The document discusses evidence-based studies presented at puerperium. It defines key terms like puerperium, evidence, evidence-based studies, evidence-based nursing, and evidence-based medicine. It discusses the objectives, goals, aims, needs, process, components, pillars, principles, sources, and barriers of evidence-based studies. It also summarizes two studies - one on the effectiveness of lukewarm water compression on nipple pain and breast engorgement among postnatal mothers and another on the effectiveness of foot and hand massage on cesarean pain among postnatal mothers.

1. 1

2. EVIDENCE
BASED STUDIES
AT PUERPERIUM PRESENTED BY
MRS.THANGAM JAYARANI J
M Sc (N),
FIRST YEAR,
GCON,CUDDALORE.
2

3. INTRODUCTION
Evidence based studies is the integration
of the best research evidence with clinical
expertise and patient values to deliver
optimal care. Best research studies means
clinically relevant and patient centered
research studies.
3

4. DEFINITION OF PUERPERIUM
The puerperium is defined as the six (6) weeks
period commencing after the completion of
third stage of labour.
E M SYMONDS
The puerperium is refers to the six (6) weeks
period following child birth, with considerable
adjustment occur before return to the
pregnant state.
PHILIP N.BAKER
4

5. DEFINITION OF EVIDENCE
Evidence is something that
furnishes proof or testimony or
something legally submitted to
ascertain in the truth of matter.
5

6. DEFINITION OF EVIDENCE BASED
STUDIES
It is systematic inter connecting
of scientifically generated evidence with
the tacit knowledge of the expert
practitioner to achieve a change in a
particular practice for the benefit of a
well-being defined client/patient group
FRENCH (1999)
6

7. DEFINITION OF EVIDENCE BASED
NURSING
Evidence based nursing is a process by
which nurses make clinical decisions
using the best available research
evidence, their clinical expertise and
patient preference.
MULLHALL (1998)
7

8. DEFINITION OF EVIDENCE BASED
MEDICINE OR PRACTICE
Evidence based medicine or practice is
the conscientious, explicit and judicious
use of current best evidence in making
decision about the care of individual
patient.
DR.DAVID SACKETT,ROSENBERG.
8

9. DEFINITION OF MIDWIFERY
PRACTICE
Midwifery practice is underpinned by
values that guide the way in which
midwives provide care. Midwives are the
most appreciate care providers to attend
women during pregnancy,labour,birth
and the postnatal period and in
collaboration with other health care
professions when required. 9

10. 10

11. MEANING OF EVIDENCE BASED
STUDIES
Evidence based studies is the use of
prior research in a systematic and
transparent way to inform a new
study.so,that it is answering questions
that matter in a valid ,efficient , and
accessible manner.
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12. 12

13. OBJECTIVES OF EVIDENCE BASED STUDIES
Evidence based studies seeks to replace practice
as usual with practice guided by rigorous
outcomes oriented research ideally randomized
controlled trails.
It also seeks to make practice a less subjective
enterprise and to rise it to a highest level of
accountability. 13

14. OBJECTIVES OF EVIDENCE BASED STUDIES…….
Reduces the variations in nursing care and assist
with efficient and effective decision making.
Providing practice to the nurse evidence based
data to deliver effective care.
14

15. 15

16. GOAL’S OF EVIDENCE BASED STUDIES
16
GOAL
Resolve problem in clinical settings
Reduces the variations in nursing care
Achieve excellence in care delivery
Assist with efficient nursing care
Effective decision making

17. 17

18. AIMS OF EVIDENCE BASED STUDIES
To provide the high quality and most cost
efficient nursing care possible.
To advance quality of care provided to
health worker.
To increase satisfaction among patients.
To focus on nursing practice away from
habits and tradition to evidence and
research. 18

19. AIMS OF EVIDENCE BASED STUDIES..
It results in better patient outcomes.
It contributes to the science of
nursing.
It helps practice current and relevant.
It increase confidence in decision
making.
19

20. NEEDS OF EVIDENCE BASED STUDIES
20
For making sure that
each client get the
best possible
essential services
Update
knowledge and is
essential for life
long learning
Improvement care
provided and save
lives
Provide clinical
judgment

