thesis on early ambulation

1. DESERTATION
PRESENTATION
PRESENTED BY
PRIYA KAJALA
OBSTETRICS AND GYNECOLOGICAL NURSING

2. STATEMENT OF PROBLEM
“A quasi experimental study to assess the effectiveness of early ambulation on
involution of uterus among postnatal mothers admitted in selected hospitals at
Bhiwani.”

3. OBJECTIVES OF THE STUDY
1. To assess the pre-test level of uterine involution during postnatal period among postnatal mothers in experimental group and
control group.
2. To find out the effectiveness of early ambulation on uterine involution during postnatal period among postnatal mothers in
experimental group and control group.
3. To compare the pre and post-test level of uterine involution during postnatal period among postnatal mothers in
experimental group.
4. To compare the pre and post-test level of uterine involution during postnatal period among postnatal mothers in control
group.
5. To associate the post-test level of uterine involution during postnatal period among postnatal mothers in experimental group
and control group with their selected demographic variables.

4. INTRODUCTION
“Being a mother is learning about strengths you don’t know you had, and dealing with fears you never knew
existed.”
Women and children are our nation’s greatest assets. Health of the women is the basis for the better health of
family as well as of the nation. It is therefore expedient that women should possess optimum health.
Results of early ambulation in gynecology are almost parallel to those in obstetrics. For years, many surgeons have
advocated leg exercises after all kinds of operations. In the past few years, surgeons have been encouraging patients to
walk within a few hours after major surgical procedures. In this regard it is appropriate to remind ourselves of the
results which have been obtained in operations on animals, with no effort made to keep the animals quiet afterward.
Moreover, patients must be warned repeatedly against too vigorous exercises and against doing too much
until the body has had time to recover and wounds are safely healed.

5. NEED FOR STUDY
Protecting a women’s health as these changes occur is important for preserving her future childbearing function
and for ensuring that she is physically fit to incorporate her new child into her family. Early ambulation in
postpartum period is the key to get rapid and maximum muscle function and restoration of mothers health.
World Health Organization (WHO) statistics suggest that 25 percent of maternal deaths are due to postpartum
haemorrhage, accounting for more than 100,000 maternal deaths per year. The death of these moResearcher during
her clinical experience has observed most of the mothers Suffer poor uterine involution. The nurses responsibility
is to improve the uterine involution after delivery, there are many pharmacological measures available to contract
the uterus but may bring more side effects. The investigator being a nurse interested in non pharmacological
method of early ambulation to improve uterine involution during postnatal period.

6. RESEARCH HYPOTHESIS:
H1 Mean post-test level of uterine involution of postnatal mothers in experimental group will be significantly higher
than the mean post-test level of uterine involution in control group.
H2 There will be a significant difference between mean pre-test and post-test level of uterine involution among
postnatal mothers in experimental group.
H3 There will be a significant difference between mean pre-test and post-test level of uterine involution among
postnatal mothers in control group.
H4 There will be a significant association between post-test level of uterine involution among postnatal mothers in
experimental group with their selected demographic variables.
H5 There will be a significant association between post-test level of uterine involution among postnatal mothers in
control group with their selected demographic variables.

7. ASSUMPTION
1. Early ambulation may increase the uterine involution.
2. Early ambulation may reduce the postpartum complication.

8. Feedback
Perception
-Need of early
ambulation for
involution of uterus.
Interaction
-Measurement of uterine
involution.
- Starting early
ambulation in postnatal
mothers.
-Measurement of uterine
involution by using same
scale on the 7th day.
Action
-Preparation of
modified measuring
scale of uterine
involution
-Preparation of
postnatal mothers
for early ambulation
-Plan for
administration of
early ambulation
Transaction
Postnatal mothers will
gain adequate uterine
involution.
- Postnatal mothers
will not gain adequate
uterine involution.
Investigator
Mutual goal setting
to improve level of
uterine involution
among postnatal
mothers
Interaction
-Participating in early
ambulation.
Perception
-Lack of uterine
involution among
postnatal mothers.
Action
-Consent
-Corporation of
patients
-Acceptatance of
suggestion
Postnatal
mothers
Feedback
Fig-1 Conceptual framework on effectiveness of early ambulation on involution of uterus among postnatal mothers

9. REVIEW OF LITERATURE
The literature review is arranged in the following sections-
Section-A: Literature related to effect of exercise and other methods on uterine involution.
Section-B: Literature related to effect of early ambulation on uterine involution

