1

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

Synopsis Proforma for Registration of subject

For Dissertion

MS. K.R. THULASI

I YEAR M.SC. (NURSING)
OBSTETRICS & GYNAECOLOGY
YEAR 2008-09

JOSCO COLLEGE OF NURSING

(A Unit of Infant Jesus Education and Charitable Trust )
Infant Jesus Building, No. 3590, Channappa Extension,
Nelamangala (Post),
BANGALORE - 562123

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RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1.

NAME OF THE CANDIDATE

AND ADDRESS

MS. K.R. THULASI

I YEAR M.SC. NURSING
JOSCO COLLEGE OF NURSING
INFANT JESUS BUILDING, NO.3590,
CHANNAPPA EXTN,
NELAMANGALA (POST),
BANGALORE 562123

NAME OF THE INSTITUTION

JOSCO COLLEGE OF NURSING,

INFANT JESUS BUILDING, NO. 3590,
CHANNAPPA EXTN,
NELAMANGALA (POST),
BANGALORE-562123

COURSE OF STUDY AND

SUBJECTS

DEGREE OF MASTER OF NURSING,

OBSTETRICS AND GYNECOLOGICAL
NURSING

DATE OF ADMISSION TO
COURSE

30/06/2008

TITLE OF THE TOPIC

A STUDY TO ASSESS THE

EFFECTIVENESS OF INFRARED
RAYS ON HEALING OF EPISIOTOMY
WOUND AMONG THE POSTNATAL
MOTHERS IN GOVERNMENT
MATERNITY HOSPITAL,
BANGALORE, KARNATAKA.

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6.

BRIEF RESUME OF THE INTENDED WORK:

Introduction
LIGHT IS THE SCIENCE OF HEALING
GREEK PROVERB

BACKGROUND OF THE STUDY

In India most deliveries are conducted in villages by natural process by village
health personnel without any operative interference. Today an average Indian woman
considers pregnancy and child birth as a natural process. One of the aim of good
intranatal care is Delivery with minimum injury to the infant and Mother child
bearing in itself is a natural phenomenon and majority of cases require no interference
only close observations, moral support and production against human meddling.

Suramanjary (2007) states that until 20th century the routine use of episiotomy
was believed to have multiple benefits for both mothers and infant. Episiotomy is
important in itself as significant factors affecting womens comfort and health after
birth. It is regarded as the unkindest cut of all. This is called trivial operation should
be an important health issue as it is the most frequently performed surgical procedure
after cutting the umbilical cord. It is performed on millions of women annually
(Graham 1997) Thacker and Bantas (1983) review of episiotomy literature from 1860
through 1980 found few good studies that showed no evidence of any benefit sparked
further investigation. During the past 20 years a large body of literature has been
published which strongly advocates the selective use of episiotomy.

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Hattinwanger (2007) says that the infrared rays is identical to that generated
by our own body, and is naturally absorbed into our episiotomy wounds. These waves
exert strong rational and vibrational forces in the treated cells. The energy that emit
penetrates up to 3.5 inches and stimulates micro-circulation, delivering high levels of
oxygen and nutrients to the damaged cells, eliminating toxins and cellular waste. This
technology is used by NASA, the San Deigo Padres and the USA Olympic track and
field team and other many. The infrared rays relieves the discomfort, pain and ill
effects of patient who suffer with episiotomy wound. This treatment relieves these
conditions by delivering high quantity of oxygen to the affected area, detoxifying the
tissues, and repairing damaged tissues.

Lask (2007) demonstrates that the infrared light diminishes inflammatory and
enhances circulation. To assess the effectiveness of a infrared light source in
episiotomy wound, they used this lamp over 60 patients, 30 were experimental and
rest 30 were control groups treated with routine care. For experimental group,
erythema duration was reduced by 90%. The healing of episiotomy wound was
substantially accelerated and discomfort was reduced.