21. PROCESS OF EVIDENCE BASED STUDIES
21
BEST
RESEARCH
EVIDENCE
PATIENT
VALUES AND
PREFERENCES
CLINICAL
EXPERIENCE
NEEDS

22. STEPS OF EVIDENCE BASED STUDIES
22
ASK- Frame focused questions to be answered by the evidence review
ACQUIRE-Find evidence based recourses to answer the question
APPRAISE-Evaluating the strength and applicability of the evidence
ANALYZE-Standardize,summarize,and rate strength of body of evidence
APPLY-Applying the evidence
AUDIT/ASSESS

23. COMPONENTS OF EVIDENCE BASED
STUDIES
23
COMPONENTS
BEST AVILABLE EVIDENCED
CLINICIANS KNOWLEDGE AND
SKILLS
PATIENTS WANTS AND NEEDS

24. PILLARS OF EVIDENCE BASED STUDIES
24
1.RESEARCH
2.PATIENT
3.PRACTICE
4.CONTEXUAL
FOUR PILLARS

25. PRINCIPLES OF
EVIDENCE BASED STUDIES
Eight evidence based principles for
effective intervention,
1.Assess actuarial risk/needs
2.Enhance intrinsic motivation.
3.Increase positive reinforcement.
4.Provide measurement feedback.
25

26. PRINCIPLES…
5.Target interventions
a. Risk principle:
Prioritize supervision and treatment resources
for higher risk offenders.
b. Responding principle:
Be responsive to temperament, learning ,
style, motivation, culture, and gender when
assigning programs.
26

27. PRINCIPLES……
c. Need principle:
Target interventions to criminogenic needs.
d. Dosage :
Structure 40-70 % of high risk offenders time
for 3-9 months.
e. Treatment :
Integrate treatment into the full
sentence/sanction requirement. 27

28. PRINCIPLES……
6.Skill train with directed practice ( use
cognitive behavioral treatment method)
7.Engage ongoing support in natural
communities.
8.Measure relevant process / practices.
28

29. SOURCES OF EVIDENCE BASED
STUDIES
SOURCES
PEER-REVIEWED
RANDOMIZES
CLINICAL
TRIALS
CLINICAL TRIALS
JOURNAL
ARTICLES
29

30. THE EVIDENCE BASED MIDWIFERY
PRACTICES ARE AS FOLLOW
Antenatal immunization.
Estimation of haemoglobulin.
Iron and folic acid supplementation.
Vaginal examination during pregnancy.
Eating and drinking in labour.
Position during labour.
Enema during labour
30

31. THE EVIDENCE BASED MIDWIFERY
PRACTICES ARE AS FOLLOW
Psychological support in labour.
Use of epidural during labour.
Episiotomy.
Use of uterine stimulants.
Water bath.
Management in obstetrics.
Caesarean birth.
31

32. THE EVIDENCE BASED MIDWIFERY
PRACTICES ARE AS FOLLOW
Cord clamping.
Breast feeding.
Kangaroo mother care.
Antenatal and postnatal exercise.
Natural therapies.
Teaching programs etc…
32

33. BARRIERS TO EVIDENCE BASED STUDIES
Lack of value for research in practice.
Difficulty in bringing change.
Lack of administrative support.
Lack of knowledge.
Lack of time for research.
Many nurse have not receive any formal
instruction in research and they lack skill
to judge.
33

34. BARRIERS TO EVIDENCE BASED STUDIES
Unavailability of research reports, which are
not easily gathered.
Complexity of the research regarding evidence
based studies.
Organization have failed to motivate or
rewards.
There is a shortage of role model nurse who
can be evaluated for their success in nursing or
promoting the use of research in clinical
practice. 34

35. ADVANTAGES OF EVIDENCE BASED
STUDIES
Provide better information to practitioner.
Enable consistency of care.
Better patient outcome.
Provide client focus care.
Structural process.
Increase confidence in decision making.
35

36. ADVANTAGES OF EVIDENCE BASED
STUDIES
Generalize information.
Contribute to science of nursing.
Provide guidelines to further
research.
Helps nurses to provide high quality
of patient care. 36

37. DISADVANTAGES OF EVIDENCE
BASED STUDIES
Time consuming.
Reduced client choice.
Reduced professional judgment /autonomy.
Suppress creativity.
Influences legal proceedings.
Publication bios.
37