10. RESEARCH APPROACH: EVALUATIVE APPROACH
TARGET POPULATION: POSTNATAL MOTHERS ADMITTED
IN CHUGH MULTISPECIALITY AND KADAM
MULTISPECIALITY HOSPITAL AT BHIWANI
Analysis
Summary, finding and conclusion
DESIGN: QUASI- EXPERIMENTAL STUDY
STUDY SETTING: CHUGH MULTISPECIALITY AND KADAM
MULTISPECIALITY HOSPITAL AT BHIWANI
SAMPLING TECHNIQUE: PURPOSIVE SAMPLING
TECHNIQUES
SAMPLE SIZE: 60 POSTNATAL MOTHERS
(30=EXPERIMENTAL GROUPAND 30= CONTROL GROUP
PRE TEST
INSTRUMENT: MODIFIED FUNDEL ASSESSMENT SCALE FOR UTERINE
INVOLUTION
NO INTERVENTION
EXPERIMENTAL
GROUP
CONTROL GROUP
INTERVENTION
EARLY AMBULATION
POST TEST
Fig. 2: Schematic representation of the research design

11. RESEARCH METHODOLOGY
• Evaluative research approach is used in this study.
• Quasi experimental design was used.
• Study setting- Kadam multispeciality hospital and Chugh multispeciality hospital, Bhiwani, harayana
• Target population- postnatal mothers admitted in Chugh multispeciality and Kadam multispeciality hospital at
Bhiwani
• Sampling technique: Non probability purposive sampling technique.
• Sample size: 60 antenatal mothers with gestational diabetic mellitus (30=experimental group and 30= control
group
• Instrument- Modified fundel assessment scale for uterine involution
• Intervention- Early ambulation
• Analysis was use as inferential statistics.
• Findings, summary, conclusion, and recommendations
• Communication and findings

12. PILOT STUDY
The investigator got permission from Principal and research ethical committee of Satya college of nursing. A formal permission was
obtained from the Director of Chugh multispeciality and Kadam multispeciality hospital at Bhiwani. The pilot study was conducted
for the period of one week from 28.04.2022 to 04.05.2022. The sample size was six in that three of them were allotted to
experimental and three of them to control group.
Rapport was established with the mothers and a brief introduction about the study was given. Consent was obtained from
each mother and reassurance was provided that the collected data would be kept confidential. The data related to demographic
variables were collected from the Interview method. Postnatal mothers in experimental group were motivated for early ambulation or
movement in body parts. No intervention was given for control group. The pre and post-test level of uterine involution assessed by
Modified fundal assessment scale. The result of pilot study showed that the experimental group had a good involution as compared to
the control group. The study was found to be feasible and hence the same procedure was decided to be followed in the main study.
There was no modification made in the tool after pilot study. The samples selected for the pilot study were not included for the main
study.

13. METHOD OF DATAANALYSIS
Descriptive statistics
 Frequency and percentage distribution was used to analysis the demographic variables among postnatal mothers in
experimental and control group.
 Frequency and percentage distribution was used to assess the pre-test and posttest level of uterine involution among
postnatal mothers in experimental and control group.
 Mean and standard deviation was used to assess the pre-test and post-test level of uterine involution among postnatal
mothers in experimental and control group.
Inferential Statistics
 Unpaired‘t’ test was used to compare the post-test level of uterine involution among postnatal mothers in experimental and
control group.
 paired‘t’ test was used to compare the pre and post-test level of uterine involution among postnatal mothers in experimental
and control group.
 Chi-square test was used to associate the post-test level of uterine involution among postnatal mothers in experimental and
control group with their selected demographic variables.

14. ORGANIZATI ON OF FINDINGS
Section A: Description of demographic variables of the postnatal mothers with uterine involution.
Section B: Assessment of the level of uterine involution among postnatal mothers of experimental and control group.
Part-1 Assessment of the pre-test level of uterine involution among postnatal mothers of experimental and control group.
Part-2 Assessment of the post-test level of uterine involution among postnatal mothers of experimental and control group.
Section C: Comparison of post-test level of uterine involution among postnatal mothers in experimental and control group.
Section D: Association of post-test level of uterine involution among postnatal mothers in experimental and control group
with their selected demographic variables.
Part-1 Association of post-test level of uterine involution among postnatal mothers in experimental group with their selected
demographic variables.
Part-2 Association of post-test level of uterine involution among postnatal mothers in control group with their selected
demographic variables.