Departments of Obstetrics, Kyoto University graduates school of medicine,

Japan (2007) describes that infrared rays stimulates episiotomy wound repair. The
TGF-(transforming growth factors) B1 and MMP (matrix metallo proteinase) 2
content of the medium of cells was significantly elevated after rays. The amount of
MMP 2 mRNA extracted from rays fibroblast was also unregulated. Infrared ray

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potentially enhances the wound healing process, presumably by its biostimulatory
effects.
Kuprowsky (2007) explains that infrared lamp is a electric heater consisting of
a high power in candescent lamp that emits infrared rays. The bathroom would be
warm with infrared ray produced heat using a ceramic heater which does not turn red
but instead produces invisible, infrared red heat. This is the same type of heat as
produced by the sun and our bodies. Infrared heat is very safe and not at all like the
heat produced by microwaves. In infrared rays, 20% of the energy is used to heat the
air, leaving the rest of the energy to heat the body. The radiant heat can penetrate the
skin to a depth of one to two inches. Producing a gentle warming inside the body. The
temperature inside an infrared is adjustable and averages a comfortable 100F to
150F (38C to 65C). This allows to heal wound faster and can tolerate a longer
period, allowing for the therapeutic effects to occur.

Electronichealing.co.u.k (2006) shows that heat treatment gained a boost with

the discovery of infrared light by British astronomer Sir William Herschel around
1800. He found out that thermometers placed just outside the visible spectrum of
sunlight shows a greater increase in temperature than one placed in the red region.
Electromagnetic waves of low frequencies are refereed to as electromagnetic fields
and those at high frequencies are called electromagnetic rays. According to their
frequency are called electromagnetic rays which can be classified as either ionizing
rays. Now ionizing rays are described as a series of energy waves composed of
oscillating electric and magnetic fields traveling at a speed of light. Non-ionizing rays

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include a spectrum of ultraviolet, visible light, infrared rays etc. visible infrared rays
are those with wave length between 0.01 to 7.5x10-5 cm.

Gentlebirth Organization (2006) describes that episiotomy was performed

back in 1742 when perineal incision was made to facilitate difficult deliveries. The
primary cause of perineal pain is due to having an episiotomy or an extensive tearing
during delivery. In 1847, Dubois first suggested making an oblique incision in the
perineum; now today as the mediolateral episiotomy. The term episiotomy was
attributed to Braun in 1857, who condemned is as necessary and inadvisable.
Episiotomy gain little acceptance until the late 1800s and early 1900s in the past
because anesthesia was not advisable, and infection rates were so high. The
episiotomy grew with introduction of local anesthesia and suturing material.
Episiotomy is now being increasingly restored to world wide because of associated
benefits.

Dutta (2006) explains that episiotomy as a surgically planned incision on the

perineum and the posterior vaginal wall during the second stage of labour. It is infact
an inflicted second degree perineal injury. Episiotomy is more over, as it means
cutting of the pudenda or the external genitalia of the women. Perineotomy is the
correct term.

Littleton (2005) says that an episiotomy is the surgical incision made to

enlarge vaginal opening for the delivery of the babys head. The episiotomy may be
incised midline down the centre of the perineum, or mediolaterally which extends in a
diagonal angle to either the left or right side.

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Khokhar (2004) concludes that infrared lamps are being used for episiotomy
wound healing as it provides surface heat. The therapeutic effects are surface
vasodilatation and pain relief. Vasodilatation and subsequent increased circulation
leads to improve healing to surface wound like episiotomies.
Ladewing (2003) said that REEDA scale is used to evaluate the healing
process of wound. The perineum should be inspected every 8 hours or at least twice
daily for signs of early developing complication. The REEDA scale helps the nurse to
assess redness, edema, ecchymosis, discharge and approximation of the wound. It was
first contributed by Davidson in 1970.

Obrund (2001) states that wound healing is a primitive response. If we dont

form that protective layer, we dont survive. It is vital to establish the barrier to keep
infection out.

Harren (2000) reveals that infrared rays are used to improve the healing
process of episiotomy by relieving pain, muscle relaxation, increase blood supply,
elimination of waste products.

Need for the Study

WHO (2005) describes that the higher birth rate indicate that a large number
of episiotomies are being performed everyday. In most of the hospitals, there is a
100% incidence of episiotomy in primigravida women.

Rode and Barger (2005) reveals that since the late 19 th century, the average
postnatal woman has been subjected to great deal of swabbing, soaking and spraying

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all in the name of perineal care, derived to prevent infection, promote healing and
provide comfort to mother often based on little psychological rationale or research
data.

Myles and Ruth (2005) describes that in 1987 Banta and Thackers have been
reviewing the risks and benefits of episiotomy. The rationale for its use depends
largely on the need to minimize the risk of severe, spontaneous, maternal trauma and
to expedite the birth when there is evidence of foetal distress.

