A COMPARATIVE STUDY TO ASSESS THE EFFECTIVENESS OF SITZ BATH VERSUS INFRARED LAMP THERAPY ON EPISIOTOMY PAIN AND WOUND

HEALING AMONG POSTNATAL MOTHERS AT SELECTED HOSPITAL, BANGALORE.
By

Ms. SUSEN GEORGE
Dissertation Submitted to the Rajiv Gandhi University of Health Sciences, Bangalore.

In partial fulfillment of requirement for the degree of Master of Science in Nursing In Obstetrics and Gynaecological Nursing Under the Guidance of Mrs. Kamala J, M.Sc. (N), Ph Associate Professor HOD of Obstetrics and Gynaecological Nursing, Kempegowda College of Nursing, Bangalore-560 004.

2013

DECLARATION BY THE CANDIDATE

I hereby declare that this dissertation entitled “A comparative study to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers at selected hospital, Bangalore” bonafide and genuine research carried out by me under the guidance of Mrs. Kamala J, M.Sc. Nursing, Ph , Associate Professor, HOD, Department of Obstetrics and Gynaecological Nursing, Kempegowda College of Nursing, Bangalore560 004.

Place: Bangalore. Date: Feb 2013

Signature of the Candidate (Ms. Susen George)

CERTIFICATE BY THE GUIDE

This is to certify that the dissertation entitled “A comparative study to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers at selected hospital, Bangalore” is bonafide research done by Ms. Susen George in partial fulfillment of the

requirement for the degree of Master of Science in Obstetrics and Gynaecological Nursing.

Place: Bangalore. Date: Feb 2013.

Signature of the Guide
Mrs. Kamala J, M.Sc. (N), Ph

Associate Professor and HOD, Dept. of Obstetrics and Gynaecological Nursing, Kempegowda College of Nusing Bangalore-560 004.

Sc. Place: Bangalore. HOD. Kempegowda College of Nursing. Department of Mrs.Sc. Lakshammama. T. Kamala J.(N). PRINCIPAL/HEAD OF THE INSTITUTION This is to certify that the dissertation entitled is “A comparative study to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers at selected hospital. V. Bangalore-560 004. M. (N). Kamala J.Sc. Associate Professor. M.ENDORSEMENT BY THE HOD. M. Ph Seal & Signature of the Principal Mrs. Seal & Signature of the HOD Mrs. Date: Feb 2013. Date: Feb 2013 . Ph Place: Bangalore. Ph Obstetrics and Gynaecological Nursing. Susen George under the guidance of .Nursing. Bangalore” bonafide research done by Ms.

COPYRIGHT Declaration by the Candidate I hereby declare that Rajiv Gandhi University of Health Sciences. Date: Feb 2013 Signature of the Candidate (Ms. Karnataka. shall have the rights to preserve. Susen George)  Rajiv Gandhi University of Health Sciences. Karnataka. Place: Bangalore. . use and disseminate this dissertation/thesis in print or electronic format for academic/research purpose.

It has been my good fortune to have her as my guide. Her contagious enthusiasm gave me a hope to surmount all the obstacles and hurdles in the study. constructive criticism and timely help to make this research experience a rich and rewarding one. Associate professor. for encouragement. Lakshamamma. whenever needed. Ph . Kempegowda College of Nursing. M. V. I owe a special thanks to Medical superintendent. Bangalore for granting me permission to conduct study. HOD. I thank Lord Almighty for his abundant grace and blessings that he has showered on me throughout the course of this study. HOD of OBG dept.ACKNOWLEDGEMENTS First of all. It has been an invaluable experience working under her. for providing me an opportunity to be a student of this esteemed institution and to conduct this study. Ph . Community Health Nursing.Sc Nursing. . It is my privilege to express my sincere thanks and profound gratitude towards my esteemed teacher and guide Mrs.Sc. We fall short of words to “Thank you madam”. N. I convey my sincere indebtedness to the Kempegowda College of Nursing. Department of Obstetrics and Gynecologcal Nursing. T. I extend my sincere thanks to Mrs. Bangalore-04. She is a mentor who infused me in confidence and encouragement in my endeavour. M. Principal and HOD. and Nursing superintendent of Kempegowda Institute of Institute of Medical Sciences. Hospital and Research Centre.. Bangalore-04. I would like to extend my deepest gratitude to all the Experts who have contributed in the form of constructive criticism and suggestions to formulate the tool. Kamala J.

for their constructive criticism and valuable suggestions. My healthy ovation of gratitude to my beloved parents Mr. my seniors and juniors for their cooperation and help rendered during my study. I owe a deep sense of gratitude to all Office staffs and Librarian of our college who have contributed for the successful completion of the study. It is because of them this thesis has seen the light of the world. George Joseph and Mrs. PhD (statistics). I strongly acknowledge that they have positively contributed to my personal growth. Rajesh George and Mr. I want to thank you for your unconditional love and unending support across the distance. Bangalore-4. I thank all my friends.Susen George . I express my words of appreciation to Dr. Finally. Omana George. classmates. KIMS. my dearest sister in law Mrs. Rejeesh George. Date: Ms. Aswathy Rejeesh who laid foundation to my higher studies. Department of Community Medicine.I extend my sincere thanks to all the M. Place: Bangalore. Bangalore for his valuable suggestions and guidance in statistical analysis.Sc Nusing Faculty of Kempegowda College of Nursing. Gangaboraiah. my loving brothers Mr. I would fail in my duty if I forget the postnatal mothers who participated in this study. I thank all those well-wishers of mine who have directly or indirectly contributed to the success of this work.

Episiotomy pain and delayed wound healing often interferes with even basic daily activities of the postnatal mother. Considering the high rates of episiotomy . The study was undertaken to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing in selected hospital. we need to offer patients treatment alternatives for perineal pain . To determine an association between pain level & wound healing status with selected demographic variables. To compare the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. following vaginal deliveries. Objectives i. To assess the level of pain and wound healing status among postnatal mothers with episiotomy. . Although episiotomy aids in safe delivery of the child. ii. iii. Bangalore.ABSTRACT Background Episiotomy is a common surgical procedure performed during second stage of labour to enlarge the vaginal introits and facilitate delivery. To assess the effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. based on scientific evidence. the discomfort of episiotomy is an added concern in the already over stressed situation of puerperium. iv.

Student ‘t’ test score (2. Purposive sampling technique was used to select the samples. . Student‘t’ test score shows that there is no significant difference between control and experimental group.Method A quasi experimental prê test and post test design with a comparison group was used for the present study. The paired ‘t’ test score shows that there is a significant difference between pre test wound scores at 0.05 level.68) and experimental group (14.62) shows that there is significant difference between control and experimental group.05 levels in both control (13. When subjects in the control group have given with routine sitz bath. subjects in the experimental group have administered with infrared lamp therapy which is introduced by the investigator. Data was collected by using verbal descriptive pain scale for assessing episiotomy pain and REEDA scale for assessing wound healing.05 levels in both control and experimental group at 0.57)which has shown a significant association with pre test pain scores only in experimental group. Data was analyzed using descriptive and inferential statistics. There was no significant association between pre test pain & wound scores and selected demographic variables with an exemption of religion (x2 = 8. Result The paired ‘t’ test score shows that there is a significant difference between pre test pain scores at 0.05 level. The sample size consisted of 60 postnatal mothers who had normal delivery with episiotomy and of which 30 were assigned to control group and 30 were assigned to the experimental group.69) at 0. Interventions continued for three days both morning and evening.

. However sitz bath and infrared therapy were found to have same effect on episiotomy wound healing. Key words Sitz bath Infrared lamp therapy Episiotomy pain Episiotomy wound Post natal mothers.Interpretation and conclusion Mothers who had undergone the treatment of infrared lamp therapy expressed decreased pain intensity compared to the mothers who had undergone treatment of sitz bath.

12. 13. 8. 7. 9. 2. 3. 15.LIST OF ABBREVIATIONS 1. 6. 4. 14. 10. REEDA Scale H n1 n2 F RMLE LMLE SD P Df N Α FEP *S NS Redness Edema Ecchymosis Discharge Approximation Scale Hypothesis Number of samples in control group Number of samples in experimental group Frequency Right mediolateral episiotomy Left mediolateral episiotomy Standard deviation Probability Degree of freedom Number of respondents Alpha Fisher’s Exact Probability Significant Not significant . 11. 5.

9-14 15-30 3. 1.TABLE OF CONTENTS Sl. No. Results Page No. Particulars Introduction  Background of the study  Need for the study Objectives  Statement of the problem  Objectives  Operational definition  Hypothesis  Conceptual framework Review of Literature  Reviews related to episiotomy  Reviews related to effectiveness of sitz bath  Reviews related to effectiveness of infrared lamp therapy Methodology  Research approach  Research design  Research setting  Population  Sample  Sample size  sampling technique  Sampling criteria  Data collection tool  Pilot study  Data collection process  Plan for data analysis. 7. 1-8 2. 6. 31-40 41-66 5. 4. 67-73 Discussion Conclusion  Implications of the study  Limitations of the study  Recommendations 74-77 .

8. 10. 90-101 Annexure . Bibliography 78-82 83-89 9. Summary  Statement of the problem  Objectives of the study  Hypotheses  Findings of the study.

1. 7. 2. 5. 9. No. 6. 3. 4. 10. 12 13 14 15 16 17 18 Title of the Table Distribution of Subjects by Age Distribution of Subjects by Religion Distribution of Subjects by Education Distribution of Subjects by Occupation Distribution of Subjects by Type of family Distribution of Subjects by Diet Distribution of Respondents by Place of living Distribution of Respondents by Parity Distribution of Respondents by Type of episiotomy Assessment of episiotomy pain level Comparison of pain scores among control and experimental group Pre test and post test pain scores in control group Pre test and post test pain scores in experimental group Comparison of post test wound scores in control and experimental group Association of pre test pain scores with selected demographic variables in control group Association of pre test pain scores with selected demographic variables in experimental group Assessment of episiotomy wound status Comparison of wound scores among control and experimental group Page No. 44 45 46 47 48 49 50 51 52 53 53 54 55 56 57 58 59 60 .LIST OF TABLES Sl. 8. 11.

19 20 21 22 23 Pre test and post test wound scores in control group Pre test and post test wound scores in experimental group Comparison of post test wound scores in control and experimental group Association of pre test wound scores with selected demographic variables in control group Association of pre test wound scores with selected demographic variables in experimental group 61 62 63 64 65 .

11. No. Schematic Representation of the Study Design. Distribution of Respondents by Sex. Distribution of Respondents by Occupation. Distribution of Respondents by Type of family Distribution of Respondents by Diet Distribution of Respondents by Place of living Distribution of Respondents by Parity Distribution of Respondents by Type of episiotomy. Title of the Figure Conceptual Framework based on Imogene King’s Goal Attainment theory. 11 40 44 45 46 47 48 49 50 51 52 .LIST OF FIGURES Sl. Page No. Distribution of Respondents by Education. Distribution of Respondents by Age. 1 2 3 4 5 6 7 8 9 10.

LIST OF ANNEXURE ANNEXURE ANNEXURE NO. Annexure –F Annexure -G CONTENTS Copy of letter seeking permission to conduct the study Copy of the letter seeking expert’s opinion for the content validity of the tool Content validity certificate Criteria rating scale for evaluation List of experts consulted for content validity of the tool Copy of consent form Tool used for the study PAGE NO. INDEX Annexure –A Annexure –B 2. 98 99-102 . 94 95-96 97 6. 4. 91 92-93 3. 1. 7. Annexure –C Annexure –D Annexure –E 5.

From a medical and physiological view point this period is called the puerperium. perineal pain. Despite the pain and discomfort. It is usually joyful when a pregnant mother gives birth to a baby she has expected. because of their closer affinity to their children. A mother is the beginning of a new chapter of human life. breast engorgement. Mothers experience some discomforts after delivery although they are considered normal common discomforts of puerperium period are after birth pain. the mother enters a period of physical and psychological recuperation. INTRODUCTION "Women. constipation. backache. birth is a long awaited grand ending of a pregnancy and a start of a new life.1. fatigue. suffer more keenly than do men. During this period a mother is going through the physiological process of uterine involution and at the same time adapting to her new role in the family2. That’s why mothers are special and labour is precious1. can lead to physical 1 . headache. The process of labour not only generates new life but also it creates new species in the world thereby makes the world as an ever ending place for the human beings to live. lactation suppression.” (Elizabeth Braxter) Post partum is a very special period for a woman and her family. Following the birth of the baby and expulsion the placenta. which is a crucial period for the mother.

Episiotomy pain often interferes with basic daily activities for the woman such as walking. Episiotomy is protective against more severe perineal lacerations4. appropriate treatment can resolve or reverse all these after effects. The prompt use of the best selected treatment for any injury 2 . psychological distress and a poor quality of life for the mothers3. infection. This shift made Episiotomy as a common surgical procedure performed during second stage of labour to enlarge the vaginal intriotus and to shorten the second stage of labour in cases of fetal distress. The discomfort of episiotomy is an added concern in the already overstressed situation3. and ultimately dyspareunia. sitting.discomfort. Pain in labour is a universal experience for childbearing women. However. a spontaneous tear or a combination of both. The shift from home birth to hospital deliveries contributed to a shift in the conceptualization of the nature of childbirth. Considerable evidences of risks are also associated with episiotomy such as pain. due to an episiotomy. It may be as a result of trauma during child birth. changes in maternity practices also affected the use of episiotomy. Episiotomy was not widely used until the 1920s. In addition to the strong advocacy for the use of episiotomy of the day. and passing urine and also negatively impacts on motherhood experiences2. edema.

