METHODOLOGY:
"Design is not just what it looks like and feels like, design is how it works"
-Steve Jobs
Methodology is the most important part of any research study. It includes various steps that
are generally adopted by the researcher in studying the research problem along with the logic
behind them.
The present study was aimed at assess the effectiveness of Tailored nursing management on
stress and anxiety among primigravida mothers. This chapter deals in detail with the
methodology adopted for the study. It also describes the rationale for research approach,
research design, setting of the study, population, sample, sampling technique, and sample
size, method of data collection, development of tool, ethical consideration, validity, pilot
study, reliability and plan for data analysis.
Research Approach:
Research approach is the most significant part of any research. The appropriate selection of
research approach depends on the purpose of the study.
A Quantitative evaluative research approach was used to assess the effectiveness tailored
nursing management on stress and anxiety among primigravida mothers. A Quantitative
evaluative research approach is generally applied where the primary objective is to determine
the extent to which a given strategy meets the desired result.
Research Design:
The research design adopted for this study was pre-experimental one group pre-test post-test
design without control group.
A pre-test was conducted using Structured Interview on stress and anxiety in primigravida by
using Perceived Cohen stress Scale and Generalized Anxiety Scale. Intervention was given in
the form of tailored nursing intervention on stress and anxiety among primigravida mother;
post test was conducted by using same Perceived Cohen Stress scale and Generalized Anxiety
Scale to assess effectiveness of tailored nursing intervention.
Schematic representation of research design:
Pre experimental pre-test post-test research design
Group O1 X O2 E
(Pre-test) (Intervention) (Post-test) (Effectiveness)
Group I➡ O1➡X➡ O2➡E
O = Pre-test for the assessment of stress and anxiety among primigravida mothers by using
Perceived Cohen Scale.
X = Implementation of Tailored Nursing Intervention like psychoeducation on management
of pregnancy, management of problems associated with pregnancy, counselling sessions to
clear the doubts along with administration of relaxation techniques such as deep breathing
exercises, culturally accepted meditation and light antenatal exercises delivered in 6 session
(3 sessions per week) for 2 weeks and also delivered in group format comprised of 5-8
members in 1 group among primigravida mothers.
O = Post-test to assess the effectiveness of Tailored Nursing Intervention on stress and
anxiety among primigravida mothers by using Perceived Cohen Scale and Generalized
Anxiety Scale.
E=Checking the effectiveness of Tailored Nursing Intervention by using Cohen perceived
stress scale and Generalized Anxiety Scale.
Population
The term 'population' refers to "the aggregate or mass of subjects upon which researcher
intended to generalize the findings". The "accessible population" is the population of subjects
which can be enumerated and studied. The 'target population' is the total group of subjects
about which the investigator is interested to make generalization. The population for this
study was primigravida mothers.
Universal Population:-Universal or target population of the present study is all
Primigravida mothers attending OBG OPD’S of various hospitals of Bagalkot district.
Accessible Population:-Accessible population of present study consists of the
Primigravida mothers aged between 20-35 years in selected hospital of Bagalkot.
Sample and sample size: The sample for the present study will be primigravida mothers
aged between 20-35 years attending OBG OPD’S of selected hospitals of Bagalkot. Sample
size will be 60 primigravida mothers.
Sample size estimation:
In the present study the sample size was calculated by using Epi info software.
The sample size was estimated using the results (mean and standard deviation)
of a previous similar study conducted in Bangalore, Karnataka, India, to assess
the stress levels by using perceived Cohen stress scale and generalised
anxietyamong primigravida mothers.
The level of confidence was 95% (a=5%) and Za=1.96
The power of test was considered 80%
The sample size estimated by the statistician was 43
Considering the attritions of data, the researcher enrolled 50 subjects
Sampling Technique: A purposive sampling technique will be used to select the sample
for the study.
VARIABLES:
Variable is a content that has measurable changing attributes. Variables are qualities,
properties, or characteristics of persons, things, or situation that can change or vary.
Independent variable: Tailored nursing intervention.
Overview of intervention:
1. Nature of intervention: Nursing intervention.
2. Format of intervention: Group intervention
3. Size of group: 5-8 primigravida mothers.
4. Total number of sessions: 6 sessions.
5. Frequency of sessions: 3 sessions per week for 2 weeks.
6. Duration of each session: 60-90 minutes.
Dependent variables: Stress and anxiety among primigravida mothers.