Bobak and Laundermik (2005) reveal that pain and discomfort from perineal
trauma can dominate the experience of early motherhood. Postnatal period offers
nurses a challenging opportunity to assist women in the achievement of motherhood.

William. (2005) reveals that warmed by heat is wonderful to help stimulate the
healing of wound and relief of pain especially in the case of anal sphincter repair,
which is much like healing form of episiotomy.

Barbara (2004) says that perineal pain is the most distressing to most of the
mother in the first week of post partum. Because of the early discharge practices in
midwifery area, only brief term is available for quickly assessing, planning and
implementing episiotomy and wound healing. Being very effective in healing of post
operative superficial wounds like episiotomy. Nurses can use infrared lamps as a dry
heat modality for quicker wound healing and there by enhancing comfort.

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Bogocheva. (2004) has shown that half an hour after rays of a small area of the
volunteers body surface with polychromatic visible infrared light, the growth
promoting substances in the blood serum increase on an average by 20% and 43%
respectively. This effect was preserved for at least 24 hours to be recorded only in
volunteers may be to a large extent, the consequences of effect exerted on the blood
by small amounts of transcutaneously photo modified blood. The obtained results
were discussed in terms of light effect on wound healing and scar tissue formation
which suggests that visible infrared rays of laser and non laser sources has a
pronounced wound making effect promoting tissue repair without production of
connective tissue elements. The effects develop as a consequence of local and
systematic light effects.
So the investigator wishes to see the effectiveness of infrared rays on healing
of episiotomy wound among the postnatal mothers

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6.2

REVIEW OF LITERATURE
A review of literature refers to activities involved in identifying and searching

for information on a topic and developing and understanding the state of knowledge
on the topic. Researchers almost never conduct a study in an intellectual vacuum,
their studies are usually undertaken within the context of an existing base knowledge
(Polit and Hungler, 1995).

The literature was reviewed and presented under the following headings
Studies related to episiotomy and perineal care
Studies related to effect of infrared therapy on wound healing and relief of
pain.

Studies related to episiotomy and perineal care

A descriptive study was conducted to assess the efficiency of methods to
minimize post partum pain. The research has highlighted that many practices relating
to perineal care remain un-researched and therefore the need for evaluating is urgent.
Further post partum morbidity has been seen to affect many women, but is often
unrecognized by the practitioners( Calvert & Fleming 2000).

A study was conducted to assess the extent of post partum pain for several
weeks after vaginal ----delivery. The percentage of women who reported perineal pain
upto 1 week after child birth varies among women depending on the degree of

11

perineal trauma, for example 75% of women with an intact perineum reported pain
one day after child birth and 38% a week later. 95% of women with first and second: 10 :
degree tears in the perineum involving the skin and muscles of the vagina reported
pain one day after delivery and 60% a week later. 97% of women who had an
episiotomy reported perineal pain one day after child birth, 71% seven days later.
100% of women who had third and fourth degree tears, an extension of episiotomy to
or through rectum, reported pain one day following vaginal delivery and 91% seven
days later( Ronnie & Falcao 2000).

A study was done on promoting the cleanliness by using and teaching a good
hand- washing technique. The women should do perineal care after each time she
urinates or bowel movement, it helps to reduce the risk of carrying fecal organisms
from the rectum to the vagina. She should be taught to use a front to back motion.
When she performs perineal care apply a perineal pad and wipes the perineal area
after toileting (Ratnam 2000).

A new mother died from toxic shock, due to an infection at the site of
episiotomy 8 days after postpartum in Texas. The treatments were unable to halt the
progress of infection, resulting in kidney failure, pneumonia and ultimately heart
failure (Paso 2001).

A study was done on the recommendation of after using the toilets always
wipe from front to back to avoid spreading germs. Change sanitary pads at least four
times a day and wash hands before and after each change. Avoid tight- fitting

12

pentyose, non- cotton (E.g: nylon) underwear, and any garment restriction ventilation
(Black 2002).
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A study was conducted in two phases to determine the /effects of planned
teaching on episiotomy and self-perineal care among primi para mothers in selected
hospitals in Karnataka. The phase 1 of the study was to identify learning needs of
primi para mothers in terms of knowledge and ability to perform self-perineal care.
By using convenient sampling technique the data were collected from 30 primi para
women. The phase 2 of the study consisted of 25 'subjects in experimental group. The
subjects received teaching and performed only self-perineal care and did not use local
antibiotics on episiotomy wound after delivery. The planned teaching programme was
effective in increasing knowledge, t = 25.62 and ability t = 24.34. An Episiotomy
Wound Assessment Scale (EWAS), which includes assessment of episiotomy in
relation to redness, edema, discharge, approximation and pain, was also devised
(Judith Angelita Noronha 2003).

