK PREGNANCIES.

5.1 STATEMENT OF THE PROBLEM

"A STUDY TO EVALUATE THE EFFECTIVENESS OF PLANNED TEACHING PROGRAMME(PTP) ON KNOWLEDGE REGARDING CARE OF MOTHERS WITH SELECTED HIGH RISK PREGNANCIES AMONG IV YEAR B.Sc NURSING STUDENTS OF SELECTED NURSING COLLEGES AT HASSAN."

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6 BRIEF RESUME OF THE INTENDED WORK:

6.0 INTRODUCTION:

“There is such special sweetness is being able to participate in creation.”

- -Pamela s. Nadav

Woman; The word women is a polite term for a lady, specifically the female

equivalent to, or spouse of, a lord or gentleman, and in many contexts a term for any

adult woman.1

Pregnancy is the period from conception to birth. After the egg is fertilized by

a sperm and then implanted in the lining of the uterus, it develops into the placenta

and embryo, and later into a fetus. Pregnancy usually lasts 40 weeks, beginning from

the first day of the woman's last menstrual period, and is divided into three trimesters,

each lasting three months.2

Childbirth is the culmination of a human pregnancy or gestation period with

the expulsion of one or more newborn infants from a woman's uterus. The process of

normal human childbirth is categorized in three stages of labour: the shortening and

dilation of the cervix, descent and birth of the infant, and birth of the placenta.3

Pregnancy is a time of joy and expectation. But for some, especially those

with chronic medical conditions, Anaemia, pregnancy induced hypertension (PIH),

eclampsia, pre-eclampsia, elderly mother, or who are expecting multiples, ectopic

pregnancy; Gestational diabetes mellitus can also be a time of fear and uncertainty.

With the right specialized care, both mother and child can ensure a more positive,

healthy experience.4

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Anaemia is a condition with Lower than normal number of healthy red blood

cells. Mother with anemia Feel tired or weak, Look pale and Feel faint and will have

Shortness of breath. Treating the underlying cause of the anaemia will help restore the

number of healthy red blood cells. Women with pregnancy related anaemia are helped

by taking iron and folic acid supplements.4

Preeclampsia is a syndrome that includes high blood pressure, urinary protein,

and changes in blood levels of liver enzymes during pregnancy. It can affect the

mother’s kidneys, liver, and brain. High blood pressure (pregnancy related) that starts

after 20 weeks of pregnancy and disappears after birth. The health of the mother and

baby are closely monitored with high blood pressure and under the treatment, many

women will have healthy babies. If left untreated, the condition can be fatal for the

mother and/or the baby and can lead to long-term health problems. Eclampsia is a

more severe form of preeclampsia that can cause seizures and coma in the mother.4

Placenta praevia were placenta covers part or entire opening of cervix inside

of the uterus. If diagnosed after the 20th week of pregnancy, but with no bleeding, a

woman will need to cut back on her activity level and increase bed rest. If bleeding is

heavy, hospitalization may be needed until mother and baby are stable. If the bleeding

stops or is light, continued bed rest is resumed until baby is ready for delivery. If

bleeding doesn't stop or if preterm labour starts, baby will be delivered by cesarean

section.4

Placental abruption is a condition in which placenta separates from uterine

wall before labour begins, which can mean the fetus doesn't get enough oxygen.

When the separation is minor, bed rest for a few days usually stops the bleeding.

Moderate cases may require complete bed rest. Severe cases (when more than half of

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the placenta separates) can require immediate medical attention and early delivery of

the baby.4

Ectopic pregnancy – When a fertilized egg implants out of the normal site of

the uterus, usually in the fallopian tube. Mother may feel abdominal pain, Shoulder

pain, Vaginal bleeding, Feeling dizzy or faint. Drugs or surgery is used to remove the

ectopic tissue so that the organs are not damaged.4

Certain women are at special risk of developing diabetes during pregnancy

and may be identified when history reveals the diabetes in first degree relatives,

recurrent abortions, unexplained still birth or congenital abnormalities. The

progressive increase in insulin demand during pregnancy can make latent diabetes

appear. This may resolve after the pregnancy. Some women show a slightly impaired

glucose tolerance during pregnancy which returns to normal after delivery.5

At present Five to ten percent of pregnancies are termed as "high risk." A

pregnancy is "high risk" or "complicated" when the life or health of the mother or