38. A STUDY TO ASSESS THE EFFECTIVENESS OF
LUKEWARM WATER COMPRESSION ON NIPPLE
PAIN AND BREAST ENGORGEMENT AMONG
POSTNATAL MOTHERS
38

39. ABSTRACT
INTRODUCTION:
• The common problems affect in breast
feeding is breast engorgement and nipple
pain.
AIM OF THE STUDY:
• To evaluate the effectiveness of lukewarm
water compression
39

40. • Lukewarm water compression on nipple
pain and breast enlargement among post
natal mothers and to find out the
association between the nipple pain and
breast enlargement among Post with their
selected demographic variables.
40

41. Methods:
• Pre experimental one group pre-test
,post -test design was adopted for this
study.
Conducted at:
• Maruthi hospital Namakkal.
Sample size:
• 50 post natal mothers.
Sample technique
• Purposive save sample technique. 41

42. The Nature after study
• Study was briefed to participants and
consent was obtained warm water
compression two part of boiling water and
one part of cold water was applied with the
sponge cloth, Over the engorged breast and
which was replaced every 5 minutes for a
total duration of 20 minutes 10 minutes
before and 10 minutes after breastfeeding
for two times on 3rd 4th and 5th postnatal
day. 42

43. Results
• There was here significant difference
between the post test scores .
conclusion
• The study Conducted that the application
of luke warm water compression is effective
in reducing the nipple pain and breast
engorgement among post natal mothers.
43

44. ASSES THE EFFECTIVENESS
OF FOOT AND HAND
MASSAGE ON CAESAREAN
PAIN AMONG POSTNATAL
MOTHER'S
44

45. ABSTRACT
Introduction:
• The birth of the child is generally viewed
as a time of rejoicing despite the physical
pain and exhaustion experienced by the
mother at the time the mother needs lots
of help for the realization and acceptance
of child birth.
•
45

46. • As normal physiological phenomenon.
Recently many complementary therapies
such as music reflexology has proved
effective in managing caesarean section
pain foot and hand massage has the
potential to aid in relaxation as well as the
pain relief.
46

47. AIMS
• To determine the effectiveness of foot and
hand massage on cesarean pain among
postnatal mother's in the experimental
group
Findings
• Qualitative approach quasi experimental
time series design.
47

48. • Assessment of caesarean pain perception
was done by numerical rating scale pre
intervention pain level and post operative
parameters where assessed for
experimental group foot and hand
massage for 20 minutes for two sessions
with an interval of 60 minutes was
provided and the post intervention pain
level post operative parameters for
assessed for both the groups.
48

49. Results:
Foot and hand massage is easy to apply,
costless and doesn't need special
equipment. Midwives are responsible to
pain management; hence their practice.
The results show that foot and hand
massage significant effect to relieve pain.
49

50. 50
EFFECTIVENESS OF DRY COLD
APPLICATION ON EPISIOTOMY
WOUND HEALING PATTERN
AND LEVEL OF PAIN AMONG
PRIMIPARA MOTHERS.

51. ABSTRACT
Introduction:
• Episiotomy a simple surgical procedure
during childbirth results in severe pain and
other complications in postnatal period.
Aims:
• The reduced pain and improve wound
healing pattern by dry and cold application
on episiotomy wound.
51

52. Evaluation approach:
• Quasi experimental study
• Pilot study
Findings:
• Dry cold application was given only to the
experimental group mother’s after delivery
within 2 to 8 hours on 2nd,3rd,4th and 5th day.
The major findings of the study where in
experimental group regarding pain score was
highly significant at the level of all days
regarding wound healing pattern is
experimental group significant differences
found in the aspects of redness oedema .
52

53. ASSESSMENT OF
EFFECTIVENESS OF INFRARED
THERAPY ON EPISIOTOMY PAIN
PERCEPTION AMONG
POSTNATAL MOTHER'S
53

54. ABSTRACT
Introduction
• A quantitative approach true experimental pre-test and
the post test control group design was chosen to assess
there effectiveness of infrared therapy in episiotomy pain
perception among postnatal mothers.
Methods:
• Quantitative approach.
Conducted at:
• Government Rajaji hospital Madurai.
Sample size:
• 60 post mortal mothers.
Sample technique:
• simple random sampling and lottery .
54