15. SECTION-A DEMOGRAPHIC VARIABLE PROFILE
Demographic variable Experimental group Control group
Frequency Percentage Frequency Percentage
1. Age
18-22 years 3 10% 2 6.67%
23-27 years 15 50% 16 53.33%
28-32 years 10 33.33% 10 33.33%
Above 32 years 2 6.67% 2 6.67%
2. Education
Primary school 3 10% 0 0%
High school 4 13.33% 5 16.67%
Secondary school 12 40% 13 43.33%
Graduation and above 11 36.67% 12 40%
3. Duration of marriage
1-2 years 7 23.33% 4 13.33%
2-3 years 12 40% 14 46.67%
3-4 years 9 30% 10 33.33%
Above 4 years 2 6.67% 2 6.67%

16. 4. Parity
Primipara 12 40% 16 53.33%
Multipara 18 60% 14 46.67%
5. Type of family
Nuclear family 20 66.67% 18 60%
Joint family 10 33.33% 12 40%
6. Area of living
Urban 16 53.33% 18 60%
Semi-urban 2 6.67% 6 20%
Rural 12 40% 6 20%
7. Type of delivery
Vaginal delivery 24 80% 22 73.33%
C-section 6 20% 8 26.67%

17. SECTION-B
ASSESSMENT OF LEVELOF UTERINE INVOLUTIONAMONG POSTNATALMOTHERS IN
EXPERIMENTALGROUPAND CONTROLGROUP
Part-1
0%
20%
40%
60%
80%
Good Average Poor
0%
46.67%
53.33%
0%
30%
70%
Level of uterine involution in pretest
Experimental group
Control group
Bar diagram reveals with regards to the level of uterine involution that in experimental group majority 14
(46.6%) of the postnatal mothers had average and 16(53.33%) of the mothers had poor involution.
With regards to the level of uterine involution in control group, majority 9 (30%) of the mothers had
average and 21(70%) of the mothers had poor involution.

18. Part-2
Assessment of the post-test level of uterine involution among postnatal mothers of experimental and control group
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Good Average Poor
86.67%
13.33%
0%
33.33%
60%
6.67%
Level of uterine involution in posttest
Experimental group
Control group
Bar diagram reveals with regards to the level of uterine involution in experimental group 26(86.66%) of the mothers
had good involution, 4(13.33%) of the mothers had average, and none of the mothers had poor uterine involution.
With regards to the level of uterine involution in control group 10(33.33%) of the mothers had good involution,
18(60%) of the mothers had average involution and remaining 2(6.66%) of the mothers had poor involution

19. Mean and Standard Deviation of Pre-test and Post-test Level of Uterine involution among Postnatal
Mothers in Experimental and Control Group
Groups Pre test Post test Mean
difference
Paired ‘t’-test
mean SD mean SD
Experimental group(N=30) 13.96 1.79 4.86 1.57 9.1 11.663 S***
Control group (N=30) 14.9 3.59 9.57 2.62 5.33 8 S*
H2 There will be a significant difference between mean pre-test and post-test level of uterine involution among postnatal mothers in
experimental group.
Table 5 reveals with regards to experimental group the pre-test mean value was 13.96 with standard deviation of 1.79. With respect to
experimental group of post-test mean was4.86 with standard deviation of 1.57. The calculated ‘t’ value 11.663 was higher than the
tabulated ‘t’ value at 0.05 level of significance with df 29. Hence the Hypothesis H2 was accepted.
H3 There will be a significant difference between mean pre-test and post-test level of uterine involution among postnatal mothers in
control group.
In control group the pre-test mean value was 14.9 with standard deviation of 3.59. The post test mean of control group was 9.57 with
standard deviation of 2.62. The calculated ‘t’ value 8 was higher than the tabulated ‘t’ value at 0.05 level of significance with df 29. Hence
the Hypothesis H3 was accepted.

20. SECTION-C
COMPARISON OF UTERINE INVOLUTIONAMONG POSTNATALMOTHERS OF EXPERIMENTALAND CONTROL
GROUP
Groups Post test Mean
difference
Paired ‘t’-test
Mean SD
Experimental group(N=30) 4.86 1.57 4.71 4.958***
S
Control group (N=30) 9.57 2.62
H1 Mean post-test level of uterine involution of postnatal mothers in experimental group will be significantly higher
than the mean post-test level of uterine involution in control group.
Table 6 reveals the unpaired ‘t’ test to compare the post-test level of uterine involution among postnatal mothers in
experimental and control group. The post test level of involution mean (4.86) in experimental group was less than post
test level of involution mean (9.57) in control group. It was found that ‘t’ value was 4.958 indicating that there was
significant difference in post-test level of uterine involution among postnatal mothers in experimental and control group
at p<0.05 level.
Hypothesis H1 was accepted.