baby may be at risk. It is estimated that approximately one out of every four pregnant

women will experience complications, sometimes leading to the birth of a premature

baby. When babies are born preterm, they have a higher risk for serious health

problems.4

Any mother who has had an unsuccessful outcome to pregnancy, for whatever

reason, is likely to enter subsequent pregnancy with some degree of anxiety. The

midwife must be aware of the mother’s emotional situation when caring for her

during the antepartum period. The midwife must be enough knowledgeable to tackle

with the complications or to identify it in the earliest.5

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6.1 NEED FOR THE STUDY:

“Will power is to the mind like a strong blind man who carries on his shoulders a

lame man who can see.”

Arthur Schopenhauer.

The worldwide maternal mortality ratio reflects a women’s risk of dying each

time she becomes pregnant. The maternal mortality rate (MMR) in India is 405 per

lakh live births in 2007. 6

In Karnataka MMR is 195 per lakh live births in 2007. 7

In Hassan District MMR is 90 per lakh live births in 2007.8

Anemia in pregnancy accounts for one fifth of maternal deaths worldwide and

is a major factor responsible for low birth weight. In India, 16% of maternal deaths

are attributed to anaemia.9 not only in India but also in most of the South East Asian

countries it has effects may have deleterious to mothers and fetuses.10

The population research centres of India showed that the increase in the

prevalence of anaemia among pregnant women was high in Andhra Pradesh (41.8

percent to 58.5 percent) followed by Kerala (19.4 percent to 35.2 percent), Karnataka

(48.2 percent to 62.6 percent) and low in Tamil Nadu 52.9 percent to 57.8 percent).11

California maternal quality care collaborative hospital, department of

perinatology had conducted a seminar on maternal mortality from

preeclampsia/eclampsia in 2012 and identified that Preeclampsia/eclampsia is one of

the 3 leading causes of maternal morbidity and mortality worldwide.12

Pregnancy-related obesity is one common condition that classifies a mother

for a high risk pregnancy. Obesity during pregnancy can cause many complications,

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such as gestational hypertension or diabetes, birth defects, macrosomia and the

necessity of a cesarean section. Studies show that 1 in 5 women in the United States

are obese at the time of pregnancy. Gestational Diabetes Mellitus (GDM) affects 2 to

10% of pregnant mothers in the United States every year.13

Pregnant mothers should be screened for the possibility of GDM during their

prenatal care and should also undergo a postpartum glucose test. Many doctors fail to

administer the postpartum test, which results in many undetected GDM cases. Many

high risk pregnancies result in a premature birth, which often results in low birth

weight. A low birth weight is considered to be less than 5.5 pounds (2500 grams). In

2007, 8.2% of the 4.3 million babies born in the United States weighted less than 5.5

pounds. Underweight infants often suffer from developmental delays, underdeveloped

body systems, brain damage and higher mortality rates. A high risk pregnancy that is

not properly identified and managed can cause serious complications, injury and even

death. Failure to properly attend to a high risk pregnancy is a type of medical

malpractice that can result in the need to file a birth injury or wrongful death claim.13

A study conducted at Iran showed that one out of every 20 pregnant Iranian

women will develop GDM. A study conducted at Kashmir showed that overall

prevalence of GDM among pregnant women was 3.8%. Gestational diabetes mellitus

(GDM) is a common metabolic abnormality which affects 2-5% of the pregnancies

annually in Karnataka.14

A cross sectional survey was conducted among pregnant mothers to assess the

knowledge and attitudes towards the gestational diabetes in Australia (2010). Diabetes

attitude scale was administered to 200 women with gestational diabetes. The result

showed that women may be at risk of poorer self management of gestational diabetes

related to lower education, lower health literacy, and a lower appreciation of

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gestational diabetes as a serious condition. Nurses and midwives provide information

and advice to women with gestational diabetes, Knowledge about factors that impact

on attitude towards gestational diabetes among pregnant mothers is important for

developing educational programmes to address their needs.15

It is estimated that 5,85,000 women die each year because of high risk factors

during pregnancy and child birth; of these 99 percent deaths are in developing

countries (WHO). The high incidence of complications during pregnancy has

increased the prenatal mortality considerably. Literature survey has shown that the

cause for stillbirths and early neonatal deaths are: poor maternal gain, anemia, PIH,

ante partum hemorrhage and lack of knowledge on risk factors during pregnancy.16

The global and national incidences of high risk pregnancies are threatening to

the vulnerable groups of pregnant mothers. Now a days there is a increased number of

mortality and morbidity in pregnancies due to anaemia, pregnancy induced

hypertension, ectopic pregnancy and bleeding in early pregnancy. So by reviewing the

factors on this topic there is a big gap between nursing care and mothers health status.