A study was done among the women to cleanse from front to back explain the
importance of changing the perineal pad each time after urination and defecation and
of not touching the inner surface of the pad, washing hands before and after perineal
care. Care should be carried out after urination and defection and at least every 4
hours during the day (Sandra M.Nettina 2003).

A study was conducted on the effects of episiotomy on bonding and mother's

health. The subjects comprised of 100 women, who gave birth by normal vaginal
delivery in a Turkish hospital between 15 March 1999 and 6 April 2000. The

13

participants were divided into episiotomy group (n = 50) and control group (n = 50).
Data on biographical characteristics and the process of labour were collected in the
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hospital and follow up was conducted at home 13 and 12 weeks after labour. He says
measures should be taken to avoid perineal trauma during labour, establish bonding
between mother and infant as soon as possible and minimize perineal discomfort after
delivery (Karacam 2003).

A study was conducted to analyze the difference between restrictive and

routine use of episiotomy. One systematic review found that restricting episiotomy to
specific fetal and maternal indications reduced the rates of posterior perineal trauma,
need for suturing and healing complication compared with routine use, but increased
the rates of anterior vaginal and labial trauma, which carries minimal morbidity.
Midline episiotomy incision is associated with a higher risk of third and fourth degree
tears compared with mediolateral incision (Chris Kettle 2004).

A clinical trial was conducted to verify the effects of aromatherapy on post

partum mothers' perineal healing. The methods of aromatherapy were applied, sitz
bath or soap application using essential oils with Lavender, Neroli, Rose, etc. The
subjects of this experiment were post partum mothers who delivered vaginally with an
episiotomy. They were allocated to one of the three groups; the aroma - sitz bath
group, aroma - soap application group or control group. To evaluate the effects of
aromatherapy, the perineal healing status was measured using the REEDA scale and
smears of episiotomy wound were obtained. The data were analysed by repeated
measures of ANOVA, ANCOVA, chi square test and multiple response analysis via.

14

SPSS programme. The results showed that REEDA scale was significantly low in the
experimental group at post partum 5th and 7th days (P = 0.009, P = 0.003) respectively.
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These findings indicated that post partum aromatherapy for perineal care could be
effective in healing the perineum (Hur 2004).
The article titled, "The development of a measurement tool for the assessment
of pain behaviour in real time" says systematic assessment of pain behaviour allows
the clinician to directly observe the effects of interventions for pain. In addition the
direct observation of defined pain behaviours may provide a greater degree of
objectivity than self-reports of pain or pain behaviours (Lorraine 2004).

A study was conducted to analyse the incidence, severity and determinants of

perineal pain after vaginal delivery. Acute post partum perineal pain is common
among all women; however perineal pain was more frequent and severe for women
with increased perineal trauma. A woman, who is having a very low tear rate, will be
comfortable in a sitting position after 24 hours of delivery. Mothers who have
extensive perineal tears will be having discomfort after 10 days of visit even
(Macarthur 2004).

Studies related to effect of infrared therapy on wound healing and relief of pain
A study was conducted with the purpose of making an objective review of
possible effectiveness of different forms of phototherapy. Recently there is an
increasing interest in the use of light therapy as a medical tool. It is a therapy with
only minimal side effects and therefore it could be widely recommended. The
problem is that well developed and generally accepted medical protocols are not

15

available. Broad variety of medical centres and private physicians use their own
protocols; differentiate one from another, based on more or less scientifically verified
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information. Gynaecology and obstetrics is one of the fields in which phototherapy is
being used ( Kymplova 2000).

A study was conducted to investigate potential effects of a newly developed

specific near infrared light source on wound repair. In this .study, cultured human
keratinocytes, endothelial cells and fibroblasts were 'exposed to the light and the
production of transforming growth factor (TGF) was examined by enzyme immuno
assay. Incisional wounds were treated with rays and the effect of rays on the wound
closure was followed photographically. The rate of wound closure was significantly
accelerated by repeated exposures. So it can be concluded that near infrared rays
potentially enhances wound-healing process, presumably by its biostimulatory effects
(Danno 2001).

