An Experimental Study to assess the Effectiveness of Acupressure on Morning Sickness among the Antenatal Mothers

Ms Shubhangi Gaikwad¹, Ms Supriya Chinchpure²

¹M.Sc Student Sadhu Vaswani College of Nursing, Pune Maharashtra

²Lecturer, Sadhu Vaswani college of Nursing, Pune Maharashtra

*Corresponding Author E-mail: supriyachinchpure@gmail.com

ABSTRACT:

Introduction:

Nausea and vomiting of pregnancy begins between the fourth and seventh week after the last menstrual period in 80 percent of pregnant women and resolves by the 20th week of gestation in all but 10 percent of these women may have the complains beyond 20 weeks of their gestation. The condition has been shown to be more common in urban women than in rural women. However, morning sickness can last even longer. A study of pregnant women conducted in USA showed that about 9% still suffered from morning sickness after 20 weeks. For some, morning sickness symptoms last throughout the entire pregnancy.

Can Gürkan et al O (2008) conducted a cohort study to assess the effectiveness of acupressure in reducing the symptoms of nausea and vomiting during pregnancy in which the treatment group comprised 26 women; and 25 in the control arm. The study occurred over a 6-day period. During this time, the treatment group applied acupressure bands to P (6) acupressure point on days 4-6 of the study. The study revealed that acupressure would appear to be effective in symptom control, and in reducing the symptoms of nausea and vomiting during pregnancy.

This study will help in giving the empirical evidence of the morning sickness reduction among the antenatal mothers by using acupressure. This study will also help the antenatal mothers to use the acupressure therapy for relief of morning sickness as a non- pharmacological self- help.

OBJECTIVES:

• To assess the morning sickness among the mothers of experimental group and control group.

• To assess the effectiveness of acupressure on morning sickness among the antenatal mothers of experimental group.

• To compare the morning sickness among the mothers of experimental and control groups before and after the intervention.

• To associate the morning sickness between primi and multi parity mothers of experimental group.

RESEARCH METHODOLOGY:

The approach for the study is experimental approach; it was a quantitative study a randomized control group design was used. The population comprises of antenatal mothers within 20 weeks of gestation with morning sickness of selected communities. Inclusion criteria included antenatal mothers within 20weeks of gestation, suffering from morning sickness and who are willing to participate. The sample size was 40, 20 in each group. The sampling technique was simple random sampling which was randomized by lottery method. Investigator used a modified Rhodes index rating scale as a research tool to measure the morning sickness.

The pilot study was conducted to assess feasibility and to decide the plan for statistical analysis. Prior permission from the administration department and bachat gat (group) head was taken. Test has been conducted on 12 samples 6 in each group. Samples have been selected using purposive sampling technique in which randomization was done by lottery method. Reliability was measured using crohnbach alfha (split half method) and it was 0.8. the findings were reliable, main study was found to be feasible for conduction, based on the findings of pilot study. Validity of the prepared tool was done by 10 experts.

The researcher has collected the demographic data, taken pre test, given intervention and again taken done post test during this period. The collected data has been organized, tabulated and analyzed by using descriptive statistics, i.e percentage, mean and standard deviation whereas Man Whitney “U” test have been used to analyze the comparison between the two groups.

FINDINGS OF THE STUDY:

Findings related to assessment of morning sickness in experimental and control group;

In experimental group majority, 80% of the subjects were having moderate morning sickness, 15% of the subjects were having severe morning sickness and 5% of the subjects were having mild morning sickness. In control group70% of the subjects were having moderate morning sickness, 15% of the subjects were having severe morning sickness and 15% of the subjects were having mild morning sickness.

Findings related to morning sickness score before and after acupressure:

Before acupressure, average sickness score of antenatal mothers was 12.35 which decreased to 9.05 after the acupressure. “Z” test was used to compare the morning sickness among the antenatal mothers before and after acupressure. Since all the p values are small (less than 0.0001), the null hypothesis is rejected. The morning sickness score of antenatal mothers was reduced significantly after acupressure; hence acupressure is effective in reducing morning sickness of antenatal mothers.

Findings related to comparison of morning sickness score in experimental and control group mothers before and after acupressure:

Man Whitney “U” test was used to compare morning sickness score among the antenatal mothers of experimental and control group before and after acupressure. The mean score of morning sickness was almost same in both the groups before acupressure, whereas the sickness score decreased among the antenatal mothers of experimental group after acupressure as compared to the sickness score among the antenatal mothers of control group. The morning sickness score of antenatal mothers in experimental group was significantly lower than the morning sickness score of antenatal mothers in control group. Hence, acupressure is significantly effective in reducing the morning sickness among the antenatal mothers.

Findings related to association of morning sickness score with parity of mothers in experimental group:

Man Whitney “U” test was used to compare the sickness score among the primi and multi mothers of experimental group before and after acupressure. The mean score of morning sickness was almost same in both primi as well as in multi mothers before and after acupressure. Hence, the null hypothesis is accepted and there is no significant relation between morning sickness and parity.

CONCLUSION:

The finding of present study is that acupressure is effective in reducing the morning sickness among the antenatal mothers.

KEY WORDS: Effectiveness, Acupressure, Morning sickness, Antenatal mothers.

INTRODUCTION:

Pregnancy and motherhood are the most beautiful and significantly life-altering events that I have ever experienced. Elisabeth Hasselbeck

Pregnancy is the most wonderful experience of women’s life as it highlights the woman's amazing creative and nurturing powers while providing a bridge to the future. It is also one of the most important transitional phase during which the mother has mixed feeling of joy as well as anxiety. Any problem during this phase may cause a direct effect on the mother and the fetus.

