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1 Name of the candidate 1st YEAR MSC NURSING



2 Name of the Institution Diana College of Nursing

no.68, chokkanahalli, jakkur post, bangalore-64

Course of study and Master of Science in Nursing

subject Psychiatric Nursing

Date of admission to
4 27/07/2011

A Study to Assess the Effectiveness of

Structured Stress Management Module on
5 Title of the topic Primi Mothers During Early Postnatal Period
in A Selected Government Hospital
Bangalore. Karnataka.

6. Brief resume of the work


The empowerment of women has been recognized through many international, regional and

national conferences as a basic human right and also as imperative for national development

and global well-being. Reproductive sexual health and rights are essential for the

empowerment of women and to all quality of life issues concerning social, economic,

political and cultural participation by women.1

UNICEF reported that in India, more than two-thirds of all maternal deaths occur in the

states of Uttar Pradesh, Uttarakhand, Bihar, Jharkand, Orissa, Madhya Pradesh, Chhattisgarh,

Rajasthan and Assam. The report found that health services were most effective in an

environment supportive of womens empowerment, protection and education. Both mothers

and infants are vulnerable in the days and weeks after birth. This is a critical time for life-

saving interventions like postnatal visits, proper hygiene and counseling about danger signs

of maternal and new born health, the report point out.2

The term stress means pressure in human life it represents an uneasy experience, it is an

unpleasant psychological & physiological state caused due to some internal & or external

stressors that go beyond our capacity .3

Stress in a inevitable past of life. Human beings experience stress early even before they are

born. A certain amount of stress is normal and necessary for survival. Stress helps children

develop the skill they need to cope with & adapt to new and potentially threatening situation

throughout life.4

On disease that is not easy to eliminate. Stress is recognized as a major health hazard of

the contemporary century underlies diverse condition such as psychosomatic disease,

behavioral change & it is a major contribute to disturbances in ones emotional, social &

family life. Furthermore, a variety of the modern diseases have their origin in stress.5

Stress in a big problem in our society. In recent year stress is its possible effect on mental

health have become increasingly important in nursing.6

Stress is a term in psychology & biology, first coined in the biological content in the 1930s.

Which in popular parlance. It refers to the consequence of the failure of an organism, human

or animal to respond appropriately to emotional or physical threats, whether actual or


Stress, a buzzword of the 90s. is a everyday fact of life at one point of the other everybody

surfers from stress relationship demands, physical as well as mental health problems.

Pressure at workplaces, traffic snacks, meeting deadlines, growing-up tensions all of these

conditions and situations are valid causes of stress. Stress refers to a broad group of

experiences in which external or internal demands, or both tax or exceed a persons resources

or coping capabilities the source of stress the external or internal is called a stresses. Stress or

stressors undergoes many changes in our body, our nerves systems and certain norm ones get

activated. These norm ones quicken our heart rate, breathing, metabolism and blood pressure

token it temperature cool. Their responses by the body to counter a stressful situation, helps

you handle the event effectively and perform well event under pressure. However after

tackling the stressful event, our body returns to normal. This natural ability of the body to

deal and stress is called stress response. Any event where our body fails to respond in manner

can cause stress.8

6.1 Need For the Study:

Train a man and you train an individual, Train a woman and you

build a nation -Bishop Nzimbe

Every woman feels that becoming a mother is the most gifted position, a woman could ever

achieve at life time. Child birth is a universally celebrated event, an occasion for dancing, fire

works flowers and gifts. Child birth is being a joyous event, at the same time it is a time of

pain fear and stress. Stress is a part of human life, and we are never completely free from

stress. Stress in one area can lead to stress in another. Many things in our life can be

stressful, such as period of development, marriage, child birth etc.

Selye defines stress as the non specific response of the body to any demand made on it.