So the Researcher planned to educate the student nurses in effective management of

such high risk pregnancies resulting in gradual reduction of the sufferings and

bringing happiness in the faces of mothers.

6.2 REVIEW OF LITERATURE:

The review of literature involves “the selection of available documents on the

topic, which contain information, ideas, data and evidence written from a particular

stand point to fulfill certain aims or express certain views on the nature of topic and

how it is to be investigated and the effective evaluation of these documents in relation

to the research being proposed”.17

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Review of literature is divided into as follows:

1. Review of literatures related to care of high risk antenatal mothers in early

pregnancy.

2. Review of literatures related to care of high risk antenatal mothers in late

pregnancy.

3. Review of literatures related to effective management and educational

interventions of antenatal mothers with high risk pregnancies.

I) Review of literatures related to care of high risk antenatal mothers in early

pregnancy.

A clinical presentation on ectopic pregnancy on august 2012 revealed that the

classic clinical triad of ectopic pregnancy is pain, amenorrhea, and vaginal bleeding;

these symptoms overlap with those of spontaneous abortion. Almost 50% of cases of

ectopic pregnancy are not diagnosed at the first prenatal visit. The study concluded

that there should be a high index of suspicion for ectopic pregnancy in any woman

who presents with symptoms and who presents with physical findings of pelvic

tenderness, enlarged uterus, adnexal mass, or tenderness.18

A prospective cohort study was conducted in China to explore the

epidemiology and risk factors of anaemia during pregnancy, using data from a

population-based pregnancy-monitoring system in 13 countries in East China. Women

who delivered singleton infants at 20-44 weeks with at least one haemoglobin

assessment during pregnancy were included. The prevalence of anaemia

(haemoglobin<10g/dl) during pregnancy was estimated. The overall prevalence of

anaemia was 32.6%, with substantial variations across trimesters. peri-conception

folic acid use was associated with a reduced risk for anaemia in the 1 st trimester.

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Initiating prenatal care after the 1st trimester was associated with increased risk of

anaemia in the 2nd and 3rd trimesters. The study found that anaemia during pregnancy

is highly prevalent in the indigenous.19

A study was conducted in India to determine the Predicting Factors in Iron

Supplement Intake among Pregnant Women in Urban Care Setting. The world health

organization estimates that 58% of pregnant women in developing countries are

anemic. In spite of the fact that most ministries of health in developing countries have

policies to provide pregnant women with iron supplementation, prevalence of

maternal anemia has not declined significantly. At last the study concluded that the

compliance was rather high but knowledge of subjects was low. Therefore, increasing

effort is required to mobilize health workers including nurses to distribute information

on anemia prevention and using iron supplements properly.20

A case control study was conducted in Karachi, Pakistan to determine the risk

factors in pregnancies complicated with abruptio placenta. All pregnant women who

were diagnosed with abruptio placenta after 28 weeks of gestation were included in

the study. Vaginal bleeding was the most common clinical finding followed by blood

stained amniotic fluid. Foetal heart sounds were absent on admission in some cases.

There were maternal deaths due to postpartum haemorrhage. The perinatal mortality

rate was 66%. Parity and gestational age were found to be significant risk factors for

abruptio placentae. The study concluded that Abruptio placenta is associated with

poor maternal and foetal outcomes.21

A questionnaire-based study was conducted in Irish to determine individual

management of women with major placenta praevia without antepartum haemorrhage

(APH). Placenta praevia complicates one in 200 pregnancies. It is associated with

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maternal mortality of 0.03%. The maternal, fetal and neonatal morbidity and mortality

are due to the complications of haemorrhage and prematurity. A total of 121

obstetricians replied (63%), to 192 questionnaires sent out. Of these, 48 obstetricians

would admit all women with major placenta praevia without APH, while 69 would

manage them on an outpatient basis. When asked whether or not they agreed with

outpatient management, 21 agreed strongly, 51 tended to agree, 23 tended to disagree

and 13 disagreed strongly. Over half of the obstetricians adopt an outpatient

management approach.22

II) Review of literatures related to care of high risk antenatal mothers in late

pregnancy.

