2. STATEMENT OF PROBLEM
A study to determine the effectiveness of breast milk application on sore
nipple among postnatal mothers visiting in selected hospitals at Hisar.
3. OBJECTIVES OF THE STUDY
1. To assess the pre-test posttest level of nipple soreness among postnatal mothers visiting in
selected hospitals in experimental group and control group.
2. To assess the effectiveness of breast milk application on sore nipple among postnatal
mothers visiting in selected hospitals in experimental group.
3. To compare the posttest level of nipple soreness among postnatal mothers visiting in
selected hospitals in experimental group and control group.
4. To determine the association between selected demographic variables and pretest level of
nipple soreness among postnatal mothers in experimental group and control group.
5. To determine the association between selected demographic variables and posttest level of
nipple soreness among postnatal mothers in experimental group and control group.
4. INTRODUCTION
Just as there is no substitute for mother’s love, There is no substitute for mother’s milk.
- Meharban Singh (2006).
Motherhood is the kinship relation between an offspring and the mother. Breast feeding provides a unique bounding
experience for mother and child. It stimulates most of the senses and close body contact allows the baby to recognize its mothers
smell. Breast milk is the best food for the babies.
A variety of interventions designed to reduce nipple pain in breastfeeding women have been reported. These include
pharmacological topical treatments with antibacterial sprays, antifungal cream; non-pharmacological topical applications as
peppermint oil/water, lanolin; dressings using warm compresses, hydrogel dressings, tea bags; breast shells and expressed
breast milk (EBM). Other interventions that have been identified in the literature include time restricted breast-feeding or
exposure of the nipples to phototherapy and air-drying. Despite a lack of evidence-based studies on efficacy of expressed
breast milk, it is widely used for the prevention and treatment of sore nipples.
5. NEED FOR STUDY
Nipple soreness is one of the most common reasons new mothers give for discontinuing breastfeeding, often
during the first week of nursing. This is quite unfortunate, for nipple soreness is almost always a short-term problem,
and can usually be corrected in a matter of days.
Worldwide, It is estimated that 34 to 96% of breast feeding women experience some nipple soreness, with
26% progressing to cracks and extreme nipple pain Furthermore, up to be one third of the mothers who experience
these symptoms may change to alternate methods of infant nutrition within the first six postnatal weeks.
The study will help uncover a critical problem that leads to unsuccessful breastfeeding which is nipple
trauma. Most of studies discuss the use of alternative methods to prevent nipple trauma during immediate postpartum
period however this study will be applied during late pregnancy to investigate the effect of nipple preparation with
olive oil application on prevention of nipple trauma.
Therefore, the current study was done to evaluate the effect of breast milk application on healing of sore
nipple among postnatal lactating mothers.
6. RESEARCH HYPOTHESIS:
• H1 - There would be a significant difference in the level of nipple soreness before and after breast milk
application.
• H2 - There would be a significant association between the pretest level of nipple soreness selected
demographic variables among postnatal mothers in experimental group and control group.
• H3 - There would be a significant association between the posttest level of nipple soreness selected
demographic variables among postnatal mothers in experimental group and control group.
7. ASSUMPTION
The soreness of the nipples causes severe discomfort to the mothers while feeding.
Breast milk has a healing effect on sore nipples
8. INPUT THROUGHPUT OUTPUT
Pre-test
Assessment of pretest level of
nipple soreness
Demographic variables
Age, Education, occupation, type
of family, monthly income,
number of deliveries, frequency
of feeding, and duration of
feeding
Demonstration of breast milk
application on sore nipple
Sample perceive,
transform, process,
organize and learn the
information received
from demonstration on
breast milk application
on sore nipple. Negative outcome
Inadequate level of
soreness of nipple
Positive outcome
Adequate level of
soreness of nipple
Fig.1 CONCEPTUAL FRAMEWORK BASED ON MODIFIED LUDWIG VON BERTALANFFY’S (1980) GENERAL
SYSTEM THEORY
Post-test
Assessment of post
test level of soreness
of nipple among
postnatal mothers.
Reassessment/ reinforcement
9. REVIEW OF LITERATURE
The literature related to this study is discussed under following headings:
PART –I: Literature related to incidence and problems of sore nipples.
PART –II: Literature related to treatments for sore nipples.
PART –III: Literature related to knowledge regarding application of breast milk to
promote healing of sore nipple.
10. RESEARCH METHODOLOGY
• Evaluative research approach is used in this study.
• Quasi experimental design was used.
• Study setting in jindal institute of medical sciences and aadhar health institute at hisar
• Target population: postnatal mothers visiting jindal institute of medical sciences and aadhar health institute
at hisar
• Sampling technique: purposive sampling techniques
• Sample size: 60 postnatal mothers (30=experimental group and 30= control group)
• Instrument: nipple trauma checklist
• Analysis was use as inferential statistics.