Beland goes further to say What ever the specific source of psychological stress in illness, it

leads to unpleasant feelings such as anxiety, anger and helplessness. Primi mothers are more

likely to face emotional stress, because it represent the beginning of major life change to the

women. Even for the most recognized mothers, pain reduce the ability to cope and may make

her short tempered and quick to criticize things around her.9

A study was conducted in Western Finland to assess experience of fears in association with

pregnancy and child birth.78% of the samples were expressed fear relating to child birth. The

cause of fears were, negative mood, alarming informations, child related problems,

multiparas and negative experience of previous pregnancy and child birth. Fears were

manifested as symptoms of stress and wish to avoid pregnancy and child birth. The

researcher recommended that it is very important for the health care providers to ask

pregnant women about their feelings related to the current pregnancy , child birth , future

mother and provide an opportunity to the women to express their fears.10

Labour, as a life event, is characterized by tremendous psychological changes that require

major behavioral adjustment in a short period of time. Consequently, the labour process

constitutes a unique set of Stressors that challenges a womans ability to cope.11

Labour stress may also contribute to depression, concern regarding children, concerns about

parenting capacities, negative interpretation of pregnancy experiences and decreased

confidence. Researchers found that, certain variables can influence labour stress, such as

nalliparity, low level of formal education, absence of antenatal education and unexpected

pregnancy. Thus it reveals that all women in labour experience stress.

Postpartum psychiatric disorders are more common during the first child birth. The risk is

highest during the first four weeks after delivery; nearly 75% of mothers begin in this period.

In these four weeks 50% of all mothers have an onset in the first 7 to 10 days and 16% of

mothers have the onset on the first day of postpartum. (Meges, 2003).

Ayers and Pickering (2001) reported that prevalence of post traumatic stress disorder after

child birth ranges from 1.5% to 5.6% Soet.JE.et.al, (2003) studied one hundred womens

child birth experiences in USA. It reveals that 34% of mothers reported traumatic stress,

1.9% of mothers diagnosed as post treatment stress disorder and 30.1% were partially


Incidence of postnatal health problems in India are bladder problem (16%), back ache (20%),

frequent headache (3.6%), pelvic pains (0.75%), hemorrhoids (12%), constipation (20%),

fatigue (12.2%), perineal pain (22%) breast problems (33%), sexual problems (71%) and

depression (23%) (Pigeon. C, 2004).

Whilbley Annette (2005) reported that the key stress factors facing new mothers are tiredness,

feeding their baby and lack of time to care for others. The new mother has to take care of not

only her new infant but has also to adjust to her husband and other family members
schedules. Some women are forced to integrate the maternal role with goals and having to do

too much too soon without an organized plan are also a common cause of emotional

disturbance in postpartum period.13

Postpartum psychological distress leads to maternal disability and disturbed mother infant

relationship. Approximately 10-15% of all new mothers get postpartum depression, which

most frequently occurs, in the first year after the birth of a child (Infan Naveed and Badar

Ahmed, 2002).14

Further the literature reviewed depicts that research studies available are more than foreign

settings. An assessment and management of the mothers actual stress and stress related

factors are felt to be essential to a nurse. Thus, the researcher felt that knowledge on the stress

management of Indian postnatal mothers will help to plan and implement a feasible program.

Hence the investigator felt the need to conduct a study on primipostmental mothers.

6.2 Review of literature

The review of literature is a broad, comprehensive, in depth, systematic and critical review of

scholarly publications, unpublished scholarly print materials, audio visual material and

personal communication.

A literature review is a written summary of the state of existing knowledge on a research

problem. The task of reviewing research involves the identification selection, critical analyses

and written description of existing information on a topic (Polit and Hungler, 2003).15

The review of literature in this study is organized under the following headings.

1. Review of literature related to level of stress

2. Review of literature related to stress among primi mothers

3. Review of literature related to Effects of stress.

1. Review of literature related to level of stress

Arthur, (2005) conducted a perspective study on postpartum stress and related psychosocial

variables in Hong Kong Chinese women, revealed that 56% of postpartum women had

stress and 19.8% of women were diagnosed that as postnatally depressed.16

(Mercer,2002) Reported that The postpartum is a transitional and potentially stressful time

during which a woman must face both the new tasks of her material role and changes in her

body. Along with these adjustments come changes in the focus of social supports needed by,

or expected of, new mothers.17

Lyon (2002) conducted a study on. A prospective study of posttraumatic stress symptoms

one month following child birth in a group of 42 first time mothers and he found that 3(7%)

mothers scored in the medium stress range and 1 (2%) in the high distress range on Impact

event scale (IES).18

Skari, (2002) observed in their study that prevalence of postpartum psychological distress

was reported by 37% of mothers, 30% of fathers and 9% and 2% of mothers and fathers show

severe intrusive stress symptoms. They concluded that psychological distress occurs more

common in mothers than in fathers. Paffenbarger (1994) reported that 46% of 126 patients

became mentally ill within 9 months of giving birth and 76% in the first month.19