A Study was conducted at Australia to find the experiences of pregnant

women with preeclampsia. Materials and Methods used were Postal survey of the 112

members of the consumer group. Many women had no knowledge of pre-eclampsia

prior to diagnosis (77%) and, once diagnosed, did not appreciate how serious or life

threatening it was (50%). Women wanted access to information about Pre-eclampsia.

Their experience contributed substantial anxiety towards future pregnancies. Study

concluded that the Pre-eclampsia experience had a substantial effect on women, their

confidants, and their babies and affected their approach to future pregnancies. Access

to information about Pre-eclampsia was viewed as very important.23

A study was conducted at Nigeria to reveal the worldwide incidence of

preeclampsia. The incidence of preeclampsia, the precursor to eclampsia varies

greatly worldwide. WHO estimates the incidence of preeclampsia to be seven times

higher in developing countries (2.8% of live births) than the developed countries

(0.4%). The incidence of eclampsia in the developed countries of North America and

Europe is similar and estimated to be about 5-7 cases per 10,000 deliveries. On the

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other hand, incidence of eclampsia in developing nations varies widely, ranging from

1 case per 100 pregnancies to 1 case per 1700 pregnancies. Rates from African

countries such as South Africa, Egypt, Tanzania, and Ethiopia vary from 1.8% to

7.1%. In Nigeria, prevalence ranges between 2% to 16.7 %. So the study revealed that

worldwide incidence of preeclampsia ranges between 2% and 10% of pregnancies.24

A study was conducted on women attending antenatal care in Saudi Arabia on

Maternal risk factors and perinatal outcome in Pre-eclampsia. Data was collected

from 27,787 pregnant women. The findings of the study showed that 685 women that

is 2.47% were diagnosed as having Pre-eclampsia among whom a high proportion

(42%) were nulliparous women. Similarly, Pre-eclampsia was encountered at a high

percentage (40%) in women at the extreme of their reproductive age (< 20 and >40

years), and more women with pre-eclampsia delivered prematurely (30.2%) as

compared to healthy records (13.5%). It was concluded more maternal and neonatal

complications were encountered in antenatal mothers with Pre-eclampsia.25

A study was conducted on Hypertensive disorder of pregnancy occurring 6%

to 8% of all pregnancy are the second leading causes of maternal death and contribute

to significant neonatal morbidity and mortality. Thus nurses working in outpatient,

home care and acute care setting must be vigilant when assessing pregnant women so

that hypertensive problems are identified early and treated promptly.26

A prospective study conducted on occurrence of gestational diabetes, maternal

and fetal outcomes beyond the 28th week of gestation in women at high risk of

gestational diabetes, showed that 72% of the women at risk had developed gestational

diabetes mellitus. Among these 54% had developed early gestational diabetes

mellitus, between 24-28 weeks of gestation and 18% had developed late gestational

diabetes mellitus beyond the 28th weeks of gestation.27

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In Tamilnadu a study was conducted to find out the Women with Gestational

Diabetes Mellitus (GDM) are at increased risk of developing diabetes in future. Total

of 4151, 3960 and 3945 pregnant women were screened in urban, semi urban and

rural areas, respectively. And the result is that the GDM was detected in 739 (17.8%)

women in urban, 548 (13.8%) in semi urban and 392 (9.9%) in rural areas. Out of

1679 GDM women, 1204 (72%) were detected in first visit and the remaining 28% in

subsequent visits. A significant increase in the prevalence of GDM was observed with

family history of diabetes, increased maternal age and BMI.28

III) Review of literatures related to effective management and educational

interventions on antenatal mothers with high risk pregnancies.