Socio-demographic and obstetrical variables: Age, education, religion, type of family,
occupation, husband education, family monthly income, place of residence, food habits, any
history of miscarriage.
Setting: The present study will be conducted from primigravida mothers attending OBG
OPD’S of selected hospitals of Bagalkot.
DELIMITATIONS:
The study is delimited to:
Primigravida mothers aged between 20-35 years attending OBG OPD’S of selected
hospitals of Bagalkot.
Intervention is administered in only 6 sessions.
Primigravida mothers willing to participate in study.
Study is limited to Primigravida mothers.
CRITERIA FOR SAMPLING:
A) Inclusion Criteria: The study includes primigravida mothers, who are,
Primigravida mothers aged between 20-35 years attending OBG OPD’S of selected
hospitals of Bagalkot.
Primigravida mothers who are suffering from mild to moderate stress and anxiety.
Primigravida mothers who are available during the period of data collection.
Primigravida mothers who are able to understand, read and write Kannada or English.
Primigravida mothers who are willing to participate in this study.
B) Exclusion Criteria: The study excludes primigravida mothers, who are,
Multigravida mothers.
Unable to cooperate throughout the period of study.
Unable to attend the intervention due to severe illness.
Primigravida mothers with severe stress and anxiety.
METHODS OF DATA COLLECTION:
The present study data from primigravida with stress and anxiety will be collected through
structured and standard tools. The investigator has planned to collect the data in following
steps:
STEP-I: Obtaining formal administrative approval from the Principal of Sajjalashree
Institute of Nursing Sciences Bagalkot.
STEP-II: Obtaining approval from Institution Ethical Clearance Committee.
STEP-III: Obtaining Permission from Concerned Authorities of Selected Hospitals
STEP-IV: Screening the primigravida mothers for Eligibility Criteria.
STEP-V: Invite primigravida mothers to participate in the study.
STEP-VI: Obtaining Informed Consent from primigravida mothers willing to participate
in the study.
STEP-VII: Assessment of socio-demographic and obstetrical profile of primigravida
mothers.
STEP-VIII: Assessment of stress and anxiety among primigravida mothers.
STEP-IX: Close the Data collection with a friendly Note.
Description Of Tool:
In the present study data will be collected by researcher herself after obtaining permission
from concerned authority and informed consent from subjects in the following sections;
Section A: Sociodemographic and obstetrical profile of primigravida mothers.
Section B: Cohens Perceived stress scale
It is a 10 item scale each item is scored on 0-4 Likert scale. Total score ranges between 0-40.
Higher score indicates higher level of stress.
Section C: Generalized anxiety scale (GAD)-7
It is a 7 item scale each item is scored on 0-3Likert scale. Total score ranges between 0-21.
Higher score indicates higher level of anxiety.
SCORING OF PERCIEVED STRESS SCALE:
Individual scores on the PSS can range from 0 to 40 with higher scores indicating higher
perceived,
► Scores ranging from 0-13 would be considered low stress.
► Scores ranging from 14-26 would be considered moderate stress.
► Scores ranging from 27-40 would be considered high perceived stress.
SCORING OF GENERALIZED ANXIETY SCALE:
1. 0-4: minimal anxiety.
2. 5-9: mild anxiety.
3. 10-14: moderate anxiety.
4. >15: severe anxiety.
Content validity of the tool:
The adequacy of sampling of the domain being studied. It is the assessment of instruments
ability to measure what it intends to measure, the degree to which the data collection tool
reflects the body of knowledge pertaining to concept being studied. The tool is validated by 5
experts from specified fields such as OBG Nursing.
Reliability of the tool:
The reliability of the tool was established by using odd and even numbers method. Karl
Pearson's co-efficient correlation 'r' was computed for finding out the reliability.
R=
The coefficient correlation for the test was found to be significant.
The reliability of the whole test was then estimated using spearman’s brown prophecy
formula
r=
the obtained value of ‘r’ was , indicating that the tool was highly reliable.
Development of intervention:
Validity of intervention:
The interventional was sent to 5 experts in the field of Obstetrics and Gynaecological Nursing
for content validity and was modified by considering their suggestions.