Balachandran (2002), stated that there are four levels of stress symptoms. The first is the

initial response and is characterized by increased heart beats, increased blood pressure,

dilatation of pupils, sweating plams and reduced activity in stomach. The second level is

irritability, difficulty in concentrating, restlessness, and loss of appetite, stuttering and

stammering. The 1third level would be more headaches, diarrhea, sweating, insomnia,

depression and the fourth level should be characterized by ulcers, stroke and psychosis.20

Motherhood is a distinct biopsychosocial process that transforms and broadens the role of a

woman into that of a mother. This period is filled with many sentence and diverse feelings

(Lucita mary,2001)21

Lowdemilk and Perry (2000), stated that majority of new mothers 50-70%) have

psychological reaction after birth. Currey (1983) reported that a rescriptive study found that

of 20 healthy, normal primiparas 25% experienced very difficult adaptation to motherhood.22

2. Review of literature related to Stress among Primi Mothers:-

Hung CH Lin CJ, Stocker J, Yu CY(2011).conducted a study to predict important factors in

womens postpartum stress. The transition to motherhood is often accompanied by stress, but

research on predictors of postpartum stress is scant. a cross sectional survey was used in the

study. Proportional stratified quota sampling based on births at 11 registerd general hospitals

and 7 speciality clinics in the Kaohsiung area of southern Taiwan was used to obtain a high

degree of representation.859 woman participated in the study within six weeks postpartum.

The Hung postpartum stress scale, the social support scale and the 12-item Chinese Health

Questionnaire were used in the study. The result was Woman with minor psychiatric

morbity,one or two children , formula feeding for their infants ,preference for infant beyond a

low level of social support were important predictors for womens postpartum

stress.the.conclutionwas to provide information data for service planning and community

care for the prevention and amelioration of postpartum stress.29

Lev-Wiesel R, daphna-Tekoah S. (2010). Conducted a study to asses the role of peripartum

dissociation in the development of childbirth-related posttraumatic stress (PTS) symptoms.


Furthermore, it examined the relation between life-traumatizing events , in particular

childhood sexual abuse (CSA)dissociation tendencies, prenatal PTS , prenatal depression,

peripartum dissociation, and postnatal PTS symptoms. A self report questionnaire was

administerd to 1,003 Israeli Jewish women at mid pregnancy (18-20 weeks) and at 2 months

postnatally. The results were women with prenatal posttraumatic stress symptoms,

depression, and dissociasion tendencies coincided with higher levels of peripartum

dissociasion.the conclusion was screening pregnant women, especially CSA victims, and

implementating models of prevention and intervention can assist these women in acquiring

better coping strategies during childbirth. Such practices are likely to decrease peripartum

dissociation, which may in turn lessen postpartum PTS symptoms.30

Postpartum depression is a widespread and disruptive depressive disorder seriously affecting

the lives of new mothers and their families. We conducted a meta-analysis of controlled and

comparative studies of psychological treatments of postpartum depression. Seventeen studies

were included. The mean standardized effect size of all psychological treatments compared to

control conditions was 0.61 (95% CI: 0.370.85). Several subgroup analyses were

conducted. Studies with waiting list control groups had a larger mean effect size (0.96; 95%

CI: 0.631.29) than studies with a care-as-usual control group (0.41; 95% CI: 0.250.58).

No definite conclusions can be drawn about the longer term effects. Too few studies were

available to draw conclusions about the relative effects of psychological treatments compared

to pharmacological and other treatments. 2007 Wiley Periodicals, Inc. J Clin Psychol 64:

103118, 2008.23

In a cross-sectional study, 163 breastfeeding women completed the Edinburgh Postnatal

Depression Scale (EPDS), a questionnaire on demographics and infant feeding and hand-

expressed breast milk for Na and K quantification, between 2 and 12 weeks postpartum.

