This document outlines the structure and contents of a research study on assessing the knowledge of staff nurses regarding prevention and management of perineal tears during normal delivery. It includes 6 chapters that discuss the introduction, literature review, methodology, data collection process, data analysis plan, and expected outcomes including conclusions and recommendations. The study aims to assess nurses' current knowledge and identify any associations between knowledge and demographic factors, with the goal of developing an educational module to improve nurses' understanding of perineal tears.

1. BY
DR.ANJALATCHI
M.SC(N)MD(AM)MBA(HA)PH.D(N)

2. Chapter-I
 Introduction
 Need for the study
 Statement of the
problem
 Objectives of the study
 Operational definitions
 Assumption
 Hypotheses
 Delimitations
 Conceptual framework
Chapter-II
• Review Of Literature
Chapter III
• Research
Methodology
• Research approach
• Research Design
• Variables under
investigation Setting
of the study
• Population
• Sample
• Sampling Technique
• Sample size
Chapter-IV
• Data collection technique
and instrument
• Description of the tool
• Pre testing of tool &
Reliability
• Pilot study
• Ethical consideration
• Procedure for Data
collection
Chapter-V
Process of data analysis and
interpretation
Chapter-VI
• Summary
• Conclusion
• Nursing Implication
• Limitations
• Recommendations
• References

3. A bodily wound or damage is referred to as trauma. One of the
injuries that may occur during vaginal delivery is genital
trauma. It includes vulva, vagina, perineum, cervix, and uterine
trauma or injury. During delivery, the perineum, vagina, uterus,
and their supporting tissues sustain the majority of acute
injuries and lacerations.
Nature has the best owed women with the capacity of producing
children the process that makes her mother. For this she has to
undergo a very painful process of labour
Introduction

4. Laceration of the perineum and vagina may occur during
normal delivery due to the head's fast and abrupt
ejection, the newborn's enormous size, and the fragile
maternal tissues. Difficult forceps births, breech
extractions, or a constriction of the pelvic exit as the
head is pulled back may all cause them. Some tears are
inevitable even in the most competent hands, but how
they are handled is crucial.
Cont….

5. Severe tearing is uncommon when delivery happens properly and
spontaneously, with the woman staying upright and active and
not hurrying the process. The most common obstetric legacy is
perineal injury. Many women discover that laying in bed with
their legs together for a few weeks repairs the tear on its own,
without the need for medical intervention, since the edges
naturally come together where they should be anyhow.
Cont….

6. There are five different types of tears:
1. First-degree Tear(vaginal mucosa torn)
2. Tear in the second degree(perineal muscle torn)
3. Third – Degree Tear(anal sphinter)
4. Fourth – Degree Tear(rectum torn)
5. Button – Tear in the Hole
Cont….

8. Perineal trauma is extremely frequent during childbirth, occurring
in approximately 40% of women during their first delivery and
about 20% in subsequent deliveries. Any laceration that extends
beyond the perineal skin and subcutaneous tissue must be
considered an obstetric problem.
Genital injury during delivery may occur accidentally as a laceration
or on purpose as an episiotomy Between 30 and 85 percent of
pregnant women experience trauma, which may result in
Perineal pain, incontinence, sexual difficulties, and other short-
and long-term morbidity varying degrees of functional
impairment.
Need of the study citation.pdf
Need of The Study

9. On a global scale, Australia ranks well when it comes to conducting
episiotomies, given that the United States' episiotomy rate is
presently at 35%. In some Latin American countries, as well as
Taiwan, an episiotomy is routinely performed on all first-time
mothers, with rates surpassing 90%.
Cont….

10. Assess the knowledge of staff nurses regarding
prevention and management of perineal tear
during normal delivery at selected hospitals of
Lucknow (U.P.) with a view to develop
self instructional module (SIM)

11.  1. To assess knowledge of staff nurses regarding
prevention and management of perineal tear
during normal delivery.
 2. To find association between knowledge
regarding prevention and management of perineal
tear with selected demographic variables.

12.  Assess
 Knowledge
 Staff Nurses
 Prevention
 Normal Delivery

13.  Staff nurses will have some knowledge regarding
prevention of perineal tear during normal delivery.
 Staff nurses will have some knowledge regarding
management of perineal tear during normal
delivery.

14.  H0: There is no significant association between
the knowledge scores of staff nurses in terms of
perineal tear and selected demographic variables.
 H1: There is significant association between the
knowledge scores of staff nurses in terms of
perineal tear and selected demographic variables.

15.  Staff nurses working in selected hospitals at
Lucknow.
 Staff nurses who are willing to participate in
research study.
 Staff nurses who will be present at the time of
study.