21. SECTION-D
ASSOCIATION OFTHE POST-TEST LEVELOF UTERINE INVOLUTIONAMONG POSTNATALMOTHERS
IN EXPERIMENTALAND CONTROLGROUPWITH THEIR SELECTED DEMOGRAPHIC VARIABLES
H4 There will be a significant association between post-test level of uterine involution among postnatal mothers in
experimental group with their selected demographic variables.
The table 7 showed association of post test level of uterine involution with selected demographical variables. The variables
such as mother’s age, education, duration of marriage, parity and type of family does not show any significant association. And other
variables area of living and type of delivery shows significant association. Hence the hypothesis H4 is accepted.
H5 There will be a significant association between post-test level of uterine involution among postnatal mothers in control
group with their selected demographic variables.
The table 8 showed association of post test level of uterine involution with selected demographical variables. The variables
such as mother’s age, education, duration of marriage, parity, area of living and type of delivery does not show any significant
association. Hence the hypothesis H5 is rejected.

22. DISCUSSION
This chapter deals with the discussion of the findings of present study in accordance with the objectives of the
research problem.
The level of uterine involution that in experimental group majority 14 (46.6%) of the postnatal mothers had
average and 16(53.33%) of the mothers had poor involution. The level of uterine involution in control group, majority 9
(30%) of the mothers had average and 21(70%) of the mothers had poor involution.
The level of uterine involution in experimental group 26(86.66%) of the mothers had good involution,
4(13.33%) of the mothers had average, and none of the mothers had poor uterine involution. The level of
uterine involution in control group 10(33.33%) of the mothers had good involution, 18(60%) of the mothers
had average involution and remaining 2(6.66%) of the mothers had poor involution.

23. CONCLUSION
 The study result shows that The pre test level of uterine involution in experimental group 26(86.66%) of the
mothers had good involution, 4(13.33%) of the mothers had average, and none of the mothers had poor
uterine involution. The level of uterine involution in control group 10(33.33%) of the mothers had good
involution, 18(60%) of the mothers had average involution and remaining 2(6.66%) of the mothers had poor
involution.
 The post test level of involution mean (4.86) in experimental group was less than post test level of involution
mean (9.57) in control group. It was found that ‘t’ value was 4.958 indicating that there was significant
difference in post-test level of uterine involution among postnatal mothers in experimental and control group
at p<0.05 level.
 Which means early ambulation was effective in involution of uterus.

24. SUMMARY
The study design consisted of an evaluative approach with one group pre test and post test control group design. The study
population consisted of 60 postnatal mothers admitted in Chugh multispeciality hospital and Kadam multispeciality hospital at Bhiwani by
using purposive sampling. The tool developed and used for data collection was structured interview for demographic variables, Modified
fundal assessment scale, and inche tape for measuring fundal height. The conceptual frame work adopted for the study is based on King’s
theory of goal attainment (Imogene M King).The model is modified to suit to the present study.
The present study revealed that the in experimental group the pre-test mean value was 13.96 with standard deviation of 1.79. With
respect to experimental group of post-test mean was4.86 with standard deviation of 1.57. The calculated ‘t’ value 11.663 was higher than the
tabulated ‘t’ value at 0.05 level of significance with df 29. Hence the Hypothesis H2 was accepted.
In control group the pre-test mean value was 14.9 with standard deviation of 3.59. The post test mean of control group was 9.57
with standard deviation of 2.62. The calculated ‘t’ value 8 was higher than the tabulated ‘t’ value at 0.05 level of significance with df 29.
Hence the Hypothesis H3 was accepted.
The post test level of involution mean (4.86) in experimental group was less than post test level of involution mean (9.57) in control
group. It was found that ‘t’ value was 4.958 indicating that there was significant difference in post-test level of uterine involution among
postnatal mothers in experimental and control group at p<0.05 level. Hypothesis H1 was accepted.

25. RECOMMENDATION
The study recommends the following future research.
1. The similar study can be conducted with larger samples for better generalization.
2. A study can be conducted to assess the knowledge and practice of fundal massage on uterine involution among nurse
midwives.
3. A study can be conducted to assess the knowledge and attitude of complementary therapies for uterine involution
among nurse midwives.
4. A study can be conducted to assess the effectiveness of other nursing measures such as abdominal binder, post natal
exercise among postnatal mothers.
5. A study can be conducted to assess the effectiveness of fundal massage in involution of uterus in postnatal mothers.

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IJCRT | Volume 9, Issue 11 November 2021 | ISSN: 2320-2882