A study conducted in India showed that the prevalence of anaemia is high

(88.64%) and severe degree anaemia is also seen in high incidence. The knowledge

about anaemia in pregnant women and complications occurring during pregnancy due

to anaemia, is very poor i.e. 6.48% of cases only have this knowledge & 93.5% are

not having this knowledge.10

A descriptive study was conducted in Belgaum, Karnataka to assess the

knowledge and to evaluate perinatal care among high risk mothers. The sample

comprised of 100 mothers, selected by purposive random sampling from KLE’s

hospital. The investigator adopted non experimental descriptive study. The

instruments used for the study are structured interview schedule and questionnaire.

The results of the study showed that mothers were having inadequate knowledge as

well as mothers had high risks for anemia (90%), PIH (30%), CPD (10%), APH

(90%) and (71%) had received inadequate perinatal care.29

12

A cross-sectional analytical study was conducted at Islamabad, Pakistan,

revealed that ectopic pregnancy is the most important cause of maternal mortality and

morbidity in the first trimester. The purpose of the study was to determine the

frequency of modes of treatment of ectopic pregnancy and their outcome.52 patients

diagnosed to have ectopic pregnancy at MCH centre unit II in the year 2004 and 2005

were included in the study. Four modes of treatment were given according to patient's

condition, ultrasound findings and β hCG levels; these were laparotomy, operative

laparoscopy, Methotrexate injection and conservative management. More than half of

women out of 52 presented with acute abdomen and required emergency laparotomy.

About 40% women could be managed with non-surgical modalities with 80% success

for methotrexate injection and 71%for conservative treatment.30

A study was conducted in Canada among married nonpregnant women to

identify and modify risks related to maternal health and pregnancy outcome. The

main components included maternal risk assessment, maternal education, and

initiation of interventions. Specific maternal populations may benefit from pre

conceptional counselling more than others with regard to optimizing pregnancy

outcome. The study shows the needs for preconception counselling and the evidence

for its effectiveness. In addition, specific topics are reviewed in depth including folic

acid supplementation, obesity, depression, seizure disorders, and drug therapy during

pregnancy.31

STATEMENT OF THE PROBLEM

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“A Study to evaluate the effectiveness of planned teaching programme

(PTP) on knowledge regarding care of mothers with selected high risk

pregnancies among IV year B.Sc nursing students of selected nursing colleges at

Hassan.”

6.3 OBJECTIVES OF THE STUDY

1) To assess the knowledge of IV year B.Sc nursing students regarding the care of

mothers with selected high risk pregnancies before the administration of PTP.

2) To plan and administer PTP on care of mothers with selected high risk pregnancies.

3) To assess the knowledge of IV year B.Sc nursing students regarding the care of

mothers with selected high risk pregnancies after the administration of PTP.

4) To evaluate the effectiveness of PTP by comparing pre and post test knowledge

scores of IV year B.Sc nursing students.

5) To find out the association between the selected socio-demographic variables of IV

year B.Sc Nursing students with their gained knowledge scores.

6.4 HYPOTHESIS

H1: There will be a significant difference between the pre and post-test knowledge

scores of IV year B.Sc nursing students regarding the care of mothers with selected

high risk pregnancies.

H2: There will be a significant association between the selected demographic variables

with the gained knowledge scores.

6.5 ASSUMPTIONS

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1) Nursing students will be having some knowledge regarding the care of the mothers

with selected high risk pregnancies.

2)Administration of PTP on the care of the mothers with selected high risk

pregnancies will help the students to enhance better knowledge and can prevent many

more complications.

6.6 OPERATIONAL DEFINITIONS

Evaluate: It refers to statistical analysis to find the difference between pre and post

test knowledge scores of IV year B.Sc nursing students regarding care of mothers

with selected high risk pregnancies.

Effectiveness: It refers to the extent to which teaching has achieved the desired

effectiveness in terms of gain in knowledge score.

Planned teaching programme (PTP): It refers to well planned teaching design to

provide information to improve knowledge regarding care of mothers with high risk

pregnancies.

Knowledge: It refers to a familiarity with someone or something, which can include

facts, information, description, acquired through experience or education.

Care of mothers: Care of the mother means providing care to the women during

pregnancy to have a good maternal and fetal outcome.

High risk pregnancies: A high-risk pregnancy is one in which some condition puts

the mother or the developing fetus, or both, at an increased risk for complications

during or after pregnancy and birth. These are categorized under following headings:

i) High risk cases in early pregnancy like Anaemia, Ectopic pregnancy, placenta

praevia, abruptio placenta,

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ii) High risk cases in late pregnancy are Gestational Diabetes Mellitus (GDM), PIH,

Pre eclampsia, Eclampsia.