Forty women (24.5%) had an EPDS score compatible with the risk of a depressive episode,

and 63 (41%) did not feel confident about breastfeeding. These 2 variables were significantly

correlated to each other and individually correlated to breastfeeding exclusiveness. Weeks

postpartum was correlated to breastfeeding exclusiveness and Na:K in milk (all P < .001). A

logistic regression model showed that supplementation increased the risk of high Na:K in

milk by 209%, whereas a longer time postpartum lowered the risk for mammary gland

permeability. This study suggests that postpartum depression and low breastfeeding

confidence, which may be present concomitantly, are associated with increased mammary

gland permeability, only to the extent in which depression dissuades the mother from

exclusive breastfeeding. J Hum Lact. 24(1):50-57.24

Soet. J.K. (2004) conducted a study on, Prevalence and predictors of womens experience by

psychological trauma during child birth and they reported that the child birth experience was

traumatic by 34% women, 1.9% of women developed all the symptoms needed to diagnose

post traumatic stress disorders, 30.1% were partially symptomatic. 25

Pantlen and Rohde (2001), conducted a study on, Psychological effects of traumatic live

deliveries, reveals that 17.2% of the women reported anxiety 9.4% depressive symptoms,

12% of a mental reexperience of delivery within the first week postpartum and it concluded

that traumatically experienced childbirth lead to serious psychological disturbances in


John, (2001) who conducted a prospective study on Psychiatric disturbances during

postpartum period at Vellore followed up 59 women during their last trimester of pregnancy

and through the first week of postpartum. They revealed that those women who had specific

sex preference seem to have higher psychiatric morbidity and their stress scores were

associated with postpartum psychiatric morbidity and the expectancy of the sex of the child

during antenatal period.

Irfan Naveed and Ahmed Bader (2002), studied the risk factors for postpartum psychological

disorders in Pakistan and revealed that were literate (80%), past history of phychosis /

depression (70%), house wives (95%), rural areas (65%), high religious (60%), poor income

(90%) and with a live baby born (70%).14

Sterling, (2002) in their study on, Relationship between body image and stress symptoms

during postpartum in ethnically diverse, low income women, reveal that 135 Hispanic new

mothers who are participating in Medicaid at least 18 years old, free of medical risk factors

and delivered at term, body image was measured by the body cathexis scale. Overall sample

body image attitude was significantly related to level of stress and also marital status and

income status were related stress symptoms.

Shakespeare, (2004) has conducted a study on, Breast feeding difficulties experienced by

women taking part in a qualitative interview study of postnatal depression reveals that

breast feeding difficulties were common, caused emotional distress and interaction with

professional could be difficult.27

Good man. P, (2004) in their report on, Factors related to childbirth satisfaction, states that

womens satisfaction with the childbirth experience may have immediate and long term

effects on her health and her relationship with her infant and also personal control during

child birth was an important factor related to the womens satisfaction with the child birth


Matthey Stephen (2002) reported that postnatal distress is most likely to be due to interplay

of several factors. The factors may include

Hormonal fluctuations

Un pleasant and /or traumatic birth experience

Demanding baby, Unresolved personal issues

Sleep deprivation

Poor eating habits

Breast feeding problems

Lack of experience with babies and younger children

Regular company apart from their partner or significant support



Relationship problems with partner

Stressful life events such as moving house, bereavement, immigration.

Slade and Czarnocke (2000), reported that perceptions of low level of support from partner

and staff, partner to blame and low perceived control in labour were found to be particularly

related to experience of posttraumatic stress symptoms following childbirth.28

Barrett, (2000) who conducted a study on, womens sexual health after child birth, reveals

that 83% of women experienced sexual problems suggesting potentially high levels of unmet


3. Review of literature related to Effects of Stress

Tseng YF , Chen CH, Lee CS.(2010) conducted a study on, Effects of listening to music on

postpartum stress and anxiety levels. The study investigated what effect listening to specially

selected, relaxing music at home, on a self regulated basis, had on the perceived stress and

anxiety of postpartum women. Lisrening to music has been increasingly used in the perinatal

period , but few studies have been undertaken to provide evidence of its effectiveness. 77

postpartum women were randomly assigned to an experimental group (n=37) and a control
group (n=40). The experimental group were made to listened to music at home for at least 30

minutes a day over two weeks and received regular postpartum care. The women in the

control group received regular postpartum care only. The perceived tress scale and state