Pharmacological pain relief methods include non-steroidal anti-inflammatory drugs. heat is recommended because it increases circulation to the region. but this relief is generally short-lived. to relieve discomfort. local anaesthetics and opioids. to promote recovery of the wound by cleaning the perineum and anus. Pharmacological and non-pharmacological methods are used to treat this discomfort. But this method is associated with serious adverse effects such as constipation. an episiotomy. It helps to reduce perineal edema. and prolonged bleeding time6 With regard to non-pharmacological methods.including. and reduces inflammation7.8 3 . Forms of heat used are sitz bath or infrared lamp therapy application. So midwives have an important role to play in the care of perineal wounds following child birth. and there is no evidence of any long-term benefit. The maintenance of effective pain relief must be balanced with the need to promote wound healing5. common practice are the use of ice packs. passage of the drug to maternal milk. ensures it will heal completely. oral analgesics. Ice packs during the first 24 hours postpartum is a traditional method used for the immediate symptomatic relief of pain since it anesthetizes the perineum. with the least amount of complications. and heat application. After 24 hours. in the shortest possible time. to avoid the formation of hematomas. gastric irritation. There are several treatments for relieving perineal pain and promoting wound healing.

and unique to every childbearing woman. emotional and psychological challenges. Episiotomy (“unkindest cut of all”). It is a transformative event in a women’s life. defined as a surgical incision in the perineum to enlarge the vaginal opening for birth. NEED FOR THE STUDY: Labour is a wondrous act of nature. It is the only surgical procedure in obstetrics is performed without the patient’s specific consent11. Considering the high rates of perineal trauma after normal deliveries that still exist in our population. The post-partum phase can become even more challenging when the new mother experiences perineal or genital tract trauma as a result of child birth10.It is vital that health professionals who care for the puerperant patient know how to evaluate and treat perineal pain. it is necessary to offer these patients alternative treatments for perineal pain &wound healing based on scientific evidence9.7%(Western Europe – Sweden) to 4 . was introduced as an obstetric procedure more than 200 years ago and became a common practice from the beginning 20thcentury. The onset of motherhood presents a unique set of physical. Studies about the episiotomy rates around the world showed that this surgery ranged from 9.

Canada and United States) and it remained high in many counties (centred south-America like Brazil: 94.3% and Asia like China 82%)12.3%) and private providers(55. Among that midwives performed episiotomies at a lower rate (21. In India.4% and conducted by nurses it was 53. A cross sectional study conducted on “population based study of episiotomy” in Chennai.4%) than faculty(33. episiotomy rate in the study population is high. the overall rate of episiotomy was 40.96. The probability of episiotomy is very high when doctors conducted the delivery and when place of delivery is private medical college hospital15 Pain following episiotomy appears to be universal.6%.2%. Episiotomy rate was very high (91. In Bangalore rates of episiotomy for vaginal birth range from 31% to 95% of the grand total of 3590 vaginal deliveries14.8%) when delivery was conducted in private medical colleges.1%. The result revealed that the rate of overall episiotomies was 67%.6%)13. In conclusion. South Africa – 63.2%(South Africa – Ecuador) with lowest episiotomy rates in English – speaking countries(North America. India among a sample of 442 women who had vaginal delivery. The episiotomy rate in Karnataka is approximately 88% in women who are undergoing difficult labour. For women whose delivery conducted by doctors the episiotomy rate was 77. The mother undergoing episiotomy is characterised by greater blood loss in 5 .

the effects of pain on postnatal recovery in Royal Women’s Hospital. The researchers suggested that the prevalence of peineal pain and the associated impact on women’s from childbirth warrants midwives’ proactive care in offering a range of effective pain relief options to women16 Various intervention are found to reduce episiotomy pain and enhance healing process. applying ice pack . Australia. performance of Kegel’s exercise and perineal care2. with 37% reporting moderate or severe pain. Researchers conducted structured interviews of 215 women in the postnatal ward of tertiary hospital. Over a third of women experienced moderate or severe perineal pain. which include administration of analgesics. sitz bath. Victoria. particularly when walking (33%) or sitting (39%). Women reported moderate or severe perineal pain when they undertook activities involving feeding their infant (12%) or caring for their infant(12%). 6 . and there is a risk of improper wound healing and increased pain during early puerperium2. within 72 hours of vaginal birth. topical application by dry heat (infra red therapy). cleanliness. A study conducted to establish the prevalence of perineal pain.conjunction with delivery. Results revealed that 90% of women reported some peineal pain. while 45% noted that pain interfered with their ability to sleep.

who attend to puerperas.A sitz bath involves immersion of the perineal area/ buttocks in warm water (medicated if ordered) at a temperature of 105 to 110 degree F for 15 to 20 minutes.3% of them also used non. It is very simple.5% used drugs. and for 10 – 15 minutes which provides relief from the discomfort. Considering the high rates of peineal trauma. It is used to relive discomfort. The bath promotes wound healing by cleaning the perineum and anus. Infrared light therapy is a unique form of treatment where the healing effects of the light is utilized for treating episiotomy. and 62. In this therapy.50 cm from it. in the relief of perineal pain after vaginal deliveries. the injury site or the diseased part of the body is exposed to infrared radiation with a light source of 245 volts at a distance of 45. The study concluded that health care professionals. following 7 . Result reveals that among 130 patients 98. A study conducted on “Pharmacological and non pharmacological treatment for relief of perineal pain after vaginal delivery” in Brazil to identify the types of pharmacological and non pharmacological treatment used during hospitalization. know how to assess and treat peineal pain. and reducing inflammation. it also helps to relax local muscles.drug treatments such as Ice pack. increasing circulation. absolutely painless and no major side effects17. warm sitz bath and Hot compress.

it is seen that in many postnatal mothers. their ability for breast feeding and attending to their baby’s need would decrease significantly.vaginal deliveries. Based on review of literature and clinical experience of the investigator. 8 . based on scientific evidence18. we need to offer patients treatment alternatives for perineal pain. Hence the investigator rightly felt to conduct a comparative study on the effectiveness of sitz bath versus infrared lamp therapy in the management of episiotomy pain and wound healing among postnatal mothers. episiotomy pain and discomfort dominate the feeling of motherhood and it has many negative impacts on women’s ability to care for their newborns.

OBJECTIVES This chapter consists of the statement of problem. To assess the level of pain and wound healing status among postnatal mothers with episiotomy. objectives. HYPOTHESES: H1: There is a significant difference between the mean pre test and post test pain & wound healing scores in sitz bath and infrared lamp therapy group. ii.” OBJECTIVES OF THE STUDY: i. iv. operational definitions & theoretical framework selected for the study. STATEMENT OF THE PROBLEM: “A comparative study to assess the effectiveness of sitz bath versus infra red lamp therapy on episiotomy pain and wound healing among post natal mothers at selected hospitals. To compare the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To assess the effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To determine an association between pain level & wound healing status with selected demographic variables. iii. 9 . Bangalore.2.

 Effectiveness: Refers to the extent to which sitz bath/ infrared lamp therapy helps in relieving episiotomy pain and enhancing wound healing in postnatal mothers which is measured by Verbal Descriptive Pain Scale and REEDA scale (Redness.  Sitz bath: A bath in which perineal area / buttocks are submerged in 4 litre of warm water added with 5-6 drops of 10% Providone iodine (Betadine) solution having a temperature of 105 to 110 0 F for 20 minutes for three days both morning and evening. focused on episiotomy suture site at a distance of 45-50 cm from it and lasting for a duration of 10. Ecchymosis. Edema. OPERATIONAL DEFINITIONS:  Comparative: It refers to statistical measurement of difference between infrared lamp therapy versus sitz bath on level of episiotomy pain and wound healing. Approximation).15 minutes for three days both morning and evening.H2: There is a significant difference in the mean post test scores between sitz bath and infrared lamp therapy group. H3: There is a significant association between pain &wound healing scores with selected demographic variables in sitz bath and infrared lamp therapy group.  Infra red lamp therapy: Refers to a lamp which emits infrared rays with a light source of 245volts (150 watts power ) and a frequency of 50 Hz. Discharge.  Episiotomy: A surgically planned incision on the perineum and posterior vaginal wall during the second stage of labour to enlarge the vaginal introitus to facilitate easy and safe delivery 10 .

 Postnatal mothers: It denotes to a women who had normal vaginal delivery with episiotomy. subjective. The device that helps to stimulate research and the extension of the knowledge of providing both direction and impetus. sensory. Approximation). Discharge. irrespective of her parity.  Wound healing: It is a dynamic process of regaining the skin integrity of episiotomy wound which is assessed by REEDA scale (Redness. up to fourth day of childbirth. Polit and Hungler states that conceptual frame work is inter related concepts or abstractions that are assembled together in some rationale scheme by virtue relevance to a common thing. and emotional experience by postnatal mothers due to tissue damage resulted from episiotomy incision which is assessed by Verbal Descriptive Pain scale. The present study was aimed at assessing the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among post natal mothers with episiotomy. 11 . It is a scientific representation of the steps. The overall purpose is to make scientific findings meaningful and generalize. CONCEPTUAL FRAMEWORK A conceptual frame work is a group of concepts and a set of prepositions that spell out the relationship between them. Ecchymosis. Edema. Concepts are the building blocks of the theory. Pain: An unpleasant. It’s a frame work which provides the investigator the guidelines to proceeds in attaining the objectives of the study based on theory. activities and outcome of the study19.

Prescription: Refers to the plan of activity directed. Identification: The present health needs of postnatal mothers are the pain and delayed healing of episiotomy wound. Wiedenbach proposes a prescriptive theory for nursing which is described as conceiving of a desired situation and the ways to attain it. 12 . Prescriptive theory directs action toward an explicit goal. A prescription may indicate the broad general action appropriate to implementation of the basic concepts and suggest the kind of behaviour needed to carry out these actions in accordance with the central purposes. Here the investigator review interventions (sitz bath and infrared lamp therapy). formulate plan for administration and develop Verbal Descriptive Pain Scale and REEDA Scale for the episiotomy pain and wound healing assessment. It is the overall goal which acts dynamically in relation to one’s belief. Central purpose: It refers to what the nurse (investigator) wants to accomplish.The conceptual frame work of the present study is based on Ernestine Wiedenbach’s helping art of clinical nursing theory (Figure-1). A nurse develops a prescription based on a central purpose and implements it according to the realities of the situation20. nursing practice consists of identifying the patients needed help and validating the provided help. The nurse investigator identifies the level of pain and wound healing status of postnatal mothers with episiotomy and sets a goal to reduce pain and improve wound healing of post natal mothers with episiotomy. consists of three steps that is central purpose. It specifies the nature of the action that will fulfil the nurse’s central purpose and the rationale for that action.In the present study Weidebach. prescription and realities.

moderate pain. Similarly wound healing status divided into no infection. The realities are      Agent – is the investigator Recipients – are the postnatal mothers Goal – to reduce episiotomy pain and improve episiotomy wound healing Means : Sitz bath and infrared lamp therapy. Reinforcement is suggested to the subjects with positive outcome. and severe pain. hypothesis. mild pain. 13 . Frame work: Kempegowda Institute Of Mediacal Sciences and Research Centre. the episiotomy pain level and wound status reassessed by using Verbal Pain Scale and REEDA Scale to determine the effectiveness of sitz bath and infrared lamp therapy. physiologic. operational definitions and conceptual frame work. mild infection. Validation: In this phase. moderate infection and severe infection. objectives. whereas negative outcome is again identified as a need for continuation of treatment (feedback) SUMMARY This chapter deals with the statement of the problem. emotional and spiritual factors that come into play in a situation involving nursing actions. In this phase the investigator carry out interventions such as sitz bath and infrared lamp therapy. The pain level is categorised in to no pain. These categorisations have been done to find out the extent of effectiveness.Realities: Refers to the physical.

Feed back Negative outcome Increased pain and delay wound healing at episiotomy site.Not included in the study Figure 1: Conceptual frame work based on modified Ernestine Wiedenbach’s helping art of clinical nursing theory 14 .Central purpose: To assess the effect of sitz bath versus infrared therapy on episiotomy pain and wound healing among postnatal mothers. effectiveness of sitz bath and infrared therapy were measured. Administration of sitz bath to control group and infrared lamp therapy to experimental group of post natal mothers for 15 minutes twice daily Post intervention pain and wound healing assessment done after a period of 3 days. ---------. Ministering the needed help Identifying the need for help Validating the provided help Assessment of episiotomy pain and wound healing status using verbal descriptive pain scale and REEDA scale. Positive outcome Episiotomy pain reduction and improvement of wound healing.

The researcher did an extensive search of existing literature. The reviewed literature provides the evidence of what has been studied in the past and published. scrutiny and summary of written material that contains information on research problem. REVIEW OF LITERATURE Review of literature is a systematic identification.3. It also serves as a valuable guide to understand what has been done and what is still unknown and untested. The researcher presents the review of literature. Reviews related to episiotomy 2. and organized it under following heading: 1. It justifies the need for study. Reviews related to effectiveness of sitz bath 3. reveals methodology and relates the findings from one to another with a hope to establish a comprehensive study of scientific knowledge. paving way for further study in the chosen subject. throws light on the feasibility of the study. which helps to study the problem in depth. Reviews related to effectiveness of infrared lamp therapy 15 .