A study was conducted to determine the effects of a normothermic dressing on

pressure ulcer healing. The ulcers were treated with standard care and with heated
dressing. Results showed that there was a statistically significant reduction in mean
surface area 60.73% and the pressure ulcers treated with heated dressing healed faster
than those ulcers treated with standard care (Kloth Berman 2001).

A study was conducted to identify the effectiveness of producing whole body

hyperthermia with water filtered infrared rays. Among the different methods of whole

16

body hyperthermia, the energy transfer with infrared rays has established a relatively
safe procedure. Infrared rays systems differ with regard to the used spectrum of rays.

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The physical effects being increased core body temperature in case of hypothermia,
which enhance a -high thermal constancy in the plateau phase (Wehner 2001).
A clinical study to describe a pilot treatment of temporo mandibular joint pain
by linearly polarized near infrared rays at University teaching hospital, Japan. Patients
comprised of 20 women (mean age +/- SD; 26.6 +/- 15.2 years with unilateral
temporo mandibular pain. Linearly polarized near infrared .rays with super lazer was
used. The painless interincisal distance of the mouth opening, which is one of the
objective parameters of temporo mandibular dysfunction and the visual analog scale
of the affected temporo mandibular joint before treatment were 33.4 +/- 6.5 mm and
5+/- 2.7 points respectively. Pilot linearly polarized near infrared rays was applied
weekly to the skin areas overlying four painful points. The present treatment
alleviated temporo mandibular pain after the patients had received only four weekly
irrays treatments with final measured values of the visual analogue scale being 1.4+/1.6 points. The final painless mouth opening distance increased by 7.6 +/- 4.6 mm
compared with the first measured distance without complications. It was concluded
that super lizer infrared rays is excellent for providing relief from temporo mandibular
pain (Yokoyama2001).
A study on 73 patients with compression ischaemic myeloradiculopathy
received treatment including infrared laser rays on the Para vertebral fields, motor
points of the affected nerves and biologically active points. The investigator
concluded that the impulse infrared laser therapy reveals pain syndrome, stimulating

17

repair processes in the affected nerve structures. Further modified electric stimulation
activates a regenerative growth of the nerve fibres, reinnervation of the limb muscles
(Miriutova 2002).
: 16 :
A study was done to assess the use of laser infrared diode for improving
wound healing in smokers was conducted in Japan. The investigator used infrared
laser diode 830 nm continuous wave, and after rays, Reactive Oxygen Species (ROS)
was measured in neutrophils of smokers. Attenuation of ROS production by
neutrophils of smokers was noted and it is due to the effect of laser infrared diodes in
treatment of inflammatory tissues. He concluded that there is a possible usage of laser
infrared diodes to improve wound healing in smokers (Fuji maki 2003).

A study was done to assess the effectiveness of healing with light. The
potential of light therapy in healing is quiet endless. The use of light emitting diodes
in the practice of medicine has moved well beyond science, fiction and into the real
world. Soldiers injured by lasers, astronauts in space and children in cancer wards are
already benefiting from the healing properties of near infrared light. Cells exposed to
near infrared range have been found to grow 150% to 200% faster than cells not given
because in simple terms, the light arrays speed up the healing process by increasing
the energy inside the cells. The Light Emitting Diodes of near infrared range are
effective in treating mucositis of young cancer patients. In the first trial at Children's
Hospital of Wincosin, Light Emitting Diode treatment proved successful in treating
mucositis (Harry 2003).

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A study was conducted at Japan University to review the outcomes and

estimate the usefulness of linearly polarized near infrared rays therapy. A total of 35
consecutive patients complained of vague and deep pain in the ano-rectum. 14
patients had a history of lower abdominal surgery. 18 patients had disordered
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defecation. The linearly polarized near infrared light was radiated to the strongly
tender point on or a few centimeters apart from the skin for 10 minutes. The effect of
the therapy was assessed as excellent, good, no change or worse by the patients
themselves. 5 patients estimated as excellent, 28 as good and 2 as no change. The
mean total number of rays was 18.8 and mean number of rays for relief from pain was
2.5. Ano rectal pain recurred in 4 patients, who received the same therapy and
improved. It was concluded that the linearly polarized near infrared rays therapy is a
simple, safe and effective modality for relief from intractable anorectal pain and
recommended for primary therapy (Mibu 2003).