17. I-Studies Related To Perineal Tear:
 Aasheim V, Nilsen AB (2017) was conducted a review on
published and unpublished randomized and quasi- randomized to
assess the effect of perineal techniques during the second stage of
labour on the incidence of perineal trauma.
 The study included 8 trials involving 11,651 randamised women .The
result of the study revealed that there was a significant effect of
warm compresses on reduction of third and fourth degree tears (risk
ratio (RR) 0.48, 95% confidence interval (CI) 0.28 to 0.84 (two
studies, 1525 women)).
 There was also a significant effect towards favouring massage vs
hands off to reduce third and fourth degree tears (RR 0.52, 95% CI
0.29 to 0.94 (two studies, 2147 women)). Hands off vs hand on
showed no effect on third and fourth degree tears, but it observed a
significant effect of hands off on reduced rate of episiotomy (RR
0.69, 95% CI 0.50 to 0.96 (two studies, 6547 women). The study
concluded that the use of warm compresses on the perineum is
associated with a decreased occurrence of perineal trauma.25

18. II. Studies Related To Prevention Of Perineal Tear
 Ma DM, Hu W, Wang YH (2017) were conducted a study on
multicentre study on the effect of moderate perineal protection
technique: a new technique for perineal management in labour. 31,249
women accepted the traditional technique were selected as control
group, and 57,056 women accepted the Moderate Perineal
Protection technique as the observation group.
 There was no significant difference in demographic characteristics between
the two groups. The perineal episiotomy rate decreased (22.913%
vs. 32.161%, p < .05), the perineal integrity significantly increased
(43.505% vs. 36.384%, p < .05) and perineal trauma reduced in the
observation group when compared to the control group (54.630% vs.
61.239% in first degree tears, and 1.826% vs. 2.340% in second degree
tears, p < .05).
 The neonatal asphyxia rate in the observation group was lower than that in
the control group (p < .05). The observation group also had a higher rate of
total satisfaction, lower VAS score for perineal pain, shorter postpartum
hospitalisation days, lower rate of postpartum urinary retention and
postpartum incontinence (p < .05). We concluded that the Moderate
Perineal Protection technique is safe, effective and worth promoting
widely.43

19. RESEARCH DESIGN
TARGET POPULATION
Staff nurses working in selected Hospital,
Lucknow
DATA COLLECTION METHOD
Assess the knowledge regarding perineal tear during normal delivery
CRITERION MEASURES
Descriptive and Inferential Statistics
PLAN FOR DATA ANALYSIS
Descriptive Research Approach
RESEARCH APPROACH
Self Administered Questionnaire
Purposive Sampling Technique
SAMPLING TECHNIQUE
Non Experimental Descriptive Research Design

20. Variables Under Investigation
 Three types of variables i.e. independent
variable, dependent and demographic
variable. In present study demographic variables
were found.
Demographic Variables
 Demographic variables selected for this study are
age, gender, education qualification, work
experience, work experience in labour
room, previous knowledge

21. INCLUSION CRITERIA
 Staff nurses who are willing to participate in the study.
 Staff nurses who are posted in labour room/OBS.Ward of the hospital.
 Staff nurses who are present at the time of study.
EXCLUSION CRITERIA
 Staff nurses who are not willing to participate in this study.
 Staff nurses who are posted in others ward of hospital except Labour room
and Obs/Gynec ward.
 Staff nurses who are not present at the time of study or on leave.
TOOL/INSTRUMENT USED
 A multiple choice question (MCQ)will be used for data collections which
have two sections.
 Section –I: This section is the first section seeking information on
demographic information of the staff nurses
 Section-II: This section is the second part of structured knowledge
questionnaire, which consists of questions assessing knowledge about
perineal tear.

22. Conducted at Era’s Lucknow Medical College and
Hospital, Lucknow
Sample size – 25 Staff nurses
Findings – Statistically significant
Pilot Study

23. Setting – Era’s Lucknow Medical College and
Hospital, Lucknow
K.K. Hospital, Lucknow
Unity Hospital, Lucknow
Sample Size – 250 Staff nurses
Data Analysis – Descriptive statistics
Inferential statistics
Main Study

24.  There are a total of 30 question regarding perineal tear in
which 11 questions related to concept of perineal tear, 6
questions related to prevention of perineal tear and
remaining 13 questions related to management of
perineal tear. Tool for knowledge assessment of
research
 The score for correct answer was „1‟ and for the wrong
answers was „0‟. The scores range from a minimum of 0 to
a maximum score of 30.
The levels of knowledge have been classified as follows:
 Poor - <50% ,Average 51-65% ,Good - >65%
 The content of data collection tool was sent for its validity in
terms of relevance and accuracy to a list of experts along with
scoring sheet. The data

25.  Data will be collected from the staff nurses
individually through structured knowledge
questionnaire.
 The data collection for main study was conducted
from 25/06/2019 to 18/08/2019 at Era‟s Lucknow
Medical College and Hospital, K.K. Hospital,
Lucknow, Unity Hospital, Lucknow.
 The investigator himself administered the
structured questionnaire schedule for assess the
knowledge of staff nurses regarding perineal tear.
 The duration of data collection for each sample was
40 – 50 minutes and approximately 10 samples
per day were approached.