16 . Two approaches were used in the analysis. assessed for factors such as issues preceding birth. The study included 495 women who had a normal delivery.8(1.5)).Reviews related to episiotomy A study was conducted in Denmark to evaluate the influence of episiotomy on the perineal state after spontaneous singleton vaginal deliveries. ‘one in five’.0-1. The results revealed that women allocated in the group with lowest rate of episiotomy were more likely to have intact perineum after delivery (OR = 1. Initially the 2188 parturient were quasi randomised to one of three equally sized groups of midwives with different attitude towards episiotomy. Secondly.2)). The study concluded that presence of perineal lacerations was higher in the group not subject to episiotomy and factors associated with episiotomies were maternal disease and absence of previous vaginal delivery22. had a tendency towards more perineal lacerations (OR(1. spontaneous vaginal deliveries21. the study was continued to find out the effect of episiotomy on the state of anal sphincter.4-2. A retrospective cross sectional study was conducted to determine the prevalence and factors associated with episiotomy in a reference centre in Brazil. characteristics of labour and perinatal outcome.3(1. The study concluded with a consecutive approach to the use of mediolateral episiotomy and suggests that episiotomy should be used in.

labour induction method.A study was conducted in UK with the objective of analysing the significance of risk factors and the role of episiotomy in preventing obstetric anal sphincter injury (OASI) at vaginal delivery. duration of second stage.983). age. The results revealed that primiparity and occipito posterior presentation are strong risk factors for the occurrence of anal sphincter injury during operative vaginal delivery. Mediolateral episiotomy protected significantly for anal 17 . A study population of 10. age. method of delivery.314 post natal women who had vaginal delivery were assessed to identify the factors that had a significant association with OASI. A population based observational study was conducted to determine the risk factors for anal sphincter injuries during operative vaginal delivery in Netharlands.021-1. and birth weight. The study included 21254 postnatal women who underwent operative vaginal delivery. use of epidural analgesia. time and month of delivery. Women giving birth without a mediolateral episiotomy were 1. method of delivery and shoulder dystocia are strongly associated with obstetric and sphincter injury. The results revealed that parity. Factors included parity. gestation.4 ties more likely to experience OASI (95% CI 1. The study concluded that mediolateral episiotomy appears to be protective against OASI23. Risk factors were determined with multivariate logistic regression analysis. birth weight. episiotomy.

07-0. A randomised controlled trail was conducted with the objective to assess the effects of restrictive use of episiotomy compared with routine episiotomy during vaginal birth in Argentina.08. restrictive episiotomy involved less posterior perineal trauma (RR=1. but there was increased risk of anterior perineal wall trauma (RR=1. In conclusion.79) with restrictive episiotomy. The relationship between episiotomy use and perineal trauma at the hospital level was examined using regression 18 .090. The results revealed that compared with routine use. restrictive episiotomy is associated with increased anterior perineal wall trauma25.11) The study concluded that highly significant protective effect of mediolateral episiotomies in both types of operative vaginal delivery warrants the conclusion that this type of episiotomy should be used routinely during these interventions to protect the anal sphincters24.68%. Trial quality was assessed and data were extracted independently by two reviewers from six studies which included 4850 samples. A study was conducted to assess the relationship between hospital episiotomy and the incidence and risk of perineal trauma among women in Pennsylvania. 95% CI 0.13) and forceps delivery (OR 0. 72. In the routine episiotomy group.sphincter damage in both vacuum extraction (OR 0.7% of women had episiotomies while the rate in the restrictive episiotomy group was 27. USA.11.74). 95% CI 0.11) and less suturing (RR=0.

lacerations. Netherlands. The results revealed that high birth weight. induced labour.analysis. Data obtained from 2041 consecutive operative vaginal deliveries and compared yearly rates of episiotomy. The results revealed that hospital episiotomy rates ranged from approximately 20 to 73%. forceps delivery. epidural anaesthesia and parity were risk factors for anal sphincter tear.001)26. The study concluded that mediolateral episiotomy may be sphincter – saving and therefore prevent from chronic faecal incontinence27. rates of episiotomy were significantly correlated with rates of third or fourth degree perineal laceration (r=0. in Amsterdam. A study was conducted in San Francisco to examine the association between maternal vaginal and perineal morbidity and episiotomy performed at operative vaginal delivery. mediolateral episiotomy was associated with fewer sphincter injuries. A retrospective case control study was conducted to determine risk factors for third degree obstetric perineal tears and to give recommendations for prevention. One hundred and twenty cases of vaginal delivery complicated by third degree perinal tear and 702 uncomplicated vaginal deliveries were compared. puerperium<0. with respect to possible risk factors. In addition. and potential confounders with linear 19 . The rate of third or fourth degree perineal lacerations varied from a low of 4% to a high of more than 13 % among hospitals.70. In conclusion.

and operative vaginal delivery.1% to 40. The study concluded that a statistically and clinically significant reduction in the use of episiotomy for operative vaginal deliveries was associated with an increase in the rate of vaginal lacerations28. A review was conducted to assess the role of episiotomy in current obstetric practice in USA.regression and stratified analyses. Although the role of the episiotomy in modern obstetrics may be limited. Reviews related to effectiveness of sitz bath A randomized controlled clinical trial conducted to determine the effect of Povidone Iodine sitz bath versus lavender Oil sitz bath treatment on episiotomy wound healing in Iran.0002). Through randomization 120 primipararous women who underwent vaginal delivery with episiotomy 20 .0%. R2=0. R2=0.0001). This change was associated with a rise in the rate of vaginal lacerations (16. The optimal type of episiotomy. if any. puerperium=0.80. the procedure is important in situations involving non reassuring fetal status.85. at forceps or vaccum delivery is yet to be determined29. shoulder dystocia. puerperium-0. The modern indications for episiotomy including the procedures place at operative vaginal delivery are discussed. The results revealed that the use of episiotomy for operative vaginal deliveries fell significantly (93.4% to 35.7%.

divided into 2 groups: control (n=60) and experimental (n=60) group. The control group took sitz bath with 5-7 drops of Povidone Iodine whereas experimental group with 5-7 drops of lavender oil in 4 L of water twice daily for 10 days. The study concluded that both therapies are significantly effective (P=0.003) in treating postpartum episiotomy pain, edema and preventing infection30.

A Quasi experimental study was conducted on Sitz bath versus Self perineal care on episiotomy wound healing. 40 postnatal mothers were taken for the study. 20 postnatal mothers were given Sitz bath and 20 postnatal mothers were given Self perineal care. The findings of the study denote that the application of sitz bath has significant influence in episiotomy wound healing. The study revealed that the REEDA score was significantly low (p=0.007) in the experimental group. The study concluded that Sitz bath is effective in episiotomy healing31.

A study conducted on “post episiotomy pain: warm versus cold sitz bath” in Colombia. Study included 20 samples to assess the effectiveness of a warm versus cold sitz bath in relieving post episiotomy pain. Sensation, distress, edema, and hematoma rating were obtained pre – and post treatments. In conclusion, both therapies were found comparable and significantly effective in managing post episiotomy pain32.

21

A study was conducted to examine the effect of aroma sitz bath therapy on postpartum mother’s perineal healing in Korea. In this clinical trial, postnatal mothers who delivered vaginally with an episiotomy were allocated to aroma sitz bath group and control group. The perineal healing status was measured using the REEDA Scale and smears for episiotomy wound were obtained. The results revealed that REEDA Scale was significantly low in the experimental group at postpartum 5th and 7th days (P=.009, P=.003), respectively. Most were observed ‘few’ (5-10 bacteria per field) bacteria in the smears of episiotomy wound. In conclusion, these findings indicate that postpartum aroma sitz bath therapy is effective in healing the perineum33.

An experimental study conducted at Coimbatore in Tamil Nadu to determine the effectiveness of infrared therapy and sitz bath. 30 samples were randomly selected for the study, out of that 15 each has been assigned to two experimental groups. Two experimental groups were selected for infrared therapy and sitz bath and treatment were given for three days in the morning and in the evening. Results revealed that mother who had undergone the treatment of infrared therapy expressed decreased pain intensity compared to mothers who had undergone the treatment of sitz bath. In conclusion, infrared light therapy and sitz bath were found to have same effect in the episiotomy34.

22

A comparative Study was conducted on effects of medicated sitz bath and non- medicated sitz bath on the episiotomy site at Chicago. The objective of the study was to evaluate postpartum healing of the perineum sample of 60 subjects were taken. 30 were given with medicated sitz bath and 30 with non-medicated sitz bath. Analysis of variance indicated no difference in REEDA score before or two hours after treatment35.

An experimental study was conducted to assess the effectiveness of sitz bath at California, the objective of the study was to determine effectiveness of sitz bath and recommendation of sitz bath in the management of episiotomy wound. 50 articles were taken The results showed that 36 articles were found with highlighted the physiology benefits risks complication and techniques of sitz bath one randomized study comparing sitz bath to placebo found. Two articles speculated that sitz bath induces relaxation of the muscle. Cold sitz bath was reported to decrease perineal edema more than warm bath. The study concluded that sitz bath is recommended in the treatment of episiotomy36.

A comparative study was conducted to assess the effectiveness of warm sitz bath and ice pack on intensity perineal pain after episiotomy in primipara women, in Sydney. The objective of the study is to evaluate the effectiveness of two devices. Perineal pain after episiotomy 121 primipara mothers was chosen. The results of the study showed that wound healing in the warm sitz bath was better when compared to the ice
23

30 postnatal mothers were given Sitzbath and 30 postnatal mothers were given Guggul Dhupan.96).pack on intensity perineal pain. (95% CI 0. the relative risk of developing an infection when cleansed with tap water compared with normal saline was 0. A comparative study was done to find the effect of Sitzbath versus GuggulDhupan on episiotomy pain in postnatal mother admitted in Pune hospital.01 to 2.3%) postnatal mothers were having severe episiotomy pain before Guggul Dhupan and 80% of postnatal mothers were having mild pain after Guggul Dhupan. three trials compared cleansing with no cleansing and one trial compared procaine spirit with water. 60 postnatal mothers were used in this study. maximum (63. warm sitz bath and ice pack were found to have varied effect on episiotomy pain intensity37. According to self . Eleven trials were included in this review. A quasi randomized study was conducted to assess the effects of water compared with other solutions for wound cleansing.3%) postnatal mothers were having mild pain after giving Sitzbath and this difference was statistically significant. maximum (53.16.assessment score. Seven trials were identified that compared rates of infection and healing in wounds cleansed with water and normal saline. The study 24 . in Australia. The study concluded that Sitz bath is effective in reducing episiotomy pain38. In conclusion.

The control group (n=30) used the existing methods of episiotomy care whereas. Through random sampling 20 postnatal women were divided into control and experimental group. An experimental study was conducted in Coimbatore. Reviews related to infrared therapy An experimental study conducted at selected Hospitals in Kovilpatti. Results reveals that the mean episiotomy pain score of the control group participants was high on all three days in comparison with the experimental group and 10% of the participants in the control group developed mild infection whereas none of the participants in the experimental group.001). The study concluded that infrared therapy is effective in managing episiotomy pain and wound healing40. the results was statistically significant (p<0. Tamil Nadu to determine the effectiveness of infra red lamp therapy on episiotomy wound healing and pain.concluded that tap water was more effective than saline in reducing the infection rate in adults with acute wounds39. TamilNadu. Comparative approach using two group quasi experimental research designs was adopted for the 25 . the subjects of the experimental group (n=30) were provided with the infrared therapy for 10 minutes for 3 days. India to assess the effectiveness of infrared therapy in healing of episiotomy wound.

30 samples were randomly assigned in to experimental group 1 and experimental group 2 for sitz bath and infrared 26 . In this experimental study.96). the laser therapy was applied to another 46 maternity patients in concomitantly with the conventional method. A study was conducted in Coimbatore. Study concluded that laser therapy improves process of the healing considerably. Study concluded that there was a significant difference between healing scores of experimental and control group after the administration of infrared radiation for three days41. in Russia. where as 70% of the mothers in control group showed poor wound healing. the injury on the perineum was conventionally treated by antiseptic in 40 maternity patients (control group). The calculated value of ‘t’ was greater (4.study. In this study 86 maternity patient with episiotomy were studied. The results revealed that in experimental group. Tamil Nadu. In treatment. promotes the rapid disappearance of inflammatory signs and renders analgesic effect42. 75% of the mothers who received infrared radiations showed adequate wound healing and 25% showed poor wound healing.05) than the expected value of ‘t’(1. A study aimed at developing the new effective method of treatment with an application of magnet laser (near infrared) radiation as a stimulating aid in healing perineum injuries in the maternity patients. India to compare the effectiveness of infrared therapy and sitz bath.

Results revealed that infrared light therapy and sitz bath were found effective in the healing of episiotomy. Eighty postnatal women with 27 .436 postnatal women with episiotomies.701) compared to mothers who had undergone the treatment of sitz bath.05=1. for the relief of perineal discomfort and to identify the sustaining time of each effect. in Korea. In conclusion. The study concluded that high healing effects with minimum secondary complications in the treatment of episiotomies using a therapeutic laser at an energy density of 2J/cm44.therapy respectively. a polarized light source of a 400-2. infrared light is a better pain relief intervention in comparison with sitz bath in treating episiotomy43. The light sources were: a laser (near infrared) of a wave length 670 nm with continuous alternations of frequencies. In this study the researchers treated a total of 2. but mothers who had undergone the treatment of infrared therapy expressed decreased pain intensity (p<0. The pain and wound score were assessed after a period of 3 days by using Verbal Descriptive pain scale and Modified Southampton Scale . An experimental study conducted to compare the effects of ice bag and heat lamp.000 nm wavelength and frequency 100 Hz and a monochromatic light source of a 660 nm wave length with simultaneous application of a magnetic field at an induction 8 mT. A study conducted to estimate the contribution of phototherapy to the treatment of episiotomies in Czech Republics.