55. The nature of the study:
The pre-test level of episiotomy pain
was assessed by using the numerical
pain scale and the level of episiotomy
pain perception among postnatal
mothers in both groups were perceived
severe. Infrared therapy 245 volts 10
minutes twice a day, for 3 days was
given to experimental group.
55

56. EFFECTIVENESS OF FOOT
REFLEXOLOGY ON LACTATION
AMONG POST NATAL MOTHERS
IN SELECTED HOSPITALS.
56

57. ABSTRACT
Introduction:
In Indian culture mothers are considered a
Visible God, because they give birth to a life
as well as take care of the baby by feeding
their own milk. Lactation is very important
for successful breast feeding. Reflexology
also helps to regain and maintain health that
is lost due to stress from surgery.
57

58. Aims:
To evaluate the effectiveness of foot
reflexology on lactation among post natal
mothers.
Methods:
A quantitative research approach
Sample size:
20 postnatal mothers.
Conducted at:
kanyakumari district hospitals,
Tamilnadu. 58

59. The nature of the study:
Mother laches breastfeeding assessment
tool was used to access the level of Lactation
among the postnatal mothers.
Results :
The results shown that Reflexology had
significant affecting promotion of lactation
among postnatal mothers.
59

60. EFFECTIVENESS OF LAVENDER
OIL SITZ BATH ON EPISIOTOMY
WOUND HEALING AMONG
POSTNATAL MOTHER'S.
60

61. ABSTRACT
Introduction:
• Episiotomy is the most common
perineal incision in obstetric and
midwifery. After the delivery most
women have some degree of
discomfort during the first stage of
postpartum days because of
episiotomy. Nowadays alternative and
complementary therapies such as using
essential oils are established in
alternative therapy. 61

62. Aims:
• This research was carried out and assess
the effectiveness of lavender oil sitz bath
in episiotomy wound healing and pain.
Methods:
• Quasi experimental design
Sample size:
• 60 postnatal mothers.
Conducted at:
• George mission hospital Nagercoil. 62

63. The nature of the study:
• The episiotomy wound healing and pain
perception were assessed on the 1st,2nd
and 5th postnatal days in both groups.
Results :
• This study concludes lavender oil sitz bath
is effective in episiotomy wound healing
and reduction in pain perception.
63

64. 64

65. WIEDENBACH MIDWIFERY THEORY
EFFECTIVENESS OF DRY COLD APPILICATION ON EPISIOTPMY WOUND HEALTHY PATTERN AND
LEVEL OF PAIN AMONG PRIMIGRAVIDA MOTHERS
REALITIES
AGENT
Researcher
ENVIRONMENT
Hospital
RECIPIENT
Mothers who
receive dry and cold
application
MEANS
Dry cold application
on episiotomy
wound healing
pattern and level of
pain among primi
mothers
IDENTIFICATION
Assess the
episiotomy
wound healing
pattern by using
Quasi
Experimental
Method
ADMINISTRATION
INTERVENTION
GROUP
Dry cold
application given
for postnatal
mothers after
delivery with in
2nd,3rd,4th and 5th
day
CONTROL GROUP
Routine care
VALIDATION
postnatal
mothers
after delivery
with in
2nd,3rd,4th
and 5th day
GOAL
To
Reduce
pain and
increase
wound
healing
pattern
NEGATIVE
OUTCOME
Not Reduce
the pain and
increase
wound
healthy
pattern
POSITIVE
OUTCOME
Reduce the
pain and
increase
wound
healthy
pattern
FEED BACK

66. ASSIGNMENT
TIME:1 HOUR 10×2=20
1.Explain about the evidence based studies
at puerperium.
2.How to apply the theory on evidence
based studies in midwifery practice.
66

67. 67

68. 1. Sheebeer.p.Basheer ,S. Yasmin Khan, (2022)."A
concise textbook of advanced nursing
practice".(3rded).Bangalore; EMMESS Medical
publisher. 748-754.
2. Navdeep Kaur brar,HC Rawat,(2015),"Text book of
Advanced nursing practice",(1st ed),New delhi:
Jaypee brothers medical publishers (P)ltd.533-542.
68

69. 69