Pilot study:
Pilot study was conducted in Shrujan Hospital, Navanagar, Bagalkot from 11-02-
2020 to 19-02-2020 to find out the feasibility and practicability of the study design. 5
primigravida mothers attending OBG OPD’S selected randomly and a pre-test was conducted
with the use of Cohen perceived stress scale and generalised anxiety scale and tailored
nursing intervention on stress and anxiety among primigravida mothers. It took 60 minutes to
complete the intervention which was found feasible. A post test was conducted by using same
tool after seven days. The study was found to be feasible suggesting no need of modifications
for main study.
Data collection procedure:
After obtaining the formal permission from the Dean, H.S.K. hospital and research center
Bagalkot. The main study was conducted from 3-03-2020 to 5-05-2020 among 50
primigravida mothers; the subject was selected by purposive sampling technique. The
investigator given self-introduction explained the purpose of the study, subject's willingness
to participate in the study was ascertained. The subjects are assured anonymity and
confidentiality of the information provided by them and written informed consent was
obtained. The assessment of stress and anxiety was conducted on 18-02-2020 by using Cohen
perceived stress scale and generalised anxiety scale each subject took 30 minutes to answer
the Cohen perceived stress
Scale and generalised anxiety scale.
Data collection was carried out in two phases as follows:
After that data was collected by researcher himself in two phases as follows
First phase: A pre-test was conducted among the specified group of 50 primigravida
mothers attending OBG OPD’S , by using perceived Cohen stress scale and generalised
anxiety scale.
Second phase: a post test was conducted after one week of tailored nursing intervention
using perceived stress scale and generalised anxiety scale to assess the effectiveness of
tailored nursing intervention.
METHODS OF DATA ANALYSIS AND PRESENTATION:
The investigator will analyze the data by using descriptive and inferential statistics .
Descriptive Statistics:
Descriptive statistics like frequency, percentage distribution will be computed to
describe the socio demographic and obstetrical variables of Primigravida mothers.
Descriptive statistics like mean and standard deviation will be used to summarize the
stress and anxiety of primigravida mothers.
Inferential Statistics:
Paired t-test will be used to examine the difference between pre-test and post-test
level of stress and anxiety among primigravida mothers.
Chi-square test will be used to find out association between pretest levels of stress
and anxiety among primigravida mothers with their sociodemographic and obstetrical
variables of primigravida mothers.
Karl Pearson’s correlation coefficient statistical test will be used to determine
correlation between pre-test stress and anxiety scores of primigravida mothers.
DISSEMINATION OF THE RESULTS:
The dissertation will be submitted to RGUHS, College, Research Guide. Principal, and
Library in partial fulfilment of the requirement for the masters of Science in Obstetrical
and Gynaecological Nursing.
ETHICAL CONSIDERATION.
The researcher will maintain privacy and confidentiality of the data.
A written permission from the Institutional Ethical Committee will be obtained.
Does the study require any investigation or intervention to be conducted on
patient’s or other human or animals? If so, please describe briefly.
Yes,
Assessment of Perceived stress and anxiety of primigravida mothers.
In the study investigates effectiveness of tailored nursing intervention on stress and
anxiety among primigravida mothers.
Has the ethical clearance been obtained from your institution in case of Ethical clearance
certificate has been obtained from institutional and ethical clearance committee of Shree
B.V.V.S. Sajjalashree Institute of Nursing Sciences, Bagalkot.
Informed consent will be taken from the participants.
Privacy, confidentiality and anonymity of the data will be guarded; Scientific Objective of the
study will be maintained with honesty and impartiality.
Summary:
This chapter describes the general pattern of organizing the procedure of gathering valid and
reliable data for the problem under the investigation. One group pre- test post-test pre-
experimental design was used to assess the effectiveness of Tailored Nursing Intervention.
The study was conducted on to assess the effectiveness of Tailored Nursing Intervention on
stress and anxiety among primigravida mothers by using perceived stress scale and
generalized anxiety scale among primigravida mothers who are attending OBG OPD’S of
selected hospitals at Bagalkot. Purposive sampling technique was found appropriate for
selected OBG OPD’S and the Standardized tools are used. Pilot study was conducted to find
out the feasibility of the study. Reliability of the tool was tested by odd-even method and
validity was ensured in consultation with experts. The collected data from the respondents
has been analysed using descriptive and inferential statistics and presented in the form of
tables, graphs and diagrams.