The results revealed that ice bag group showed significantly lower discomfort (p<0. Samples were divided into control group and experimental group. This difference was statistically significant. They were randomly divided into cold therapy group and infrared therapy group. Both experimental groups received ice bag therapy and heat lamp therapy simultaneously. Pre test was conducted prior to the study to identify the degree of perineum discomfort. One hour after the completion of the intervention. both cold pack and infrared therapy recommended for treating episiotomy wound46. An experimental study was conducted in Vellore to compare the effect of cold pack versus infrared radiation on episiotomy wounds among 60 postnatal mothers.6 % mothers did not had pain at all and 23. A comfort scale. Post test was conducted soon after each therapy. 18cm graphic scale was used.6% had mild pain and 33. An experimental study was conducted in Hyderabad.3% mothers experienced very mild pain in cold therapy group whereas 66.7% had moderate to severe pain in infrared therapy group. Result 28 .episiotomy were randomly selected and divided into two experimental groups. In conclusion. two hour and four hours of the therapy45.05) than the heat group at the half an hour. to assess the effectiveness of electric heat lamp on healing of episiotomy wound. the results reveals that 76.

In this . presumably by its bio stimulatory effects48 A study was conducted at Japan University to review the outcomes and estimate the usefulness of linearly polarized near infrared rays therapy. Otsu. A study was conducted to investigate potential effects of a newly developed specific near infrared light source on wound repair. in Shiga university of medical sciences. 18 patients had disordered defecation. The rate of wound closure was significantly accelerated by repeated exposures. endothelial cells and fibroblasts were 'exposed to the light and the production of transforming growth factor (TGF) was examined by enzyme immuno assay. The linearly polarized near infrared light was radiated to the strongly tender point on or a few 29 . Incisional wounds were treated with rays and the effect of rays on the wound closure was followed photographically.reveals that there was a significant difference in rates of healing between control and experimental groups. 14 patients had a history of lower abdominal surgery. cultured human keratinocytes.study. The study concluded that near infrared rays potentially enhances wound-healing process. A total of 35 consecutive patients complained of vague and deep pain in the ano-rectum. Those who received heat lamp therapy had faster healing compared to those mothers who did not receive therapy47.

28 as good and 2 as no change.8 and mean number of rays for relief from pain was 2. 5 patients estimated as excellent. good. In brief the literature review has provided an understanding and broadened the investigator’s outlook necessary for designing the conceptual framework. no change or worse by the patients themselves. sitz bath and infrared therapy. Anorectal pain recurred in 4 patients. research design and construction of the tool of the study 30 .5.centimetres apart from the skin for 10 minutes. who received the same therapy and improved. The study was concluded that the linearly polarized near infrared rays therapy is a simple. The effect of the therapy was assessed as excellent. safe and effective modality for relief from intractable anorectal pain and recommended for primary therapy49. SUMMARY This chapter had dealt with the review of literature related to episiotomy. The mean total number of rays was 18.

development and description of the tool. sample selection. RESEARCH APPROACH In the view of the nature of the problem selected for the study and the objectives to be accomplished. The methodology is the most important part of research as it is the framework for conducting the study. This chapter comprises of the research approach used. a comparative approach was considered an appropriate research approach for the present study regarding the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. population.4. method of data collection and plan for data analysis. METHODOLOGY Methodology of research indicates the general pattern of organizing the procedure for gathering valid and reliable data for the problems under investigation19. RESEARCH DESIGN Research design incorporates the most important methodological decisions that a researcher makes in conducting a research study (Figure-2). research design. setting of the study used. The research design 31 . pilot study. The study conducted was to compare the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. sampling technique.

O2 Where as. Hospital and Research Centre 32 .O2 C = O1 .X . Postnatal mothers who had normal vaginal delivery with episiotomy.selected for the present study was quasi experimental with pre-test and post-test design with comparison group to achieve the objectives of the study. admitted in postnatal ward of Kempegowda Institute Of Medical Sciences. Target Population The target population for the present study was postnatal mothers who had normal vaginal delivery with episiotomy. C is the control group E is the experimental group O1 is the pre intervention assessment O2 is the post intervention assessment X is the intervention routinely administered in the hospital (sitz bath) X1 is the intervention which is introduced by the investigator ( Infra red therapy) SETTING OF THE STUDY: The study subjects were selected from Kempegowda Institute Of Medical Sciences and Research Centre. Sample A sample consists of a subset of the units that comprises the population. E = O1 .X1 .

Mothers with medical disorders or abnormal purerperium. In this study the purposive sampling was used to collect data from the available samples falling under inclusion criteria.Sample Size The sample size was 60 postnatal mothers who had vaginal delivery divided 30 each in control and experimental group. Mothers with episiotomy who are willing to participate in the study Exclusion criteria:    Mothers with infected perineum. REEDA Scale. 33 . Criteria for selection of sample Inclusion criteria:   Mothers who had full term vaginal delivery with episiotomy. Modified Verbal Descriptive Pain Scale. Mothers with operative vaginal delivery TOOL FOR RESEARCH Data collection tools are the procedures or instruments used by the researcher to observe or measure the key variables in the research problem The episiotomy pain and wound healing and pain was assessed with the following instruments: Demographic variables. Sampling Technique Sampling is the process of selecting a portion of the population to represent the entire population.

one expert in the field of medicine. A criterion rating scale of the tool was developed. Content Validity Content validity is the extent to which a measuring instrument provides adequate coverage of the topic under the study. Need modification.Modified Verbal Descriptive Pain Scale is the tool to assess the level of pain & REEDA Scale is the tool used for recording the wound healing. It consisted of columns like Very relevant.  REEDA scale was developed to assess the level of wound healing in episiotomy area. Relevant. the tool was given to 10 experts in the field of nursing. The following steps were undertaken to prepare the final tool:    Tool was developed based on related literature review and experts suggestions Demographic and clinical variables were developed to obtain baseline characteristics Modified Verbal Descriptive Scale was developed to assess the level of pain in the episiotomy area. Not relevant and remarks for suggestions from the experts for each item regarding accuracy. Modifications were made based on suggestion and comments given by the experts and the guide. The researcher did an extensive review of literature to collect relevant materials and based on it selected the tool for the study. To establish the content validity of the tool. relevancy and appropriateness of the content. DEVELOPMENT OF THE TOOL The tool was prepared on the basis of the objectives of the study. 34 .

It was used to identify the level of pain in the episiotomy area. DESCRIPTION OF THE TOOL: Demographic data Demographic variables and clinical variables consisted of total 9 variables like. occupation. Verbal Descriptive Pain Scale The pain scale was constructed based on the Verbal Descriptive Pain Scale given by Jack Harich (2002). The subjects in the study were asked to specify the point at which they feel pain. The reliability of the Verbal Descriptive Pain Scale and REEDA Scale was established for its equivalence by inter rater method after administering the tool to ten postnatal mothers in selected hospitals. parity and type of episiotomy. age. type of occupation. Karl – Pearson’s Correlation Coefficient formula was used to find the reliability. stability and homogeneity. It is thus concerned with consistency. place of living.96. accuracy. religion. The maximum score is 3. Point 0 indicates no pain and point 3 indicates severe pain.Reliability Reliability is defined as the extent to which the instrument yields the same result on repeated measures. education. dietary pattern. It is a pain scale ranging 0 to 3. 35 . The reliability of Verbal descriptive pain scale is 0.89 and for the REEDA scale reliability is 0. thus the tools were found to be reliable.

Redness. Formal written permission obtained from the respective authorities. ecchymosis. the pilot study was conducted from 3’rd September ’2012 to 11th September’2012 to find out the feasibility of the study. DATA COLLECTION PROCESS Data collection was done in Kempegowda Institue Medical sciences and Research centre. Totally 10 postnatal mothers with episiotomy were selected by using purposive sampling technique. discharge. edema. The data collection done from 1st of November 2012 to 30th of November. Five samples are assigned to the control group (sitz bath) and five to the experimental group (infra red lamp therapy group).REEDA Scale The wound scoring scale was constructed based on the REEDA Scale given by Nancy Davidson (1972). The total score is 15 PILOT STUDY After having obtained formal administrative approval from the Medical superintendent. approximation are the five categories of the scale. Bangalore.The subjects for the pilot study possessed the same characteristics as that of the sample for the main study. The scoring for each category ranges from 0 to 3. 36 . Bangalore. HOD of OBG department and Nursing Superintendent of the Kempegowda Institute of Medical Science and Research Centre.

Post test was conducted on third day for both control group and experimental group by using the same tool. The mothers were intimated regarding the purpose of the study and their consent was secured. 60 postnatal mothers were selected from the postnatal ward. The episiotomy pain was assessed by Modified Verbal Descriptive pain Scale and wound healing was assessed by REEDA scale. Thirty(30) postnatal mothers got selected to the control group and another thirty(30) to the experimental group.Based on inclusion criteria. PLAN FOR DATA ANALYSIS Analysis is the systematic organization and synthesis of research data and testing of research hypothesis by using those data. A master data sheet was prepared by the investigator to organize and compute data. The plan of data analysis includes the following Section I: Distribution of demographic and clinical characteristics of the subjects is done by descriptive statistics. 37 . Pre test was conducted for both control and experimental group on the first day before starting therapy. Sitz bath was given to control group and infrared therapy to the experimental group for three days in the morning and evening for 15 minutes. Subjects were selected for postnatal ward on each day based on the inclusion criteria. The data would be analysed using both descriptive and inferential statistics based on the objectives and hypothesis stated. Samples were selected by purposive sampling technique.

Section VI: Association between pre test pain scores and selected demographic and clinical variables is done by using chi – square test. Section IX: Effectiveness of infrared therapy on episiotomy wound healing among experimental group is assessed by using paired t test. Section III: Effectiveness of sitz bath on episiotomy pain reduction among control group is assessed by using paired t test Section IV: Effectiveness of infrared therapy on episiotomy pain reduction among experimental group is assessed by using paired t test. Section X: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy wound healing is done by using student t test.Pain Section II: Assessment of episiotomy pain and comparison of pain scores among control &experimental group. Wound healing Section VII: Assessment of episiotomy wound status and comparison wound healing scores among control &experimental group is done by descriptive statistics. Section VIII: Effectiveness of sitz bath on episiotomy wound healing among control group is assessed by using paired t test. 38 . Section V: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain reduction among control and experimental group is assessed by using student t test.

Data collection method and Plan for data analysis.Section XI: Association between pre test wound scores and selected demographic and clinical variables is done by using chi – square test. Variables under study. Population. Sampling criteria. Development of tool. Research design. Reliability. Validity. SUMMARY This chapter deals with the methodology adopted for this study. Sample size. Setting. 39 . This included Research approach.

40 . Bangalore. Verbal descriptive pain scale and REEDA Scale Data collection technique: Structured interviews schedule & clinical assessment.Research purpose: To assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers with episiotomy. Data analysis: Descriptive and inferential statistics Findings and conclusion Report writing FIGURE :2 SCHEMATIC REPRESENTATION OF STUDY DESIGN. Research approach: Comparative Research design: Quasi experimental pre test post test design with a comparison group Samples:60 post natal mothers (30 in control &30 in experimental group) Target population: Postnatal mothers Sampling technique: Purposive sampling technique Accessible population: Postnatal mothers admitted KIMS. Data collection tool: Questinonnaire.

ordering. ii. To compare the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To determine an association between pain level & wound healing status with selected demographic variables 41 . Analysis is the process of categorizing.5. To assess the level of pain and wound healing status among postnatal mothers with episiotomy. manipulating and summarizing of data to obtain an answer to the research question. To assess the effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. iv. Objectives of the study i. RESULTS Analysis and interpretation of data This chapter presents the results of the study conducted to compare the effectiveness of sitz bath versus infrared therapy in reducing pain and improves wound healing among postnatal mothers of selected hospitals. iii. The purpose of analysis is to reduce the data to an intelligible and interpretable form so that relations for the research problem can be studied and tested19. in Bangalore.

data were entered in a master sheet. 42 .Hypotheses: H1: There is a significant difference between the mean pre test and post test pain & wound healing scores in sitz bath and infrared lamp therapy group. for tabulation and statistical processing. Section III: Effectiveness of sitz bath on episiotomy pain reduction among control group. H2: There is a significant difference in the mean post test scores between sitz bath and infrared lamp therapy group. H3: There is a significant association between pain &wound healing scores with selected demographic variables in sitz bath and infrared lamp therapy group. The findings were presented under the following heading Section I: Distribution of demographic and clinical characteristics of the subjects. Presentation of data: To begin with. Pain Section II: Assessment of episiotomy pain and comparison of pain scores among control &experimental group.

Section IX: Effectiveness of infrared therapy on episiotomy wound healing among experimental group. 43 . Section X: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy wound healing.Section IV: Effectiveness of infrared therapy on episiotomy pain reduction among experimental group. Section V: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain reduction among control and experimental group. Section VI: Association between pre test pain scores and selected demographic and variables. Section XI: Association between pre test wound healing scores and selected demographic variables. Section VIII: Effectiveness of sitz bath on episiotomy wound healing among control group. Wound healing Section VII: Assessment of episiotomy wound status and comparison wound healing scores among control &experimental group.

67 50 70 60 Percentage (%) 50 40 30 20 10 0 46.67 0 100 14 15 1 0 30 46.67 3.33 0 0 18. 44 . 66.29yrs 30-35yrs Above 35yrs Age in years Table 1 and figure 3 depict that.29 c) 30-35 d) Above 35 Total 20 8 2 0 30 66.67% of the subjects from control group were between the age group of 18 to 23 years where as 50% of the subjects from experimental group were between the age group of 24 to 29 years.67 Control group Experimental group 26.23yrs 24.Section I: Distribution of demographic and clinical characteristics of the subjects Table – 1: Distribution of subjects by age Variables Control group n1= 30 Frequenc Percenta y ge (f) (%) Age in years a) 18.33 0 100 Experimental group n2=30 Frequenc Percenta y ge (f) (%) Figure 3: Distribution of samples by age 66.67 6.66 26.66 50.00 3.67 6.23 b) 24.