Both visible and infrared lights have been proven to be beneficial in clinical
healing related to pain relief, wound healing. The mechanism of action is believed to
be the absorption of infrared energy by cellular tissues, which causes a biological
response of releasing healing enzymes within those cellular tissues. Light therapy has
been proven in over 40 years of independent research. It shows that the following
advantages.

Increases vascularity and formation of new capillaries.

Stimulates production of collagen essential for tissue repair.
Stimulates release of Adenosine Triphosphate.

19

Increases lymphatic system activity.

Stimulates fibroblastic activity. Increases phagocytosis.
Stimulates acetylcholine release, causes vasodilatation.
(Bioscan Technology 2004).
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A study have shown that half an hour after rays of a small area of the
volunteer's body surface with polychromatic visible infrared light, the growth
promoting substances in the blood serum increase on an average by 20 and 43%
respectively. This effect was preserved for at least 24 hours to be recorded only in
volunteers with the initially normal and decreased levels of growth factors. This
allows to suggest that the changes in growth promoting activity of circulating blood of
the rays volunteers may be to a large extent, the consequence of effect exerted on the
blood by small amounts of transcutaneously photomodified blood. The obtained
results were discussed in terms of light effect on wound healing and scar tissue
formation, which suggests that visible infrared rays of laser and non laser sources has
a pronounced wound healing effect promoting tissue repair without hyper production
of connective tissue elements. This effect develops as a consequence of local and
systemic light effects (Bogacheva 2004).

Factors influencing heat and cold tolerance.

A person is better able to tolerate short temperature variations. These include
the neck, inner aspect of the wrist and forearm, and the perineal region. The
foot and the palm of the hand are less sensitive.
Exposed skin layers are more sensitive to temperature variations.
The body responds best to minor temperature adjustments.

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A person has less tolerance to temperature changes to which a large area of the
body is exposed
Tolerance to temperature variations changes with age. Clients who are very
young or old are most sensitive to heat and exposure to temperature extremes.
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Certain areas of skin are more sensitive to cold.
(Cochrane Collaboration 2004).

A study was conducted to examine how Thai women perceive and experience
childbirth in hospitals. This is based on in depth interviews with 30 women living in a
village in Thailand. The women believed that safety was the primary reason for their
choice of birth in hospital. The women's embodied experiences with hospital birth
reveal that they are safe with physicians and nurses. Of interest, among post partum
care provided in Thai hospital in the north, is the use of a spotlight to help heal the
episiotomy wound. This is an adaptation of Thai traditional confinement practices in
the era of modernity. The use of spotlight in hospital not only provides the women
with symbolic rituals but also is believed to assist them in healing process (Elicia
2004).

A study was conducted to evaluate the influence of low laser on the

proliferation of fibroblast and on the lymphatic regeneration. The subjects comprised
of 20 members in the experimental group and another 20 in the control group. Low
laser was applied to experimental group. The results showed a significant increase in
fibroblast proliferation. The adhesion of scar with the underlying tissues disappeared
after 10 days in control group and after 4 days in experimental group. The local

21

edema disappeared in the test group after 8 days while in control group it lasted until
10 days. A considerable acceleration of the regeneration of both the vein and lymph
vessels was seen in the test group (Leivens 2004).

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A study was done in Sweden involved a 70-year-old man who had rheumatoid
arthritis, secondary to acute rheumatic fever. He had reached his toxic limit of gold
injections and his ESR was still 125. After using an infrared heat system for less than
five months, his ESR came down to 11. The rheumatologist worked with a 11 year old
Swedish girl who had difficulty in walking downstairs due to knee pain from the age
of 8. This therapist told her mother the girl would be in a wheel chair but infrared
souna treatment improved her condition (Untitled document 2005).

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Statement of the Problem
A study to assess the effectiveness of infrared rays on healing of episiotomy
wound among the postnatal mothers at Government Maternity Hospital, Bangalore.

6.3

Objectives of Study

6.3.1. To asses the pretest level of wound healing process in experimental and
control group.
6.3.2

To assess the post test level of wound healing process in experimental and

control group.
6.3.3

To compare the pre and post test level of wound healing process in

experimental group.
6.3.4

To compare the pre and post test level of wound healing process in control

group.
6.3.5

To compare the post test level of wound healing process between experimental

and control group.

6.3.6

To associate the post test level of wound healing process in experimental

group with their selected demographic variables.

6.3.7

To associate the post test level of wound healing process in control group with

their selected demographic variables.