• Findings, summary, conclusion, and recommendations
• Communication and findings
11. PILOT STUDY
• After obtaining permission from the authority concerned, a pilot study was done with 6 postnatal mothers
diagnosed with sore nipples who are visiting in Jindal Institute of medical sciences, Hisar for experimental
group and Aadhar Health Institute at Hisar, for control group, during 8-4-2022 to 15-4-2022. After 1week of
breast milk appplication, the posttest soreness of nipple level was improved in experimental group. For
control group pretest was given and after 1week posttest was given. The pilot study was designed to find out
the feasibility of the tool and practicability of designed methodology. The pilot study samples were excluded
in main study.
12. METHOD OF DATAANALYSIS
The collected data would be arranged and tabulated to represent the finding of the study. Both descriptive
and inferential statistics would be used.
Percentage, mean, standard deviation were used to analyze the demographic data.
Paired t‟ test was used to compare the pretest and the post test scores of nipple soreness.
Chi-square was used to know the association between demographic variables with posttest level of nipple
soreness scores.
13. ORGANIZATI ON OF FINDINGS
The analysis of data has been organized and presented under the following headings
• SECTION-1: Distribution of samples according to their demographic variables in experimental group and control group
• SECTION-2: Distribution of pre and post test frequency and percentage of level of nipple soreness among post natal mothers in
experimental group and control group.
• SECTION-3: Comparison of mean scores between pretest with posttest level of nipple soreness among post natal mothers in
experimental group and control group.
• SECTION-4: Comparison of posttest level of nipple soreness among post natal mothers in experimental group and control group.
• SECTION-5: Association of selected demographic variables with pretest level of nipple soreness among post natal mothers in
experimental group and control group.
• SECTION-6: Association of selected demographic variables with posttest level of nipple soreness among post natal mothers in
experimental group and control group.
14. SECTION-A DEMOGRAPHIC VARIABLE PROFILE
Demographic variables Experimental group Control Group
Frequency % Frequency %
1. Age of the mother
Below 20 years 7 23.33% 7 23.33%
20-25 years 15 50% 12 40%
26-30 years 4 13.33% 6 20%
Above 30 years 4 13.33% 5 16.67%
2. Educational status
Elementary education 2 6.67% 2 6.67%
School education 12 40% 12 40%
Graduation 10 33.33% 9 30%
Post graduation 6 20% 7 23.33%
3. Occupation
Working 10 33.33% 10 33.33%
Home maker 20 66.67% 20 66.67%
4. Family’s monthly income (in Rs)
Below 10,000 3 10% 5 16.67%
10,000-20,000 4 13.33% 2 6.67%
21,000-30,000 12 40% 13 43.33%
Above 30,000 11 36.67% 10 33.33%
15. 5. Type of family
Nuclear family 17 56.67% 12 40%
Joint family 13 43.33% 18 60%
6. Number of deliveries
One 8 26.67% 2 6.67%
Two 19 63.33% 24 80%
Three or more 3 10% 4 13.33%
7. Frequency of feeding in
Every hour 7 23.33% 3 10%
Every 2 hour 17 56.67% 21 70%
Every 3-4 hour 6 20% 6 20%
8. Duration of feeding (in minutes)
Less than 5 3 10% 2 6.67%
5-10 4 13.33% 4 13.33%
More than 10 23 76.67% 24 80%
16. SECTION-2:
DISTRIBUTION OF PRE AND POST TEST FREQUENCY AND PERCENTAGE OF LEVEL OF
NIPPLE SORENESS AMONG POST NATAL MOTHERS IN EXPERIMENTAL GROUPAND
CONTROL GROUP
Nipple soreness
scale
Experimental group (N=30) Control group(N=30)
Pre-test Post-test Pre-test Post-test
F % F % F % F %
No nipple soreness 0 0% 9 30% 0 0% 0 0%
Mild 0 0% 10 33.33% 4 13.33% 18 60%
Moderate 15 50% 11 36.67% 22 73.34% 12 40%
Severe 15 50% 0 0% 4 13.33% 0 0%
Table-3 shows that in experimental group, pre test majority (50%) of postnatal mothers had
severe nipple soreness and 50% had moderate nipple soreness. After post test 30% postnatal mothers had
no nipple soreness, 33.33% had mild nipple soreness, 36.67% had moderate nipple soreness and no one had
severe nipple soreness.
In control group, pre test majority (73.34%) of postnatal mothers had moderate nipple soreness
and 13.33% had severe nipple soreness and 13.33% had mild nipple soreness. After post test 60% postnatal
mothers had mild nipple soreness, 40 % had moderate nipple soreness, no one had severe nipple soreness.
17. SECTION-3:
COMPARISON OF MEAN SCORES BETWEEN PRETEST WITH POSTTEST LEVEL OF NIPPLE SORENESS
AMONG POST NATAL MOTHERS IN EXPERIMENTAL GROUPAND CONTROL GROUP
Groups Pre-test Post-test Mean difference Paired ‘t’ test
At p<0.01
Mean SD Mean SD
Experimental group 13.53 2.71 5.27 4.49 8.26 11.30***
Control group 9.43 4.31 6.53 6.03 2.9 3.21
H1 - There would be a significant difference in the level of nipple soreness before and after breast milk application.