B.Sc nursing students: It refers to the students who are undergoing Bachelor of

nursing programme in selected nursing colleges at Hassan.

6.7 CRITERIA FOR SAMPLE SELECTION

INCLUSION CRITERIA

IV year B.Sc Nursing students who are

Present in the selected nursing colleges at Hassan during the time of data

collection.

Willing to participate in the study.

EXCLUSION CRITERIA  

IV year B.Sc Nursing students who are

Not willing to participate in the study.

Not present at the time of data collection.

6.8 LIMITATIONS OF THE STUDY

The study is limited to:

The IV year B.Sc Nursing students of selected nursing colleges at Hassan.

The period of 4-6 weeks.

The sample size of 60 IV year B.Sc. Nursing students.

Pre-experimental design.

6.9 SIGNIFICANCE OF THE STUDY

This study will

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1. Promote the knowledge of nursing students regarding selected high risk

pregnancies and its care.

2. Help the students to create awareness in the mothers and her surrounding groups

regarding the high risk pregnancies and its care.

3. Help the nursing students to effectively manage the high risk pregnancies in

future.

6.10 CONCEPTUAL FRAMEWORK

This study is based on REVA RUBIN’S: Theory of Maternal role attainment

[Reva Rubin’s Model of attainment of the maternal role.]

7. MATERIAL AND METHODS OF STUDY

7.1 SOURCE OF DATA

Data will be collected from the IV year B.Sc nursing students of selected

nursing colleges at Hassan.

7.2 METHODS OF COLLECTION OF DATA

7.2.1 RESEARCH DESIGN

Pre experimental single group pre test- post test design.

Schematic plan of the study:

GROUP PRE TEST INTERVENTION POST TEST

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E O1 X O2

key words

E- Experimental Group (60 IV year B.Sc nursing students)

01-Pre test observation on knowledge of students regarding care of mothers with

selected high risk pregnancies before the administration of PTP.

X- PTP on care of mothers with selected high risk pregnancies.

02 –Post test observation on knowledge of students regarding care of mothers with

selected high risk pregnancies after the administration of PTP.

7.2.2 RESEARCH SETTING

The study will be conducted in selected B.Sc nursing colleges at Hassan.

7.2.3 POPULATION

Target population: All the IV year B.Sc nursing students of nursing colleges

at Hassan.

Accessible population: IV year B.Sc nursing students of selected nursing

colleges at Hassan.

7.2.4 SAMPLE

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All the IV year B.Sc nursing students of selected nursing colleges who fulfills

the inclusion criteria.

7.2.5 SAMPLE SIZE

Sample comprises of 60 IV year B.Sc nursing students of selected nursing

colleges at Hassan.

7.2.6 SAMPLING TECHNIQUE

     Probability Simple Random sampling technique will be used.

7.2.7 COLLECTIONS OF DATA

Data will be collected from the IV year B.Sc nursing students of selected

nursing colleges at Hassan.

7.2.8 SELECTION OF TOOL

Part A- Socio demographic profile.

Part B- Collection of data is done by structured knowledge questionnaire.

7.2.9 RESEARCH APPROACH: Evaluative approach.

7.3 VARIABLES

Independent variable: PTP on care of mothers with selected high risk pregnancies.

Dependent variables: Knowledge of students regarding care of mothers with

selected high risk pregnancies.

Extraneous variables: Age, sex, Religion, Type of Family, Area of residence,

Attended any Seminars or Conferences on care of mothers with high risk pregnancies,

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Previous knowledge regarding care of mothers with high risk pregnancies, Source of

health information.

7.4 PLAN FOR DATA ANALYSIS

·Descriptive statistics: The descriptive statistical analysis includes frequencies,

percentages, mean, and Standard deviation for the knowledge of IV year B.Sc nursing

students regarding the care of mothers with selected high risk pregnancies.

·Inferential statistics: - Difference in knowledge score will be analyzed by using

student’s paired t-test and an association between demographical variables of students

and level of knowledge regarding the care of the mother with high risk pregnancies

will be analyzed using Pearson chi-square test.