Anxiety inventory were used to measure outcomes . the result was after controlling the

present scores and educational level of mothers, which was a significant covariate, there were

no significant differences in the posttest levels of perceived stress and state anxiety between

the two groups. This study does not provide evidence that preselected designer music reduced

stress and anxiety levels among postpartum women. 31

Cheng CY, pickler RH. ( 2009) conducted a study on, Effects of stress and social support on

postpartum health of Chinese mothers in the united states. Postpartum maternal well being

across cultures has received limited research attention. They examined relationships among

tress, social support , and health in 152 Chinese mothers <1 yea postpartum in the united

states. These mothers did not perceive high levels of stress, although they did not receive as

much support as they indicated they needed; 23.7% of mothers scored high for depressive

symptoms. About half of the mothers experienced interrupted sleep, decrease in memory, and

lack of sexual desire. All health measures were inter-correlated. Social support moderated the

effects of stress on depressive symptoms. Culturally relevant care that is perceived as

supportive may promote postpartum maternal health.32

Mental disorders are highly prevalent across the world and are associated with serious

impairment. Depression after childbirth affects both the mother and her infant. Women sleep

less in the postnatal period, but there has been little attention to the altered sleep pattern in the

postnatal period and its association with maternal depression. Objectives: The aim of the

study was to assess the prevalence of depression and to identify risk factors for the disease

among postnatal mothers in Lalitpur, Nepal and in Rogaland, Norway. In Norway, we further

aimed to study the prevalence and risk factors for postnatal maternal sleep problems, as well
as associations between depression and sleep, measured retrospectively, prospectively and

objectively. Methods: c) In Nepal: from October 2001 to January 2003, postnatal women

from three primary health care populations were included in a cross-sectional structured

interview study of mental health. Depressive symptoms were measured by the Edinburgh

Postnatal Depression Scale (EPDS), and mental distress by the Self Report Questionnaire20

(SRQ-20). d) In Norway: All women (n=4191) who had delivered at Stavanger University

Hospital from October 2005 to September 2006 were mailed a questionnaire seven weeks

after delivery. Sleep was measured by the Pittsburgh Sleep Quality Index (PSQI), and

depressive symptoms by the EPDS. From this population-based study, we recruited 42

women, of whom half scored 10 or more and the other half low at the EPDS, for prospective

sleep registrations by sleep diaries and actigraphy two months after delivery. Results: In

Nepal, the prevalence of depressive symptoms (EPDS >12) was 4.9 % and the prevalence of

mental distress (SRQ-20 >10) was 3.1 %. Multivariate analysis showed that postnatal

depression was strongly associated with husbands alcoholism, polygamy and previous

depression. Other significant factors were stressful life events, multiparity, smoking and

depression during pregnancy. There was a non-significant trend of lower depressive scores

among women practicing the tradition of going to their maternal home some weeks after

delivery. In Norway, the response rate was 68% (n=2830). The prevalence of depressive

symptoms (EPDS 10) was 16.5%, and the prevalence of postnatal sleep problems (PSQI >5)

was 58%. Mean self-reported nightly sleep time was 6.5 hours and sleep efficiency was 73%.

Depression was the factor most strongly associated with sleep problems in this period.

Being primipara, having previously had sleep problems, not exclusively breastfeeding,

having younger or male infant, or co-sleeping were also factors associated with poor

postnatal sleep quality. Poor sleep was associated with depression also when adjusted for

known and significant risk factors for postnatal depression, such as poor partner relationship,

previous depression, depression during pregnancy and stressful life events. There were no

significant differences in sleep measured prospectively by subjective sleep diaries and

objective measures of actigraphy according to depressive status. Primiparas had worse sleep,

measured by actigraphy, compared with multiparas. Conclusions The prevalence of

depressive symptoms in the postnatal period was lower than previously reported from Nepal,

but higher than previously reported from Norway.Traditional family structures may influence

the risk of depression among postnatal women in Nepal. Poor sleep, reported retrospectively,

was associated with depression independently of other risk factors. However, there

registrations according to depressive status.

Statement of the Problem:

A study to assess the effectiveness of structured stress management module on primi

mothers during early postnatal period in a selected Government hospital, Bangalore,


6.3 Objectives of the study:

1. To assess the level of stress among primi postnatal mothers.

2. To evaluate effectiveness of structured stress management module on primi

postnatal mothers.

3. To identify the association between the level of stress and their selected

demographic variables.

Operational Definitions

Assess: In this study Asses refer to finding out the level of stress among primi mother.

Effectiveness: Refers to significant gain in stress management.

Structured stress management module: Systematically planned group of instructions

designed to provide information regarding stress management to primi postnatal mothers.