67%) and experimental group(70%) were Hindus.67 Control group Experimental group 26. 45 .67 26.67 6.67 30 20 10 0 Hindu Muslim Religion Christian Others 6.66 0 0 20 10 Table 2 and figure 4 that majority of subjects in both control(66.Table 2: Distribution of samples by religion Variables Control group n1= 30 Frequen cy (f) Experimental group n2=30 Frequen cy (f) 21 6 3 0 30 Percenta ge (%) 66.66 0 100 Percenta ge (%) 70 20 10 0 100 Religion a) Hindu b) Muslim c) Christian d) Others Total 20 8 2 0 30 Figure 4: Distribution of samples by religion 70 70 60 Percentage (%) 50 40 66.

33 Control group Experimental group Percentage (%) 16.66 83.33%) and experimental(83.Table 3: Distribution of samples by education Variables Control group Frequency (f) n1= 30 Percentage (%) 0 16.33 10 100 a) b) c) d) Education No formal Primary Secondary/Diploma Graduation and above Total 0 5 22 3 30 Figure 5: Distribution of samples by education 90 80 70 60 50 40 30 20 10 0 83.67 10 10 Education Table 3 and figure 5 depict that majority of subjects in both control(73.67 0 0 6.66 73.33 10 100 Experimental group Frequency (f) 0 2 25 3 30 n2=30 Percentage (%) 0 6. 46 .33%) groups were having secondary/diploma education.33 73.

33 0 33.33 33.Table 4: Distribution of samples by occupation Variables Control group n1= 30 Frequen cy (f) Experimental group n2=30 Frequen cy (f) 21 9 0 30 Percenta ge (%) 63.33% and 70% respectively.33 100 Percenta ge (%) 70 30 0 100 Occupation a) Housewife b) Private c) Government Total 19 10 1 30 Figure 6: Distribution of samples by occupation 70 70 60 Percentage (%) 50 40 30 20 10 0 Housewife Private Occupation Government 3.33 03.33 Control group Experimental group Table 4 and figure 6 depict that both in control and experimental group majority were housewives ie 63. 47 .33 30 63.

33 40 Control group Experimental group 50 Percentage (%) 6. 48 .67 100 15 12 03 30 50 40 10 100 Figure 7: Distribution of subjects by type of family 50 50 45 40 35 30 25 20 15 10 5 0 43.67 10 Nuclear Joint Type of family Extended Table 5 and figure 7 depict that in control group 50% of subjects belonged to joint family whereas in experimental group 50% of subjects were from nuclear family.Table 5: Distribution of samples by type of family Variables Control group n1= 30 Frequen cy (f) Experimental group n2=30 Frequen cy (f) Percenta ge (%) Percenta ge (%) Type of family a) Nuclear b) Joint c) Extended Total 13 15 02 30 43.33 50 6.

67 Vegetarian Type of diet In relation to type of diet the data presented in above table and figure depict that.67% in control group &93.33 100 Figure 8: Distribution of samples by diet 96. majority of subjects (96.33 Control group Experimental group Percentage (%) 3.67 93.33 6.67 100 2 28 30 06.33 96. 49 .Table 6: Distribution of subjects by diet Variables Control group n1= 30 Frequen cy (f) Experimental group n2=30 Frequen cy (f) Percenta ge (%) Percenta ge (%) Dietary pattern a) Vegetarian b) Mixed Total 1 29 30 03.33 in experimental group) belonged to mixed diet group.67 100 90 80 70 60 50 40 30 20 10 0 Mixed 93.

50 .Table 6: Distribution of samples by place of living Variables Control group n1= 30 Frequenc Percenta y ge (f) (%) Experimental group n2=30 Frequenc Percenta y ge (f) (%) Place of living a) Rural b) Urban Total 6 24 30 20 80 100 9 21 30 40 60 100 Figure 8: Distribution of samples by place of living 80 80 70 Percentage(%) 60 50 40 30 20 40 60 control group Experimental group 20 10 0 Urban Place of living Rural The table 6 and figure 8 reveals that majority of subjects from both control and experimental group were living in urban area ie 80% and 60% respectively.

667 36.33%) were multiparas 51 .33% of subjects were primiparas and in control group and in experimental group majority (53.Table 8: Distribution of subjects by parity Variables Control group n1= 30 Frequenc Percenta y ge (f) (%) Experimental group n2=30 Frequenc Percenta y ge (f) (%) Parity a) Primi b) Multi c) Grand multi Total 19 11 0 30 63.33 46.33 0.67 Control group Experimental group Percentage (%) 50 40 30 20 10 0 Primi 0 Multi Parity 0 Grand multi The table 8 and figure 10 depicts that 63.0 100 Figure 10: Distribution of subjects by parity 70 60 63.66 0.33 53.0 100 14 16 0 30 46.66 53.33 36.

Table 9: Distribution of samples by type of episiotomy Variables Control group n1= 30 Frequenc Percenta y ge (f) (%) Experimental group n2=30 Frequenc Percenta y ge (f) (%) 0 0 28 2 30 0 0 80 20 100 Type of episiotomy a) Median b) Lateral c) RMLE d) LMLE Total 0 0 30 0 30 0 0 100 0 100 Figure11: Distribution of samples by type of episiotomy 100 100 90 80 70 60 50 40 30 20 10 0 80 Control group Experimental group Percentage (%) 20 0 0 0 0 RMLE 0 LMLE Median Lateral Type of episiotomy It revealed from the figure 9 and table 11 that 100% subjects form control group and 80% of subjects from experimental group were having right mediolateral episiotomy (RMLE). 52 .

Section II: Assessment of episiotomy pain and comparison of pain scores among control &experimental group. a) Assessment of episiotomy pain level Table 12: Pre test and post test pain level assessment in control and experimental group Pain range Severe Pain (3) Control group (n1= 30) Pre test Post test f % F % 12 40 0 0 53.33 6.67 0 12 15 3 40 50 10 Experimental group (n2=3 Pre test Post test F % F % 14 46.67 0 0 14 2 0 46.67 6.67 0 4 8 18 13.33 26.67 60

Moderate 16 pain(2) Mild pain(1) No Pain (0) 2 0

With regard to pre test scores, in control group majority (53.33%) reported moderate pain and remaining reported severe (40%) and mild pain (6.67%) where as in experimental group severe pain and moderate pain were reported by an equal percentage of 46.67% and a minority (6.67%) reported mild pain. Comparison of pain scores among control and experimental group Table 13: Mean, Median, Standard deviation, Range, Mean Percentage (%) of pre test and post test pain score in control group and experimental group. Group Score Mean Median Standard Deviation Range Mean Percentage(%) Control Group Pre test 2.23 2 0.61 2 74.33 Post test 1.3 1 0.65 2 43.33 Experimental Group Pre test 2.4 2 0.62 2 80 Post test 0.87 1 0.63 2 29

53

The data in the table shows that the mean percentage of pre-test and post-test in control group was 74.33 and 43.33 respectively, whereas in experimental group it was 80and 29 respectively which shows that the pain score of experimental group during post-test was lower when compared with other pain scores.

Section III: Effectiveness of control group

sitz bath on episiotomy pain reduction among

This section deals with the analysis and interpretation of pain score in postnatal mothers in the episiotomy area. Paired ‘t’ test is done to analyse the pre test and post test. In order to test the statistical significance null hypothesis was stated. H0: There is no significant difference between the pre test pain scores and post test pain scores in control group. Table 14: Pre test and post test pain scores comparison in control group Group Pre test Post test Mean 2.3 1.3 SD 0.61 0.65 ‘t’ value Inference

13.68

*S t(29,0.05)=1.699

The data presented in above table shows that the pre-test mean pain score was 2.3 with S.D of 0.61 and post test mean pain score was 1.3 with S.D of 0.6 which indicates that there was decrease in the pain score during post test. The paired ‘t’ test value (13.68) shows there is a significant difference between pre test and post test wound score at 0.05 level. This implies that sitz bath was effective in episiotomy wound healing.

54

Section IV: Effectiveness of infrared therapy on episiotomy pain reduction among experimental group

This section deals with the analysis and interpretation of pain score in postnatal mothers in the episiotomy area. Paired ‘t’ test is done to analyse the pre test and post test. In order to test the statistical significance null hypothesis was stated. H0: There is no significant difference between the pre test pain scores and post test pain scores in experimental group. Table 15: Pre test and post test pain scores comparison in experimental group Group Pre test Post test Mean 2.4 0.87 SD 0.62 0.63 ‘t’ value Inference

14.69

*S t(29,0.05)=1.699

The data presented in above table shows that the pre-test mean pain score was 2.4 with S.D of 0.62 and post test mean pain score was 0.87 with S.D of 0.6 3 which indicates that there was decrease in the pain score during post test. The paired ‘t’ test value (14.69) shows there is a significant difference between pre test and post test pain score at 0.05 level. This implies that infrared therapy was effective in episiotomy wound healing.

The student t test shows that infrared therapy is effective in reducing episiotomy pain as the calculated t value is greater than the table t value.

55

87). Student ‘t’ test was used to compare the effectiveness between sitz bath and infrared therapy in control and experimental group.Section V: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain reduction This section deals with the analysis and interpretation of pain score after sitz bath and infrared therapy on postnatal mothers. In order to test the statistical significance null hypothesis is stated. Student‘t’ test value (2. It means that infrared therapy was effective in episiotomy pain reduction 56 .87 SD 0.0.62 *S t(58.63 ‘t’ value Inference 2.67 The data presented in above table shows that mean post test score of control group (1.test pain scores of control and experimental group.62) shows that there is significant difference between post. H0: There is no significant difference between the post-test pain scores of control and experimental group. Table 16: Comparison of Post test pain scores in control and experimental group Group Control Experimental Mean 1.05)=1.3) was higher than the experimental group score (0.3 0.65 0.

07NS 2 0.54NS 1 1 1.72NS 2 0.07NS 27 6 0.17NS 2 1 1 0 2 0 0 0 2 0 2 Above median 19 7 2 18 8 2 18 8 2 18 1.67NS 2 pre test Chisquare value df 57 .16NS 10 1 0 1 1 0 0 2 2 9 12 14 2 1 0.Section VI: Association between pre test pain scores and selected demographic and clinical variables a) Control group Demographic variables Responses Overall knowledge Below median 18-23 Age (yrs) 24-29 >35 Hindu Religion Muslim Christian Primary Education Secondary Graduation House wife Occupation Private Nuclear Family Joint Extended Diet Vegetarian Mixed Rural Place of living Urban Parity Primi Multi 20 1 1 22 8 0.78NS 2 1.

43NS 2 8.10NS 15 2 0.57S 2 2.59NS 7 13 12 3 2 0.15NS 26 1 1 1 1 2.15NS 26 9 0.92NS 19 `13 0.14NS 2 pre test Chisquare value Df 58 .a) Experimental group Demographic variables Responses Overall knowledge Below median Age (yrs) 18-23 24-29 >35 Hindu Religion Muslim Christian Primary Education Secondary Graduation Occupation House wife Private Family Nuclear Joint Extended Diet Vegetarian Mixed Place of living Rural Urban Parity Primi Multi Episiotomy RMLE LMLE 2 0 0 0 2 0 0 2 0 1 1 2 0 0 0 2 0 2 1 1 0 2 Above median 13 14 1 21 4 3 2 23 3 31 0.14NS 2 2 0.

all subjects (100%) had moderate wound infection in both control and experimental group.33 0 Moderate infection 30 (6-10) Severe Pain (11-15) 0 With regard to pre-test scores. For the purpose of establishing the association between the demographic variables and the overall pain score is divided into two categories as below median and above median The chi – square test analysis shows that there is no significant association between pre test episiotomy wound scores and selected demographic & clinical variables at 0. 59 .67 0 Experimental group(n2=30) Pre test Post test F % F % 0 0 0 0 0 30 0 0 100 0 5 25 0 16.57)only in experimental group.05 level in both control and experimental group with an exemption of religion which has shown significant association (x2= 8.This section explains association between episiotomy pain scores and selected demographic variables. WOUND HEALING GRADING Section VII: Assessment of episiotomy wound status and comparison pain scores among control & experimental group a) Assessment of episiotomy wound status Pre test and post test wound healing grading in control and experimental group Wound healing No infection (0) Mild infection (1-5) Control group(n1=30) Pre test Post test f % F % 0 0 0 0 0 0 100 0 7 23 0 23.67 83.33 76.

38 4. H0: There is no significant difference between the pre test wound scores and post test wound scores in control group.43 4.00 1.00 54.00 The data in the table shows that the mean percentage of pre-test and post-test in control group was 53. Mean Percentage(%) of pre test and post test wound healing score in control group and experimental group.13 and 46 respectively. Range. Median.20 Post test 6.13 8.25 4. In order to test the statistical significance null hypothesis was stated. Section VIII: Effectiveness of sitz bath on episiotomy wound healing among control group This section deals with the analysis and interpretation of wound score in postnatal mothers in the episiotomy area.00 1.00 1.90 7.00 53.2 and 46 respectively which shows that there were no difference in post-test wound scores among control and experimental group.00 46. whereas in experimental group it was 54. Paired ‘t’ test is done to analyse the pre test and post test.00 1. Group Score Control Group(n1=30) Pre test Mean Median Standard Deviation Range Mean Percentage (%) 7.53 6.b) Comparison of wound healing scores among control & experimental group Mean.00 46. 60 .90 7. Standard deviation.13 Post test 6.00 Experimental Group(n2=30) Pre test 8.97 8.