7.5 PILOT STUDY

The pilot study is planned with 10% of the total sample size which will be

conducted in selected nursing college of Hassan and that will be excluded in the main

study.

7.6. ETHICAL CONSIDERATION

DOES THE STUDY REQUIRE ANY INTERVENTIONS TO BE CARRIED

OUT ON STUDENTS OR OTHER HUMANS?

Yes,

Study will be conducted on students of selected nursing colleges of Hassan District

and consent will be taken from the concerned authorities of selected nursing colleges,

at Hassan.

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HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR

INSTITUTION?

Yes,

Permission will be obtained from the research committee of the Nisarga college of

Nursing, Hassan.

8. LIST OF REFERENCES (VANCOUVER STYLE)

1. Wikipedia, free encyclopedia.“Woman” cited on 16/11/2012.Available from:

http://en.wikipedia.org/wiki/Woman.

2. The free dictionary by farlex. “Pregnancy” cited on 16/11/2012. Available from:

http://medical-dictionary.thefreedictionary.com/pregnancy.

3. Wikipedia free encyclopedia. “Childbirth.”cited on 16/11/2012. Available from:

http://en.wikipedia.org/wiki/Childbirth.from

4. Dr. Gerard M., DiLeo, “The High-Risk Pregnancy”, Verginia hospital centres

medical services, maternal and fetal medicine. cited on 17/11/2012.Available at

http://www.virginiahospitalcenter.com/medical/women/medicine/default.aspx.

5. Bennet, Brown. “Myles text book for midwifes”, mary law publications,

international student edition of 12th edition, 1996 page no:358,269.

6. http://www.newindpress.com/Newsitems.asp?ID=IE920071017003444.2007.

7.http://ellakavi.wordpress.com/2007/10/22/health-care-in-karnataka-envisaging-a-

healthy.growth/.

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8.http://www.thehindu.com/2006/07/02/stories/2006070216100300.htm.

9. Alhossain A, Khalafallah, Amanda E, Dennis. “Iron deficiency Anaemia in

pregnancy and postpartum:pathophysiology and Effects of oral versus intravenous

iron therapy”, J of pregnancy, volume 2012(2012), Article ID 630519, 10 pages,

doi:10.1155/2012/630519.Available from:

http://www.hindawi.com/journals/jp/2012/630519/

10. Dr.Vijaynath,Patil Ramesh, Jitendra, Dr.Patel Abhishek. “Prevalence of anemia in

pregnancy”, Indian Journal of Applied Basic Medical Sciences, year:

2010,volume:12B,Issue:15.Availablefrom:http://indianjournals.com/ijor.aspx?

target=ijor:ijabms&volume=12b&issue=15&article=011

11.Oommen P.Mathew. “Population research centres Division, ministry of Health and

family welfare, Government of India (Head quarter)”, 3-12-2012. Available from:

http://prcs-mohfw.nic/showprcdetail.asp?id=675

12. Ghulmiyyah L, Sibai B. “Maternal Mortality from Preeclampsia/eclampsia”.

Seminars in Perinatology 2012; 36: 56-59.Available from:

http://www.cmqcc.org/resources/preeclampsia_eclampsia.

13.The Becker Law Firm. “High risk pregnancy statistics, posted in birth injury.”A

journal-Ohio Injury Law Firm Blog L.P.A. on November 16,2010 4:39PM. Available

from:http://www.ohio-injurylawfirm.com/2010/11/high-risk-pregnancy-

statistics.html.

14. Arash Hossein-Nezhad, Zhila Maghbooli, Ali-Reza Vassigh, Bagher Larijani.

“Prevalence of Gestational Diabetes Mellitus and Pregnancy Outcomes in Iranian

Women”, Taiwanese Journal of Obstetrics and Gynaecology,Volume 46,Issue

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3,September 2007,pages 236-241.Available from: http://dx.doi.org/10.1016/S1028-

4559(08)60026-1

15. Carolan M, Steele.C et al. Attitude towards gestational diabetes among a

multiethnic cohort. J Clin Nurs. 2010 sep10; Available from URL:

http//www.ncbi.nih.gov/pubmed.

16. Noronha AJ. “To determine the effectiveness of teaching using an informational

Booklet on warning signs in pregnancy for primigravida women attending selected

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