6.4.

Operational Definitions
Infrared Rays
Infrared rays refer to application of light using an infrared lamp of 250
watt ruby red bulb, in which a lamp glows red. Lamp is placed at a distance of

23

50cm from the area of exposure to light, which is for a period of 10 minutes, after
cleaning the perineum.
Healing

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It refers to absence of redness, edema, ecchymosed, discharge and well approximation
of wound and scored as zero for each of the observation and recorded on episiotomy
as a REEDA Scale.
Effectiveness
The outcome of care of episiotomy which will be assessed by observing
the difference in healing pattern in mothers those who have given infrared rays
and those who are on routine care.

Episiotomy Wound
It is the surgical incision on the perineal area on the right or left
mediolateral aspect of perineum performed during the second stage and repair
after the third stage of labour with intermittent absorbable sutures. All type of noninfected, fresh and non lacerated episiotomy wound have taken in this study.
Postnatal Mother
Refers to mothers within the first three days of normal vaginal delivery with
episiotomy.

Sampling Criteria : Inclusion Criteria

Postnatal mothers, who had a normal or forceps delivery with episiotomy

24

Mothers who are able to communicate in Kannada, English.

Mothers who are willing to participate in the study.

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Exclusive Criteria
Mothers who have undergone forceps or vacuum delivery.
Mothers with diabetes mellitus.
Mothers with an infected or lacerated episiotomy.

Assumption
Mothers

with

complicated

intranatal

period.

Episiotomy

causes

discomfort, pain and risk for infection due to its proximity to the anal
region.
Women who have undergone episiotomy require meticulous care.
Dry heat application increases blood circulation of the local area and aids
in healing of episiotomy wound and relief pain.

Hypothesis
H1:

There is a significant difference in the wound healing process between

experimental and control.

H2:

There is significant association of wound healing process of experimental

group with their selected demographic variables.

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7.0

MATERIALS AND METHODS:-

7.1

SOURCE OF DATA
Post natal mothers with normal vaginal delivery with

episiotomy.
7.2

METHODS OF COLLECTION OF DATA:

7.2.1

RESEARCH DESIGN
Experimental design

7.2.2

SETTING OF THE STUDY

Study will be conducted in Government Maternity
Hospital, Bangalore.

7.2.3

SAMPLING TECHNIQUE:

26

60 postnatal mothers who were fulfilling the

inclusion criteria were selected by simple random
sampling.

25

7.2.4

SAMPLING SIZE:
The Selection of sample depends on the available
postnatal mothers. The sample size is 60.

7.2.5.

METHOD OF DATA COLLECTION:

Demographic variable.
REEDA scale.

7.2.6

TOOL FOR DATA COLLECTION:Demographic variable.

REEDA scale.

27

7.2.7

METHODS OF DATA ANALYSIS &

INTERPRETATION:Descriptive statistics
Freequences and percentage distribution to
analyze the descriptive variables .
Mean and standard deviation used to aces
the back ground differences

26

Inferential statistics
Paired t test to compared the
effectivness of infrared rays on
episiotomy wound healing process in
experimental group.
Unpaired t test to compare the
effectiveness of wound healing between
experimental and control group .
Chi square test to associate the
demographic variable of experimental

28

group with their selected demographic

variables .

7.2.8.

DURATION OF THE STUDY

Six weeks.

7.2.9.

VARIABLES

The independent variable was applying infrared rays with an infrared lamp on the
episiotomy wound. The dependent variables were healing and relief of pain in the
episiotomy wound. The influencing variables are demographic variables.
27

Influencing
variables

Age of the mothers

Education
Religion
Income
Obstetrical score
Mode of delivery
Type of episiotomy

Dependent
variables

Healing of
episiotomy
wound

Independent
variables

Application of
infrared radiation to
the episiotomy wound
in postnatal mothers

: 26 :

7.2.10.

PROJECTED OUT COME

The study will enable the mother feel or know the effectiveness of
infrared rays on healing of episiotomy wound.

29

7.3

DOES THE STUDY REQUIRE ANY INTERVENTION TO BE

CONDUCTED ON PATIENTS OR OTHER HUMANS OR
ANIMALS.
Yes

7.4

HAS THE ETHICAL CLEARANCE BEEN OBTAINED FROM

YOUR INSTITUTION?
Yes

Permission will be obtained from

The research committee of the Josco College of Nursing.

28

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