53 which indicates that there was decrease in the wound score during post test.96) shows there is a significant difference between pre test and post test wound score at 0.86 Mean SD ‘t’ value Inference 7.97 1. This implies that sitz bath was effective in episiotomy wound healing.05 level. Section IX: Effectiveness of infrared therapy on episiotomy wound healing among experimental group This section deals with the analysis and interpretation of wound score in postnatal mothers in the episiotomy area.699 S The data presented in above table shows that the pre-test mean wound score was 7.0.D of 1.43 and post test mean wound score was 6.86 with S.53 4. In order to test the statistical significance null hypothesis was stated.96 t(29.D of 1.Table 17: Pre test and post test wound healing scores in control group Group Pre test Post test 6. Paired ‘t’ test is done to analyse the pre test and post test.05)=1. The paired‘t’ test value (4. H0: There is no significant difference between the pre test wound scores and post test wound scores in experimental group.43 1. 61 .97 with S.

59) shows there is a significant difference between pre test and post test wound score at 0.D of 1. Student ‘t’ test was used to compare the effectiveness between sitz bath and infrared therapy in control and experimental group.13 with S. H0: There is no significant difference between the post test wound healing scores of control and experimental group.93 SD 1.Table 18: Pre test and post test wound healing scores in experimental group Group Pre test Post test Mean 8. This implies that infrared therapy was effective in episiotomy wound healing.25 which indicates that there was decrease in the wound score during post test. The paired ‘t’ test value (6. In order to test the statistical significance null hypothesis is stated.13 6.38 and post test mean wound score was 6.0.699 The data presented in above table shows that the pre-test mean wound score was 8.D of 1. Section X: Comparing the effectiveness between sitz bath and infrared lamp therapy on episiotomy wound healing among control & experimental group This section deals with the analysis and interpretation of wound healing score after sitz bath and infrared therapy on postnatal mothers.05 level.59 S t (29.25 ‘t’ value Inference 6.93 with S.38 1.05)=1. 62 .

Table 19: Post test wound healing scores in control and experimental group Group Control Experimental Mean 5. 63 .test wound scores of control and experimental group.67 The data presented in above table shows that mean post test score of experimental group (5.67 1. 0.34 ‘t’ value Inference 0. Student ‘t’ test value (0.19 NS t (58. It means that there is no comparable difference among sitz bath and infrared therapy in promoting episiotomy wound healing.07 SD 1.13 5.13).19) shows that there is no significant difference between post.05)=1.07) was slightly lower than the control group score (5.

Section XI: Association between pre test pain scores and selected demographic and clinical variables a) Control group Demographic variables Responses Overall knowledge Below median Age (yrs) 18-23 24-29 >35 Hindu Religion Muslim Christian Primary Education Secondary Graduation Occupation House wife Private Government Family Nuclear Joint Extended Diet Vegetarian Mixed Place of living Rural Urban Parity Primi Multi 7 5 0 9 2 1 1 10 1 9 2 1 3 8 1 0 2 0 2 1 1 Above median 4 12 2 11 6 1 4 12 2 11 7 0 10 7 1 1 0.23NS 2 pre test Chisquare value df 64 .74NS 2 2.16NS 10 1 1 1 0.89NS 2 1.16NS 2 1.07NS 27 6 0.04NS 2 3.54NS 22 18 0.

24NS 17 1 1 1 1 0.57NS 2 3.64NS 6 10 7 2 2 1.22NS 2 1 2.34NS 14 8 0.24NS 17 5 0.77NS 2 pre test Chisquare value df 65 .b) Experimental group Demographic variables Responses Overall knowledge Below median Age (yrs) 18-23 24-29 >35 Hindu Religion Muslim Christian Primary Education Secondary Graduation Occupation House wife Private Family Nuclear Joint Extended Diet Vegetarian Mixed Place of living Rural Urban Parity Primi Multi Episiotomy LMLE RMLE 7 3 1 7 3 1 1 10 0 9 2 5 5 1 0 11 4 7 6 5 0 11 Above median 8 11 0 14 3 2 1 15 3 13 0.01NS 2 0.43NS 11 2 1.

education. Sitz bath were received by control group and infrared therapy was administered for experimental group for three days after conducting pre-test.This section explains association between episiotomy wound scores and selected demographic variables. 66 . infrared light therapy and sitz bath were found to have same effect in healing and condition of healing.99 SUMMARY This chapter has dealt with the analysis and interpretation of the findings of the study. The result concluded that mothers who had undergone the treatment of infrared light therapy expressed decreased pain intensity compared to mothers who had undergone the treatment of sitz bath.841. Note: Critical value for 1 degree of freedom at 5%level of significance=3. place of living. religion. Critical value for 1 degree of freedom at 5%level of significance=5. diet.05 level in both control and experimental group. With regard to wound healing. type of family. occupation. For the purpose of establishing the association between the demographic variables and the overall wound score is divided into two categories as below median and above median The chi – square test analysis shows that there is no significant association between pre test episiotomy wound scores and selected demographic & clinical variables such as age. The data obtained was entered in the master sheet and computed using descriptive and inferential statistics. parity and episiotomy at 0. Post test conducted after the completion of three days therapy.

The sample size comprised of 60 postnatal mothers (30 in control &30 in experimental group). Bangalore. The present study was done to compare the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among post natal mothers at selected hospitals. quasi experimental pre-test and post-test design with a comparison group was adopted to compare the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing. so that patterns and relationship can be discussed. 67 . The study was conducted at Kempegowda Institute of Medical Science. In this study. Evaluation of effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing. Demographic characteristics of the subjects. Association between demographic variables and pre test pain & wound healing scores. analyzed in an orderly and coherent fashion. DISCUSSION In order to find meaningful answers to research questions. Hospital and Research Centre. analyzed and interpreted by using descriptive and inferential statistics. Findings of the study: The findings of the study have been organized and discussed under the following sections: The findings of the study are discussed under the following headings: 1. 2. Bangalore. 3. Data collected from the subjected were tabulated. based on the objectives of the study.6. the collected data must be processed. Assessment of level of pain and wound healing status among postnatal mothers. The purposive sampling technique was used to select the sample. 4.

6.33% of subjects had secondary/ Diploma education. were house wives. majority 63. In experimental group.66% had primary education. Occupation: In control group. Similarly. 16.66% were between 18-25 years. Discussion on testing of the hypothesis. and 68 .67% belonged to Muslim and remaining 6. Education: In control group. majority 73. 3. 20% belonged to Muslim and remaining 10% belonged to Christian. 26. 46. 2. and remaining 3.67% belonged to 24 -29 years.67% belonged to 24 -29 years. majority 70% belonged to Hindu religion. and 10% had attained graduation. and 10% had attained graduation. most of the subjects that is 66.67 % belonged to 26-33 years.33 % belonged to 26-33 years. majority 83. The findings of the study shows that.5.33% were private employees and remaining 03. In experimental group. DEMOGRAPHIC CHARACTERISTICS OF THE SUBJECTS.33% of subjects had secondary/ Diploma education. 33. majority 66. majority 70% remaining 30% were private employees. 1.67% of the subjects belonged to Hindu religion. in experimental group. Similarly in experimental group. Age: In control group.66% had primary education. most of the subjects that is 50% were between 18-25 years. and remaining 6. Religion: In control group.33% were house wives. 26.66% belonged to Christian. 4.33% were government employees.

9. 69 . majority 93. Parity: In control group.33% of the subjects belonged to mixed diet group. 43. majority 96.67% were primiparas. majority of the subjects that is 80% were from urban area and remaining 20% from rural area.5. 40% belonged to nuclear family and remaining 10% belonged to extended family.67% were multiparas.33% belonged to vegetarian diet group. 8. majority 63. 50% of the subjects belonged to joint family. In experimental group. 7. 50% of the subjects belonged to joint family. 53. and remaining 6. Type of episiotomy: In control group.33% belonged to nuclear family and remaining 6. Type of family: In control group. majority 80% had right mediolateral episiotomy and remaining 20% had left mediolateral episiotomy. all subjects (100%) had right mediolateral episiotomy. Place of living: In control group. 6.33% of subjects were multiparas and remaining 46.67% belonged to extended family.67% belonged to vegetarian diet group.33% of subjects were primiparas and remaining 36.67% of the subjects belonged to mixed diet group. majority of the subjects that is 60% were from urban area and remaining 40% from rural area. In experimental group. and remaining 3. In experimental group. Diet: In control group. Similarly in experimental group. Similarly in experimental group.

The findings are supported by a similar study conducted to identifying the frequency. The findings of related to the pain level in the present study supported by a similar study conducted by Imarengiaye CO and Andet AB in Nigeria to identify the place of postpartum perineal pain as morbidity in the immediate postpartum period.9%). by De Oliveira SM and Miquilini EC in Portuguese.33%) reported moderate pain and remaining reported severe (40%) and mild pain (6. with it there is a lesser risk of complications(16. The results show that episiotomy was performed in 76.2% of the normal births. The most mentioned type was the right medio. in control group majority (53. The results revealed that episiotomy was twice likely to produce perineal pain than no trauma group at time of 70 .67% and a minority (6. it is adopted routinely((19. In this study 12 doctors and 12 nurses who attend women at birth interviewed. ASSESSMENT OF LEVEL OF PAIN AND WOUND HEALING STATUS AMONG POSTNATAL MOTHER The present study confirms that with regard to pre test scores. the types and the criteria adopted to recommend episiotomy. All (100%) had moderate wound infection in both control and experimental group. the most frequent indications were perineal rigidity and primiparity.67%) reported mild pain. All women over 18 years who were delivered of a live neonate vaginally and were in hospital for at least 3 days after delivery were studied.4%).1%)50.1%).lateral episiotomy (92%). and the justifications were: it was learned during academic formation(25.67%) where as in experimental group severe pain and moderate pain were reported by an equal percentage of 46. with it there is a lesser chance for causing lesions to the anal sphincter(16.

9 respectively) are lower than that of the mean pre test pain & wound scores (2. The findings of related to the wound healing status in the present study supported by a similar study conducted by Uygur D. there were 37 patients with episiotomy wound dehiscence. This implies that sitz bath and infrared therapy was effective in reducing episiotomy pain and wound healing. Infection was obvious cause of dehiscence in the majority (25 out of 37) of women.23 & 7. Similar results were also found in the studies reviewed. EVALUATION OF EFFECTIVENESS OF SITZ BATH AND INFRARED LAMP THERAPY ON EPISIOTOMY PAIN AND WOUND HEALING.84 & 6. mean post pain and wound scores (1. 71 .9respectively) is lower than that of the mean pre test pain & wound scores (2.4 & 8. The study concluded that the rate of episiotomy wound infection was high in the study population52. The study concluded that perineal pain increased with perineal trauma and episiotomy and the current management of post partum perineal pain is inadequate51.3 & 6.discharge on day 3 (RR=2. mean post pain and wound scores (0.9 respectively). Yesildaglar N in Turky to determine the outcome of episiotomy. In the study period.4). In control group.13 respectively). Similarly in experimental group. The present study shows that there was a considerable improvement of the episiotomy pain and wound healing scores after administration of the sitz bath and infrared lamp therapy and is statistically established as significant.

there was no significant association found at 0. mother’s weight and previous infection41.05 level between pre-test pain & wound scores of postnatal mothers and demographic variables in both control and experimental group. .82) and the results were statistically significant43. However. education. The finding of the present study was similar to a study conducted by John Esther on “Effectiveness of infrared therapy on healing episiotomy wound in postnatal mothers” in which there was no association between healing of episiotomy wound with selected demographic and obstetrical variables such as age. 72 . Two experimental group were selected in terms of infra red lamp therapy and sitz bath.The findings of the present study supported by a similar study conducted by V. there was a significant association only between religion and the pre-test pain scores in experimental group (x2=8. income. obstetrical score. ASSOCIATION BETWEEN DEMOGRAPHIC VARIABLES AND PRE TEST PAIN & WOUND SCORES. haemoglobin.05 level of significance). mode of delivery. Dhanalakshmi in Coimbatore. which influence the wound healing process and pain perception. India to assess the effectiveness of infrared therapy and sitz bath. number of vaginal examinations. The results revealed that sitz bath and infrared lamp therapy and sitz bath found to be effective in healing episiotomy and mothers underwent for infra red lamp therapy experienced decreased pain intensity (t=2.57 is more than the table value at 0. In this study when demographical variables were analyzed.

H3: There is a significant association between pain &wound healing scores with selected demographic variables in sitz bath and infrared lamp therapy group. The investigator accepts the research hypothesis H2 as there is significant difference in the mean post test pain scores between sitz bath and infra red lamp therapy group. The investigator accepts the research hypothesis H3 because there is significant association between religions in experimental group with pre test pain scores. significant difference in the mean post test wound scores was not evident. H2: There is a significant difference in the mean post test scores between sitz bath and infrared lamp therapy group. 73 . However. The research hypothesis H1 stated in the study is accepted since there is significant difference between the mean pre test and post test pain & wound healing scores in control and experimental group at P<0.05 level after administration of sitz bath and infrared lamp therapy administration respectively. H1: There is a significant difference between the mean pre test and post test pain & wound healing scores in sitz bath and infrared lamp therapy group.DISCUSSION ON TESTING OF THE HYPOTHESIS.