Stress: Stress denotes the state of fear, anxiety worries of the primi postnatal mothers due to
child birth

Stress Management: Technique used to relieve or decrease the stress among primi postnatal

Primi postnatal Mother: A women after first child birth

Early Postnatal period: It is duration following child birth up to 3 days of primi mothers.

Level of stress: It is categorized as mild, moderate and severe which indicate the degree of
stress experienced by primi postnatal mothers.

Assumptions: The primi mothers may have some stress due to child birth and stress of primi
mothers may vary with their demographic variable.


H1: There will be significant difference between levels of stress among Primi mothers.

H2: There will be significant association between level of stress among primi postnatal
mothers and their demographic variables.


The study will be limited to the primi mothers who were

Admitted for delivery

Present for 3 days in the hospital after delivery

Present during the period of data collection

Willing to participate in the study

Knowing to read and write Kannada language

7. Materials and Methods used:

7.1 Source of data Primigravida mothers who admitted In the

selected government hospital, Bangalore

7.2 Methods of data Collection

Research Design Quasi-experimental design with one group

pretest and post test approach will be used to
assess the effectiveness of stress of primi
mothers in early postnatal period.

Setting The setting of the study will be selected Govt.
Hospital Bangalore.

Population Primigravida Mothers.

Sample Primigravida mother admitted in Government

Hospital Bangalore

Sample size The sample size will be 60Primigravida


Sampling Technique Purposive sampling will be used to select the

Primi gravida in selected Government Hospital,

Tools The structure interview questioners will be

used to assess the effectiveness of structured
stress management module on Stress of Primi
mothers during early postnatal period. The
structured teaching programme will used for

Data Collection Prior to the data collection the written

permission will be obtained from the
concerned authority further the investigator
himself will collect the data. Before and after

Data Analysis Presentation Data Analyzing will be done through

descriptive statistics and inferential statistics
mean, median, mode percentile, standard
deviation, Chi- square test and relevant
statistics analysis will be used. The analysed
data will be presented in the form of
tables,diagrams and graphs.

7.3 Doest the study requires any investigation or intervention to be

conducted on points or other humans or animals?


7.4 Has ethical clearance been obtained from your institution in case of 7.3?

Yes, informed consent will be obtained from concern subjects and

authority of institution. Privacy, confidentiality and anonymity will be guarded

Scientific objectivity will be maintained with honesty and impartiality.

7.4 Ethical committee

Assess the effectiveness of structured stress

management module on primi mother during
Title of the topic
early postnatal period in a selected
government hospital Bangalore, Karnataka.

Name of the candidate Mrs.Vijayalakshmi.R

Master of science in nursing psychiatric

Course and subject


Name of the guide Head of the department

Department of psychiatric nursing

Diana college of nursing, Bangalore-64

Ethical committee APPROVED

Members of Ethical committee

1. Prof. Veda vivek

Principal and HOD

Department of community health nursing.

Diana college of nursing, Bangalore-64.

2. Prof.Elizabeth Dora

Head of the Department.

Department of Child health Nursing.

Diana College of Nursing, Bangalore-64.

3. Prof Kalaivani

Head of the Department

Department of obstetrics and gynaecological nursing.

Diana college of nursing, Bangalore-64.

4. Prof Vasantha Chitra.

Head of the Department

Department of medical surgical nursing.

Diana college of nursing, Bangalore-64.

5. Prof. Mrs Kalai selvi. S.

Head of the Department

Department of Psychiatric Nursing.

Diana College of nursing, Bangalore-64.

6. Prof Rangappa.

Biostatistician. Bangalore.

8. List of References

Books and Journals

1. Daftary S.N. Mannual of obstetrics 2nd edition New Delhi, Elsevier India Private

Limited 2005. PP 529-532.

2. 9.Report says maternal mortality rate on rise,UNICEF organization march 2009.

3. Elizabath . M. varagolis foundation of psychiatric mental Health Nursing, 2nd

edition W.B. Saunders company, Philadelphia, 1994.

4. Bhavani. V. Stress among people with diabetis, Indian Journals of Holistic

nursing: 6; june 2010.

5. Sreevani. R. All about your stress nightingale Nursing times, 2006:1;24-27.

6. Sreevani .R. A guide to Mental Health and psychiatric Nursing 2nd edition 2007

Jaypee Publication; 208-211.

7. Mary . C. Townsend. Psychiatric mental health Nursing. 5th edition, Jaypee

publishers; 2007.