Table-4 shows that in experimental group, pretest mean score of nipple soreness was 13.53 with SD 2.71 which was higher than the post test
mean score nipple soreness 5.27 with SD 4.49. The mean difference in pretest and post test was 8.26. The calculated ‘t’ value 11.30 was higher
than the table value at df 29 at p<0.01 level of significance. It means the breast milk application on sore nipple was effective. Hence the
hypothesis H1 was accepted.
In control group, pretest mean score of nipple soreness was 9.43 with SD 4.31 which was higher than the post test mean score nipple
soreness6.53 with SD 6.03. The mean difference in pretest and post test was 2.9. The calculated ‘t’ value 3.21 was less than the table value at df
29 at p<0.01 level of significance.
18. SECTION-4:
COMPARISON OF POSTTEST LEVEL OF NIPPLE SORENESS AMONG POST NATAL MOTHERS IN
EXPERIMENTAL GROUPAND CONTROL GROUP
Groups Post-test Mean
differenc
e
Paired
‘t’ test
At
p<0.01
Mean SD
Experimental
group
5.27 4.49 1.26 8.45***
Control group 6.53 6.03
*** significant At p<0.01
Table-4 shows that in experimental group, post test mean score nipple soreness 5.27 with SD 4.49 was less than the
control group mean post test score 6.53 with SD 6.03. The calculated ‘t’ value 8.45 was higher than the table value at df 59 at
p<0.01 level of significance. It means the breast milk application on sore nipple was effective.
19. SECTION-5:
ASSOCIATION OF SELECTED DEMOGRAPHIC VARIABLES WITH PRETEST LEVEL OF NIPPLE
SORENESS AMONG POST NATAL MOTHERS IN EXPERIMENTAL GROUPAND CONTROL GROUP
• H2 - There would be a significant association between the pretest level of nipple soreness selected
demographic variables among postnatal mothers in experimental group and control group.
• Table 6 shows that in experimental and control group demographic variables such as age, education,
occupation, type of family, monthly income, number of deliveries, frequency and duration of breast feeding
does not show association with nipple soreness score in pre test. Hence the hypothesis H2 was rejected.
20. SECTION-6:
ASSOCIATION OF SELECTED DEMOGRAPHIC VARIABLES WITH POSTTEST LEVEL OF
NIPPLE SORENESS AMONG POST NATAL MOTHERS IN EXPERIMENTAL GROUPAND
CONTROL GROUP
• H3 - There would be a significant association between the posttest level of nipple soreness selected demographic variables
among postnatal mothers in experimental group and control group
• Table 6 shows that in experimental and demographic variables such as age, occupation, type of family, number of
deliveries, frequency and duration of breast feeding does not show association with nipple soreness score in post test. The
variables such as education and monthly income shows significant association with post test nipple soreness score. Hence
the hypothesis H3 was accepted.
• In control and demographic variables such as age, occupation, type of family, monthly income, number of deliveries,
frequency and duration of breast feeding does not show association with nipple soreness score in post test. The variables
such as education shows significant association with post test nipple soreness score. Hence the hypothesis H3 was accepted.
21. DISCUSSION
• This chapter deals with the discussion of the findings of present study in accordance with
the objectives of the research problem.
• In experimental group, post test mean score nipple soreness 5.27 with SD 4.49 was less
than the control group mean post test score 6.53 with SD 6.03. The calculated ‘t’ value
8.45 was higher than the table value at df 59 at p<0.01 level of significance. It means the
breast milk application on sore nipple was effective.
22. CONCLUSION
In experimental group, post test mean score nipple soreness 5.27 with SD 4.49 was less
than the control group mean post test score 6.53 with SD 6.03. The calculated ‘t’ value
8.45 was higher than the table value at df 59 at p<0.01 level of significance. It means the
breast milk application on sore nipple was effective.
23. SUMMARY
The conceptual frame work adopted for the study is Modified Ludwig Von Bertalanffy’s (1980) General System Theory to the present
study.
The study design consisted of an evaluative approach with one group pre test and post test control group design. Purposive
sampling technique was adopted. The tool developed and used for data collection was nipple trauma checklist.
In experimental group, pretest mean score of nipple soreness was 13.53 with SD 2.71 which was higher than the post test
mean score nipple soreness 5.27 with SD 4.49. The mean difference in pretest and post test was 8.26. The calculated ‘t’ value 11.30
was higher than the table value at df 29 at p<0.01 level of significance. It means the breast milk application on sore nipple was
effective. Hence the hypothesis H1 was accepted. In control group, pretest mean score of nipple soreness was 9.43 with SD 4.31 which
was higher than the post test mean score nipple soreness6.53 with SD 6.03. The mean difference in pretest and post test was 2.9. The
calculated ‘t’ value 3.21 was less than the table value at df 29 at p<0.01 level of significance.
24. RECOMMENDATION
Application of breast milk could be suggested as a treatment of nipples soreness.
Postnatal lactating newly breastfeeding mothers should be educated about proper positioning and
attachment of the baby to the breast for breastfeeding to prevent traumatic nipples incidence.
Replication of the current research on a larger sample size and different settings is recommended to
validate results.
Further studies are recommended to gain more insight into the effectiveness of breast milk. Nurses
and mothers must be educated about evidence-based practice in nipple soreness of breast milk.
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