SUMMARY This chapter dealt with the discussion of results under various headings. Demographical variables discussed in the beginning section followed by effectiveness of sitz bath and infrared therapy and its association with demographic variables. The result was discussed in terms of objectives and the hypothesis formulated. 74 .

square test showed that there was no significant association between pre test pain scores and selected baseline characteristic in both control and experimental group with an exemption of religion which has shown significant association with pre test pain score only in experimental group. 75 . Implications in Nursing The findings of the study have several implications for nursing education.6. and promoting wound healing. The present study was conducted in order to find the effectiveness of sitz bath versus infrared therapy in reducing episiotomy pain and wound healing. education. CONCLUSION This chapter presents the conclusion which has drawn based on the findings of the study. the result showed significant difference between the mean scores of pain and wound healing in both control and experimental group before and after administration of sitz bath & infrared therapy and was demonstrated using ‘t’ test analysis. practice and research. Administration of sitz bath and infrared therapy were found to be effective in reducing episiotomy pain . And student ‘t’ test showed that there was significant difference between post-test scores of pain in both control and experimental group. The computed chi. administration. administration and research The pain and delayed healing of the episiotomy wound are the main problems of postnatal mothers in the puerperium. It also include the implications for nursing practice.

The knowledge about infrared lamp therapy will help the nurses to provide beneficial care to the postnatal mothers during puerperium. Continuing education is the key component to update and improve the knowledge of the individual. nursing administrator can arrange the periodic in service education programme for the staff nurses regarding uses of infrared therapy. 76 . The use of non-pharmacological measures like infrared therapy can be incorporated in nursing education along with other contemporary therapies. The findings of this study can be utilized by nursing personnel while providing care for the postnatal mothers. Nursing administrator should organize periodic educational programme for nursing staff to improve their knowledge and skill.Nursing education Nursing education prepares the nurses to function as a good educator. To equip nurses to provide holistic care to their clients. Nursing administration There is an increasing need for quality and holistic care in today’s health care system. The nurse educators have the responsibility to update the knowledge of the nursing personnel in order to meet the needs of postnatal mothers and solve their difficulties related with episiotomy wound. It has a vital role in the field of the nursing profession. the nursing curriculum should be covered with several types of non – pharmacological measures such as infrared therapy for episiotomy pain and wound healing. Thus the student nurses can be guided in developing the right attitude and skills required for caring the patients with episiotomy wound. In collaboration with education department.

lavender oil application and self care on episiotomy wound will help the nurses attain more knowledge and it will initiate them to provide more quality care for the patients. Each hospital can make their own practice models for this type of treatment. 77 . cold therapy. The appropriate measures and proper management of episiotomy pain and wound healing will help in reducing the sufferings during postnatal period.Nursing practice Confronting with episiotomy pain and delayed wound healing are the common problems that interfere in the care of the baby and also in the self care during the puerperium. in the area of clinical practice. further studies could be conducted in the hospital with increased frequency for larger samples. Therefore there is great need for adopting more measures for the management of episiotomy during the puerperial period. Several researches on non – pharmacological therapies like heat therapy. Since it is a new method nurses as well as postnatal mothers need to be introduced to this method of treatment. Nursing research Episiotomy pain and delayed wound healing will extent the number of days of hospital stays among postnatal mothers with normal vaginal delivery. in service education programme regarding infrared therapy can be conducted to know the various upcoming benefits of infrared therapy for providing care for the episiotomy wound . Such knowledge generated through research will help in more popular implementation of different type of therapy in this area. as it was found to be one of the effective measures in reducing pain and improves wound healing with no side effects. For the generalization of infrared light application.

The study can be conducted in different settings with similar facilities 4. Infrared therapy was limited to three days therapy for each patient.Limitation 1. A comparative study can be conducted on the effectiveness of infrared therapy between urban and rural area 8. 7. A comparative study can be conducted between infrared therapy and pharmacological measures. A comparative study can be conducted with hot and cold therapy 5. Recommendation 1. A comparative study can be conducted between primiparous women and multiparous women to assess the effectiveness of infrared therapy 9. A similar study can be conducted by selecting a larger sample on a long-term basis 3. The time duration for therapy was limited to 15 minutes in morning and evening. 3. A comparative study can be conducted between infrared therapy and other non pharmacological measures 6. The study was confined to only 60 postnatal mothers and limited to one hospital 2. A descriptive study can be conducted on the awareness of postnatal mothers about non pharmacological methods of care of episiotomy 78 . 2. A similar study can be conducted with increased frequency of administration of infrared lamp therapy which may yield more reliable result.

SUMMARY The present chapter dealt with the findings of the study related to demographic characteristics. nursing practice. nursing administration and nursing research areas. effectiveness of sitz bath & infrared lamp therapy and includes the major implications of the nursing service related to nursing education. 79 .

H3: There is a significant association between pain &wound healing scores with selected demographic variables in sitz bath and infrared lamp therapy group. The study attempted to examine the following research hypothesis:H1: There is a significant difference between the mean pre test and post test pain & wound healing scores in sitz bath and infrared lamp therapy group. meeting the needs of the patients becomes a major challenge in the current nursing practice. To assess the effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. II. III. The main aim of the study was to assess the effectiveness of infrared therapy on episiotomy pain and wound healing. The main objectives of the study were:I. To assess the level of pain and wound healing status among postnatal mothers with episiotomy. H2: There is a significant difference in the mean post test scores between sitz bath and infrared lamp therapy group. With the increasing needs of the postnatal mothers having episiotomy. IV. SUMMARY This chapter presents the summary of the study.8. 80 . To compare the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To determine an association between pain level & wound healing status with selected demographic variables.

prescription and realities. 60 postnatal mothers were selected by purposive sampling technique. The research design selected for the study was quasi experimental. The independent variable was infrared therapy and dependent variables were episiotomy pain level and wound healing status in pre-test and post-tests. pre-test and post-test design with comparison group. literatures related episiotomy. consist of three steps that is central purpose. 9 experts validated the content validity of the tools and tool was found to be reliable and feasible. In this study various literatures were reviewed which includes. tool proved to be comprehensible. The target population was postnatal mothers. effectiveness of sitz bath and effectiveness of infrared lamp therapy.The conceptual frame work utilized in this study was based on Ernestine Wiedenbach’s helping art of clinical nursing theory.89 for Verbal descriptive pain scale and r=0. 81 . feasible and acceptable. Pilot study was conducted on 3/10/12 to 12/10/12 as a part of the major study.96 for REEDA Scale. The reliability of the tools were established by Spearman’s Brown Prophecy formula where r=0. The tool developed and used for the data collection was Verbal descriptive pain scale and REEDA Scale. The permission was obtained from authorities of hospitals and consent taken from study subjects.

and inferential statistics like paired ‘t’ test was included to test the hypothesis and Chi-square test was included to test the association of pain scores with demographic and clinical variables and the data obtained are presented in the graphical form. Major findings of the study In control group  Majority (66. 82 .  Half of the subjects (50%) were belonged to joint family and remaining to nuclear and extended family.33%) were educated till secondary/diploma education .  All subjects (100%) had right mediolateral episiotomy.67%) of the subjects belong to the age group of 18-23 years.  Most of subjects (63.67%) were non vegetarians.  Majority of subjects (80%) resided in urban area.  Majority (73. The Data gathered were analyzed and interpreted according to objectives. The pre-test was administered followed by interventions (sitz bath to control group & infrared therapy to experimental group for 3 days for twice daily).  All most all subjects (96. median and standard deviation.Data collection procedure for main study began from 01/11/2012 to 30/11/2012.33%) of subjects were housewives. post-test was taken after 3 days of administering the interventions by using the same Verbal descriptive pain scale and REEDA scale used in the pre-test.33%) were primiparas.  Majority (63.67%). Descriptive statistics like mean.  Most of the subjects were Hindus (66. The investigator personally explained the need and assured them of the confidentiality of their responses.

05 level. 83 .62 (pain) and 0. not between post test wound scores. whereas in experimental group it was 80and 29 respectively which shows that the pain score of experimental group during post-test was lower when compared with other pain scores.  Half of the subjects (50%) were belonged to nuclear family and 40% to joint family.33%) were from mixed diet grop. This implies that sitz bath and infrared therapy was effective in reducing episiotomy pain and wound healing.  Majority of subjects (93.  There was a significant difference between pre test and post test pain score and wound healing score in both control and experimental group at 0. It means that infrared therapy more effective than sitz bath in episiotomy pain reduction where as with regard to wound healing.  The unpaired t test values 2.33 respectively.  The mean percentage of pre-test and post-test in control group was 74. and reaming 10% were from extended family.  Majority of the subjects (70%) were housewives.  Majority of subjects (60%) resided in urban area.  Majority of subjects (60%) were multiparas.  Most of the subjects (80%) had right mediolateral episiotomy. both sitz bath and infra red therapy have same effect.33 and 43.In experimental group  Half (50%) of the subjects belong to the age group of 24-29 years.19 (wound healing) shows that there is significant difference only between post test pain scores.  Majority of subjects (70%) were Hindus.  Most of the subjects (83.33%) were educated till secondary/diploma education.

square test. parity and type of episiotomy with pre test pain & wound healing scores in both control and experimental group.05 level of significance. education. there was significant association only between religion and the post-test pain scores in experimental group. 84 . The association between pre test pain &wound healing scores and demographic variables were computed by using Chi. family. place of living. There were no significant association between age. However. religion. occupation.  The investigator accepts the research hypotheses stated in the study at 0. diet.

Ligia de Sousa. Obstet Gynecol 79: 945 –949. et al :Selected use of : Effect on perineal trauma. Churchill Livingstone. Measurement and characteristics of pain after episiotomy and its relationship with the activity limitations. Hofmeyr J. Robinson S. Midwives. 14th ed: Philadelphia. 7(2):194-20 10. 6(1): 25-39 4. Pharmacological and non pharmacological treatment for relief of perineal pain after vaginal delivery. Banta HD Benefits and risks of episiotomy.65(2). Neilson J. Available from: URL:http://www. Perineal care: a series of five randomised controlled trials. Myles text book for midwives. Thacker SB. Ana Carolina Sartorato Beleza. Bowes W.A.com Januvary 1. Cristine Homsi Jorge. Effectiveness of self perineal care on Episiotomy wound healing. Z Zainur. A Guide to Effective Care in Pregnancy and Childbirth. Ana Márcia Spanó Nakano.2003. 2007. Joyce Hasegwa. 199-251. 3rd ed. vol. Keirse MJNC. 2009. 5. The Indian Journal of Nursing and Midwifery 2003 Sep.Survey 1983: 38(6): 322-338. Duley L. Crowther C.1992 6.632 3. Fraser D M. p. Cooper M. Oxford: Oxford University Press. 2000 9. Hodnett E. Brame R.9. Noronha Judith. Enkin M. enferm.practicalpainmanagement. BIBLIOGRAPHY 1. Rev.What we can do” Med J Malaysia 2006 Dec 61(5) 2. Thompson A. an interpretive review of the English language literature 1860 Obst Gynecol. 2011 85 . “Postpartum morbidity . Therapy for management of childbirth perineal tears.P . bras. Einstein. Lucila Coca Levenhal. In: Sleep J. Ferreira. London: Champman & Hall. 8. Thorpe H. 7. research and childbirth.

Pharmacological and non pharmacological treatment for relief of pain after vaginal delivery. Midwifery. Kerr’s operative obstetrics. Sabaratnam Arul kumaran.org/. Andrew A Calder. P 253 12. Jadhav Sonali Tarachand. Said J. London.P.11. 1992 Dec. Medves. Gopal Palani. 1977. 2005. Einstein. HedegaardM. John Martin Munro Kerr. 17. 19. Brazil. BekKM. Sherburn M. 4th ed. MoraesFilhoOB. Elsevier Sounders. Sriramachandra journal of medicine.155-159 20.105-106. Non walk: Appleton and Lange publishers. and J. East CE. 2010 May-Jun.2010 15.M. Rekha R. Rev Assoc Med Bras.Prevalence and factors associated with practice of episiotomy at a maternity school in Recife. Joyce Hasegawa. Chithraa Devi Dharmappal “et al”. Nursing research.oxfordjournals. B. 1st ed: New delhi. Nagle C. Pernambuco. SouzaAS. Sathiyasekaran. Lucila Coca Leventhal. Philadelphia: Lippincott company.56(3):333-9 in 86 .W. SecherNJ.Accessed2010 14. G. Bernadette P. 11th ed. 18. Perineal pain following childbirth: Prevalence.jabfmorg/cgi/content/full/18/1/18. Episiotomy rate in India: URL:http://jpubhealth.Episiotomy and perineal lesions spontaneous vaginal deliveries Br J Obstet Gynaecol. (7): 194 – 200. Annamma Jacob. 1999. 6th ed.D. effects on postnatal recovery and analgesia usage. George B Julia B. CarvalhoCC. 2009. Clinical nursing procedures: The arts of nursing practice. Forster D. Episiotomy rates around the world: An update. 2011 Jan. Popualtion based study of episiotomy. Thomas F Baskett. Ramesh Harihara Iyer. 32: 219-22 13. Jaypee publications 2007. Denise F Polit. 99(12): 950-4 22. HenriksenTB. EpisiotomyrateinBangalore:URL:http://www. I. Hungler. C. Shanthi Edward. Graham. 2007 Nov 16. Munro. 179-191 21. Birth.C. 2009. Nursing theroies. Davies.P.P. Carroli.