8. Josephine Jacquline mary. Stress management of health care personal

Nightingale Nursing times 2009. June 3;4(11);14-16.

9. Lucita M. Maternal Stress and Maternal and Foetal outcome, A comparative study.

Indian Journal of Nursing of Midwifery. 2003 Sep 53(5):458 60.

10. Melender H L . Experience of fears associated with pregnancy and child birth: a

study of 329 pregnant women. Birth.2002 Jun 29(2):101-11.

11. Abushaikah, Lubna, Sheil, Eileen P.Labour stress and nursing support : how to do

they relate ? Journal of international Womens studies 2006. May1.available



12. Ayers. S and Pickering A.D, Do women get posttraumatic stress disorder as a

result of childbirth? A prospective study of incidence, Birth, 222011, Jan,28(2),


13. Vyas and Ahuja Niraj; Text book of postgraduate Psychiatry 2nd edition, Jaypee,

New Delhi, 2003, Pp700-721.

14. Irfan Naveen and Badar Ahmed, Determinants and pattern of postpartum

psychological disorders in Hazata decision of Pakistan, 2002,6(7);7.

15. Maya. C, women and stress, The Hindu online edition of Indias National News

papers, Life Thiruvananthapuram, 2005,Pp 145.

16. Arthur. Postpartum stress and related psychosocial variables in Hong Kong

Chinese women, finding from a prospective study, Res Nurse Health,2005.

17. Mecer, R.T, First month received fatigue and frustration, In first time

motherhood; experiences from Teem to forties, Mercer. R.T ed, Springer. New

York; 2002,Pp119-162.

18. Lyon S.J, A prospective study of posttraumatic stress symptoms one month

following child in a group of 42 first time mothers?, Journal of Reproductive and

infant psychology(Press),2002.

19. Skari. Comparative levels of psychological distress, stress symptoms depression

and anxiety after child birth a prospective population based study of mothers and
fathers, BJOG. 2002,Oct,109(10); 1154-63.

20. Balachandran.S, Stress Management, Indian infoline, Mumbai, 2002.

21. Lucita Mary; Maternal stress and foetal outcome, The Nursing Journal of India,

2001,May, Vol;Lxxxx11,No;5,Page No;105.

22. Lowdermilk and perry, Maternity and Womens Health Care, 8th edition, Mosby,


23. Wiley Periodicuals, Inc, J Clin Psychol 64;103-118, 2008.

24. Humlact .J. 24(1):50-57.

25. Soet . J.K, Prevelence and predictors of womens expetiences of psychological

trauma during child birth, Birth, 2003, March, Vol;30, No1, Pp;36-46.

26. Pantlen. A and Rohde. A, Psychological effects of traumatic live deliveries,

Zentrabl Gynakol, 2001,Jan,. Vol 123, No;1 Pp42-47.

27. Shakespeare, Breast feeding difficulties experienced by women taking part in a

qualitative interview study on postnatal depression,

28. Czarnocka and slade, Prevalence and predictors of posttraumatic stress Gj

symptoms following childbirth, Brirish Journal of clinical

psychology;2000,March, 39(1), 35-51.

29. J Clin Nurs. 2011 Mar;20(5-6):666-74. Doi: 10.1111/j.1365-2702.2010.03555.x.

Predictors of postpartum stress.

30. J Trauma Dissociation. 201011(3):266-83.

31. J Clin Nurs. 2010 Apr;19(7-8):1049-55

32. Res Nurs Health 2009 Dec;32(6):582-91

9 Signature of the candidate:

10 Remarks of the Guide There is a great need to asses the

effectiveness of structured stress management
module on primi postnatal mothers during
early postnatal period in a selected
government hospital, Bangalore,Karnataka.
Hence, the research topic selected for the
candidate is suitable.

11 Name and designation of PROF. MRS. KALAI SELVI. S.

11.1 Guide Head of the department

Department of psychiatric Nursing

Diana college of Nursing, Bangalore-64

11.2 Signature

Prof. Mrs. Kalai Selvi. S.

11.3 Head of the department Head of the department

Department of psychiatric Nursing

Diana college of Nursing, Bangalore-64

11.4 Signature

12 12.1 Remarks of the Principal This study is feasible to conduct and will be
beneficial to nursing profession and
psychiatry, hence permitted to conduct study.

12.2 Signature