26.  Data will be analyzed by descriptive and
inferential statistics used .
 For the analysis of demographic data
frequencies and percentage was calculated.
 The significance was calculated by using
mean, mean percentage, median, standard
deviation was used to find the co-relation with
every item & the findings were documented in
tables, graphs & diagrams.
 Data analysis and interpretation results citation

27.  Section I: Description of demographic
variables of the staff nurses.
 Section II: Assess the knowledge levels of staff
nurses regarding perineal tear.
 Section III: Association between knowledge
levels of staff nurses with demographic
variables regarding perineal tear
Analysis And Interpretation

30. Association Level of Awareness With
Selected Demographic Variables
S.
No.
Variables Df Tabulated
value
X2
Value
Remarks
1. Age 6 12.59 7.06 NS
2. Gender 2 5.99 3.70 NS
3. Educational
Qualification
6 12.59 23.16 S
4. Working experience 6 12.59 19.11 S
5. Experience in labor
room
6 12.59 13.67 S
6. Previous knowledge 2 5.99 6.47 S

31. S. No. Level Of
Knowledge
Frequency Percentage
1. Poor (<50%) 70 28%
2. Average (51% to
65%)
85 34%
3. Good (> 65%) 95 38%
The table no. 4.7 showed the comparison of level of knowledge of
staff nurses regarding prevention and management of perineal tear.
With regard to scores, 70 (28%) staff nurses had poor knowledge, 85
(34%) staff nurses had average knowledge and 95 (38%) staff nurses
had good knowledge regarding prevention and management of
perineal tear.
SECTION II: ASSESS THE KNOWLEDGE LEVELS OF STAFF NURSES REGARDING PERINEAL TEAR

32. S.
No.
Aspect Of
Knowledge
Max.
Score
Mean Mean % Median Standard
Deviation
1. Questionnaires related
to
concept of perineal tear
11 7.94 72.18% 8 2.00
2.
Questionnaires related
to prevention
of perineal
Tear
06 3.70 61.66% 4 1.04
3.
Questionnaires related
to management of
perineal
Tear
13 10.76 82.76% 11 1.68
Total 30 22.40 74.66% 22 2.91

33. Major finding of the study are as follows:
 The most of samples were from age of 31 – 40 years 110 (44%), followed by
from 21 – 30 years 65 (26%), some of them 41 – 50 years was 45 (18%) and
remaining from 51 – 60 years was 30 (12%).
 The majority of samples was male 130 (52%) and remaining were female 120
(48%).
 The most of samples 90 (36%) have done B.Sc. Nursing followed by 75
(30%) have done G.N.M., 65 (26%) have done PB B.Sc. nursing and remaining
20 (08%) was M.Sc. nursing.
 Most of samples 110 (44%) have 5 to 15 years experience and other was 55
(22%) have less than 5 years experience and remaining 50 (20%) have 16 – 25
years of experience and remaining 35 (14%) have more than 25 years
experience.
 Most of samples 115 (46%) from 5 to 15 years work experience in
labour room following by 75 (30%) have less than 5 years work experience in
labour room and some of them 40 (16%) have 16 to 20 years and remaining 20
(08%) have more than 20 years work experience in labour room.
 Most of samples about 140 (56%) have previous knowledge regarding
perineal tear and remaining 110 (44%) have not previous knowledge.

34.  With regard to scores, 70 (28%) staff nurses had
poor knowledge, 85 (34%) staff nurses had average
knowledge and 95 (38%) staff nurses had good
knowledge regarding prevention and management of
perineal tear.
 The overall level of knowledge of staff nurses
regarding prevention and management of perineal
tear the mean, mean percentage, median and
standard deviation were 22.40, 74.66%, 22 and 2.91
respectively.

35. Area Wise Level Of Knowledge Score Of
Staff Nurses
Aspect Of Knowledge
Max.
Score
Mean
Mean %
Median
Standard
Deviation
Questionnaires related to
concept of perineal tear
11 7.94 72.18% 8 2.00
Questionnaires related to
prevention of perineal
tear
06 3.70 61.66% 4 1.04
Questionnaires related to
management of perineal
tear
13 10.76 82.76% 11 1.68
Total 30 22.40 74.66% 22 2.91

36. The Recommendation
 A study can be replicated on a larger sample
thereby findings can be generalized for a larger
population.
 A comparative study can be conducted to
evaluate the effectiveness of a planned teaching
programme.
 A similar study can be conducted in community
setting. An experimental study can be
undertaken with control group

38.  On the basis of results it is conclude that
maximum number of staff nurses were had
average knowledge and minimum had good
knowledge regarding prevention and
management of perineal tear.
 The maximum mean score of Staff nurses
was in the area of management of perineal
tear with 1.68 SD. The overall knowledge
score of staff nurses was 22.40 mean,
74.66% mean percentage, 22 median with
2.91 SD.

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42.  End………………..