Carroli G. 2002 Jun.150(2):142-6. Morris EP.176(2):411-4 29.27(1):3-12.23. Cleary-Goldman J. Webb DA. Br J Obstet Gynaecol. 2008 Jan.29(2):132-6 27. 25. 2003 Feb.(17): 50-52 31. Felt-Bersma RJ. Cuesta MA.115(1):104-8. De Leeuw JW. Episiotomy for vaginal birth. Cochrane Database Syst Rev. 1997 May. A comparison of cold and warm sitz baths for relief of postpartum perineal pain. Healing advantages of lavender essential oil during episiotomy recovery: A clinical trial. Poen AC. Katayon Vakilian. 1997 Feb. Ecker JL. BJOG. Revicky V. 87 . Semin Perinatol. The role of episiotomy in current obstetric practice. 1986 November-December. 15(6):471-4. . Mahtab Atarha . Mukhopadhyay S. Birth. Bruinse HW. Mignini L.104(5):563-6 28.(1). 2010 Jun. Reza Chaman. Ramler D. Kilpatrick SJ. 2009 Jan 21. 30. Is there a benefit to episiotomy at operative vaginal delivery? Observations over ten years in a stable population. 24. Am J Obstet Gynecol. Culhane J. Tan WM. Dekker GA. Kuijken JP. Nirmal D. Hospital variation in episiotomy use and the risk of perineal trauma during childbirth. Mediolateral episiotomy reduces the risk for anal sphincter injury during operative vaginal delivery. Meuwissen SG. Could a mediolateral episiotomy prevent obstetric anal sphincter injury? Eur J Obstet Gynecol Reprod Biol. Third degree obstetric perineal tears: risk factors and the preventive role of mediolateral episiotomy. De Wit C. 26. Nieto JJ. Bishop JT.Journal of Obstetrics Gynecol ogy and Neonatal Nurse. Bansal RK. Roberts J. Robinson JN. Devillé W. Complementary Therapies in Clinical Practice 2011. Reza Bekhradi.

.Helen. 33. M. 2012 May. 18(2) 124-9 36. 2006 Feb. Vimiji. Onley Community Health Center.V. Feb. Perdita M.67. Jo Lafoy. Hur MH. Onancock. Nightingale 88 . Effectiveness of infrared therapy upon Episiotomy pain and Wound healing in postnatal mothers. Jain A. Venkatesan Latha. S. 34. J Obstet Gynecol Neonatal Nurs. 4(11): 60-1. Talar tejirian. Effectiveness of infrared radiations in healing of episiotomy wound in postnatal mothers. J Hand Surg Eur Vol. 38.32. Anita Sali. John Esther. Effects of heat and cold perineum after episiotomy laceration. March – April. Journal of heat and cold on the perineum after episiotomy. Seena. Henton J. 35. Journal of Nursing research Society of India 2007 Oct-Nov. Geden. Venkadalakshmi. Taechan Kanho Hakhoe Chi 2004 Feb. Episiotomy discomforts relief using infrared light therapy.4(3):19 41. Nightingale Nursing Times 2009. Nursing Times 2010 Mar. Department of Obstetrics and Gynecology.Post episiotomy pain: warm versus cold sitz bath. No-2. The Official Journal of Trained Nurses’ Association of India 2009Jul-Sep. Rakel D. Han SH. Cochrane corner: water for wound cleansing. Health line Pregnancy Guide.9(6):14-5. Effect of sitz bath versus guggul dhupan on pain related to episiotomy in postnatal mothers. 34(1): 53-62. VA. Clinical trial of Aromotherapy on postpartum mothers perineal healing. 37. J of obstet gynecol neonat nsg 2006 Jan – Feb: 19 (1): 13. 39. Elizabeth A.37(4):375-6. Oan Lingen. Vol-1. 40. 19-21. R Sheeba. Hill PD. An experimental study to assess the effectiveness of sitz bath department of obg surgery California publication 2005 June.

A study on comparison of ice bag and heat lamp for the relief of perineal discomfort Kanho Kakhoe Chi. GeorgiaMedNews. Best remedial measure after Episiotomy? Sitz bath? Or Infrared Light Therapy?. A study to compare the effect of cold pack versus infrared radiation on episiotomy wounds in postnatal mothers in a selected hospital. Dhanalakshmi. 46(2):159-71. Unpublished thesis. Leos Navratil. Enhancement of fibroblast growth promoting activity of human blood after its irradiation in vivo (transcutaneously) and in vitro with visible and infrared polarized light.21(1):27-40. 2001 Dec. Israfilbeili SG. Bogacheva ON. 39(3): 288-95 89 . Varalakshmi K Y. Tsitologiia 2004. Hyderabad. A Utani. 44. Journal of Clinical Laser Medicine & Surgery. 46. Vellore. Rzakulieva LM. et al. February 2003. The University of Andra Pradesh. Zhevago NA. Contribution of phototherapy to the treatment of episiotomy. Rev Esc Enferm USP 2005 Sep. 45. 48. K Toda. Jaroslava Kymplova. De olivera SM. Gasymova G. the tamil nadu Dr. Apr.(138):71-3.5(12):12-6.Photodermatol PhotoimmunolPhotomed. 2006Sep. 50. Nam HK. Miquilini EC. V. Nightingale Nursing Times 2010 Mar.42. 47. K Danno. A study to compare the effect of cold pack versus infrared radiation on episiotomy wounds in postnatal mothers in a selected hospital. N Mori. 21(1): 35-39. Application of magnet laser radiation to stimulate healing of perineum injuries in the maternity patients. 1991. MGR Medial university Chennai. Bowel Rina. and Jirl Knizek. Samoĭlova KA. Near-infrared irradiation stimulates cutaneous wound repair: laboratory experiments on possible mechanisms. T Kobayashi. Frequency and criteria for the indication of episiotomy. 43. Unpublished thesis.17(6) 49. Park YS.

27(3):148 52. West Afr J Med. Andet AB. YesildaglarN.Earlyrepairof episiotomy dehiscence. 2004 Jun. UygurD. AustN Z J Obstet Gynaecol.51. Imarengiaye CO. 2008 Jul.44(3):24 90 . KisS. SipahiT. Postpartum perineal pain among Nigerian women.

ANNEXURE A COPY OF LETTER SEEKING PERMISSION TO CONDUCT THE STUDY 91 .

Kempegowda College of Nursing Bangalore-560004. The Principal. Susen George II Year M. Bangalore”. Bangalore. Susen George. Forwarded through. have selected the below mentioned topic for the dissertation.Sc Nursing Kempegowda College of Nursing Bangalore-560004. Title of the project: “A comparative study to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among post natal mothers at selected hospitals. I. Bangalore.ANNEXURE B COPY OF THE LETTER SEEKING EXPERT’S OPINION FOR THE CONTENT VALIDITY OF THE TOOL From. To. as a partial fulfillment of the master degree in Medical-Surgical Nursing of Rajiv Gandhi University of Medical science. a post graduate student of Kempegowda College of Nursing. Mr. 92 . Respected Sir/Madam. Sub: Requisition for expert opinion on content validity of the research tool.

To compare the effectiveness between sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To determine an association between pain level & wound healing status with selected demographic variable With regard to this I kindly request you to validate my tool for its appropriateness and relevancy. Thanking you in anticipation. vii. To assess the effectiveness of sitz bath and infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers. To assess the level of pain and wound healing status among postnatal mothers with episiotomy.Objectives: v. vi. Your expert opinion and kind cooperation will be highly appreciated and gratefully acknowledge. Susen George) Place: Bangalore Date: Signature of Principal 93 . viii. Yours faithfully (Ms. I request you to kindly go through the content and give your expert and valuable suggestion in the columns given and mark ( ) if you agree. Here with I am enclosing a copy of a) Numerical intensity pain scale for diabetic foot pain b) Criteria rating scale/ check list c) Content validity certificate.

II Year M.ANNEXURE C CONTENT VALIDITY CERTIFICATE This is to certify that the tool developed by Ms. Place: Date: (Name and signature of the expert) 94 . Bangalore”.Sc Nursing student of Kempegowda College of Nursing. Susen George. Bangalore (Affiliated to Rajiv Gandhi University of health Science) is validated by the undersigned and can proceed to conduct the main study for dissertation entitled as “A comparative study to assess the effectiveness sitz bath versus infra red lamp therapy on episiotomy pain and wound healing among postnatal mothers at selected hospital.

Part II: a) Verbal descriptive pain scale b) REEDA Scale. Part I: Consists of 10 items related to demographic variable under the study. Kindly go through the content and place the tick mark ( ) against the questionnaire in the following columns ranging from very relevant to not relevant.ANNEXURE D CRITERIA RATING SCALE FOR EVALUATION Respected Madam/Sir. Part I Demographic data Item 1 2 3 4 5 6 7 8 9 10 Very Relevant Relevant Need modification Not Relevant Remarks 95 . The tool is present in two parts. When the question is found not relevant and need modification kindly give your opinion in the remarks column.

Item 1 2 3 4 Very Relevant Relevant Need modification Not Relevant Remarks Suggestions if any: Over all opinion of the validator: Signature of the validator Name and address of the validator 96 .Part II a) Verbal descriptive pain scale to assess episiotomy pain. Item 1 2 3 4 Very Relevant Relevant Need modification Not Relevant Remarks b ) REEDA Scale to assess episiotomy wound healing.

Mrs. Rajeshwari Associate professor Dept. Maria Preethi Miranda HOD of OBG dept. 97 . 9. HOD of OBG JSS College of nursing Mysore. Mrs.V. Bangalore. Tajnisha Bhanu Professor. Swarna Latha Puerperium Principal. V. Mrs. Gangaboraiah Professor of Statistics KIMS. Lalitha Haemorrhage Professor. Mrs. of OBG HMH College of nusing. Dept. Dept. HOD of OBG dept. Mrs. Puram College of Arts and commerce. Bangalore 6. 5. 4. Gouri Sai Associate Professor. Mrs. Kauvery College of Nurisng Mysore 3. Sabina Monica Associate Professor. 7. Sabitha Sibbla Assistant Professor. Mrs. Mrs. of English. of OBG Fortis college of nursing Bangalore 10. BMS hospital nursing college Banglore 11. of OBG Fortis College of Nursing Bangalore. Mrs. Dept. Mysore 2.ANNEXURE E LIST OF EXPERTS CONSULTED FOR CONTENT VALIDITY OF THE TOOL 1. Mr. HOD of OBG dept. Dept. Bhavya Associate professor. Shenbagalakshmi Principal. of OBG Government college of nursing Bangalore. Krupanidhi college of nursing Bangalore 8. HOD of OBG dept HMH college of nursing Mysore. Mrs.

I will also co-operate with the researcher in providing necessary information.ANNEXURE F COPY OF CONSENT FORM I am voluntarily willing to participate in the study conducted by Ms. II year M. I was explained that the information provided would be kept confidential and used only for above mentioned study purpose. Bangalore”. Nursing (OBG) student of Kempegowda College of nursing on “A comparative study to assess the effectiveness of sitz bath versus infrared lamp therapy on episiotomy pain and wound healing among postnatal mothers at selected hospital. Susen George.Sc. Signature of the Investigator Signature of the participant Date: Place: Bangalore 98 .

..... Sample code 1... Religion Hindu ( Christian ( Muslim ( Any others specify. c. So listen carefully to the questions and respond as accurately as possible........ Age ( in years)…………………………………………………… 2........ I Susen George.. 99 .......... PART – I Demographic data Instructions to the respondent: Dear participant........ programme and the information will be kept confidential... d.... Occupational status………………………………………………….......... ) ) ) 3.. Sc Nursing student would request you to answer some questions related to your background..I: Questionnaire consists of 10 items related to demographic variables under study...II: a) Verbal descriptive pain scale to assess the episiotomy pain level b) REEDA Scale to assess the episiotomy wound healing... a.... II year M.. Part. 4. Educational status of parents……………………………………….ANNEXURE ......... I assure you that the provided information will be exclusively utilized for the partial fulfillment of P...G.G TOOL USED FOR THE STUDY The data collection tool has two parts Part.. b..

Vegetarian b. Parity Primi Multi Grand multi Type of episiotomy Median Lateral Right mediao lateral Left medio lateral ( ( ) ) ( ( ) ) ( ( ( ) ) ) ( ( ( ( ) ) ) ) 100 . a. Type of the family Nuclear Joint Extended ( ( ( ) ) ) 6. b. Urban 8. Dietary pattern a. Mixed 7. c. b. a. c. Rural b. 9. d. Place of living a. c. a.5. b.

Unable to adapt pain. mild pain. Verbal pain scales. use words to describe pain. 2002) POINTS LEVEL OF PAIN DESCRIPTION 0 No pain No pain. and severe pain are used to describe pain levels. Requires lifestyle 2 Moderate pain changes but patient remains independent. as the name suggests. Words such as no pain. moderate pain. Feeling perfectly normal.PART . Does not interfere with most of the activities. A score from 0 to 3 is assigned to each of those word pairs and is used to measure the pain level. No pain Mild pain Moderate pain Severe Pain -0 -1 -2 -3 101 . Interferes with many activities. 3 Severe pain Unable to engage in normal activities. Able 1 Mild pain to adapt to pain psychologically and with medication or comfort devices. Patient is disable and unable to function independently.II a) Verbal descriptive pain scale (Jack Harich.

25cm from bilaterally or serum incision 0. As the score increases.b) REEDA Scale ( Nancy Davidson.0 Grade I Grade II Grade III -1 to 5 . No infection . The REEDA score ranges from 0 to 15. it will indicate higher rate of infection. it shows the evidence of healing process.The REEDA scale consist 5 major items.5-2cm sanguinous incision unilaterally >1 cm > 2 cm bilaterally or Bloody from >2 cm purulent incision unilaterally Skin separation 3mm or more 2 Skin and subcutaneous fat separate Skin subcutaneous fat and fascia separate 3 REEDA is a scientific tool to assess the episiotomy wound healing. The maximum score is 15. 1972) POINT S 0 REDNES S None Within 0.5 cm of incision bilaterall y EDEM A None ECCHYMOS IS None DISCHARG APPROXIMATI E ON None Closed 1 Within <1 cm 0. If the score decreases.5 cm of incision bilaterall y Beyond 0.6 to 10 -11 to 15 102 . Each item will be given a minimum score of 0 and maximum score of 3.25 cm of incision bilaterall y Within 0.5 cm unilaterally 0.25-1cm 1-2 cm bilaterally or Serofrom 0.