Every woman is a unique individual, and every pregnancy has unique sets of discomforts. Morning sickness is very common. Most pregnant mothers have at least some morning sickness, and one third has vomiting. Morning sickness usually begins during the first month of pregnancy and continues until fourteen to sixteen weeks. Morning sickness should be viewed as a signal to the woman that her body is preparing for a new phase in her life morning sickness is something of a misnomer for the nausea or vomiting that may occur in the early months of pregnancy at any time of day.

Pregnancy can be one of life's most exciting and fulfilling adventures. A healthy mom and healthy baby--that's the goal for every pregnancy. Sometimes this is easy, sometimes it requires intensive efforts by the mother, her physicians, her nurses, other health care givers, family members and new born child's physicians.

During pregnancy each woman may experience one or more discomforts. These discomforts are significant to every pregnant woman who experiences them, and necessitates therapeutic remedies

In modern obstetrical nursing care, the emphasis is on the utilization of non- pharmacological measures for treatment of diseases and returning to the normal healthy state based on these complementary alternative therapies which are natural, have no side effects and also give positive results all lifelong.

National Institute of Health office of Alternative Medicine has brought out evidences of growing acceptance of forms of “alternative health care approaches” in this area.

BACKGROUND OF THE STUDY:

Nausea and vomiting of pregnancy, commonly known as “morning sickness,” are common experiences in pregnancy which affects 70–80% of all pregnant women. Although most women with nausea and vomiting of pregnancy have symptoms limited to the first trimester, a small percentage of women have a prolonged course with symptoms extending until delivery.

Worldwide it is estimated that 70–80% of all pregnant women experience nausea and vomiting in pregnancy. In the United States and Canada this translates to approximately 4,000,000 and 350,000 women who are affected each year, respectively.¹ The description "morning sickness" is a misnomer, because nausea and vomiting can occur at any time of the day and not only in the morning.

The incidence of morning sickness in a normal singleton pregnancy is reported to occur in 73.4% of 39,710 pregnant women.²Nausea is reported in all women who have morning sickness except for 0.64% who have vomiting alone, making nausea the most frequent symptom. 32.0% of 8435pregnant women had nausea only.

According to the papers from Medline studies the severity of nausea in a study (conducted in Coventry) of 363 women, 292 of whom had morning sickness, the mean number of hours of nausea per pregnancy was 56 hours and this symptom lasted for a median of 41 days (almost 6 weeks) . In 36% of women who had morning sickness, the nausea lasted for up to 33 hours per pregnancy, but 21% had nausea which lasted for 100-300 hours and a further 10% from 300-700 hours, a thoroughly distressing and depressing experience.³ Vomiting is also a significant symptom of pregnancy, occurring in 47.1% of 19,330 pregnant women with about 10% of pregnant women experiencing 40 or more vomits during their pregnancy, but women describe nausea as the more distressing symptom.⁴

Morning sickness typically starts in the morning and continues into the afternoon and evening. Severe nausea and vomiting in pregnancy (hyper emesis gravidarum) affects less than 1% of women, but it can be debilitating, sometimes requiring hospitalization and rehydration.¹⁰ if left untreated, symptoms can even become worse. Early treatment can prevent more serious complications, including hospitalization.⁵

Women suffer not only physically, but also psychologically, which has been documented in a number of studies. In addition, some women have decided to terminate their pregnancies rather than tolerate the severe symptoms.⁶

NEED OF THE STUDY:

In a study by Smith et al. (2000) of 593 Australian women with nausea and vomiting in pregnancy, most reported that their symptoms produced major negative impacts on employment, household duties, and parenting with 96% of women reporting mild to moderate distress from nausea and 28% reporting moderate to severe distress.⁷

Similarly, a study by Mazzotta et al. (2000) of Canadian women found more severe nausea and vomiting to be associated with more frequent feelings of depression, consideration of termination of pregnancy, adverse effects on women’s relationships with their partners or their partners’ everyday lives, and the perceived likelihood that NVP would harm their baby. Notably, women with mild symptoms also reported experiencing the same psychosocial problems, suggesting that the severity of nausea or vomiting does not adequately reflect the distress caused by nausea and vomiting in pregnancy.⁸

Similarly Attard et al. (2002) found that women with nausea and vomiting in pregnancy had lower scores in physical functioning, physical role, bodily pain, vitality, social functioning, and emotional role on survey evaluating quality of life compared to healthy pregnant controls in early pregnancy and women with chronic depression. Mental health scores for the women with nausea and vomiting in pregnancy were similar to those of the women with depression.⁹

A study was conducted by Smith C et al (Nov 2000) in Australia with an aim to describe the impact of nausea and vomiting on women in early pregnancy by interviewing, using a structured questionnaire. 593 pregnant women presenting with nausea and vomiting in the first trimester of pregnancy were included in this study. The women were asked to complete the Rhodes index of nausea and vomiting. Nausea was the most troublesome symptom experienced by women, both in its duration and intensity. The women described substantial effects on working, household duties and parenting activities. Findings from this study suggest nausea and vomiting in early pregnancy has a profound impact on women's general sense of well-being and day to day life activities.¹⁰

As the above reviews describes about many complications that may arise due to the nausea and vomiting of pregnancy, and there are many studies done to treat it using many alternatives. But there are very few reviews that explain about the effect of acupressure on nausea and vomiting of pregnancy. Hence the researcher felt the need to do this study and put more light on this topic.

STATEMENT OF THE PROBLEM:

“An experimental study to assess the effectiveness of acupressure on morning sickness among the antenatal mothers in selected communities”.

OBJECTIVES:

• To assess the morning sickness among the mothers of experimental group and control group.

• To assess the effectiveness of acupressure on morning sickness among the antenatal mothers of experimental group.

• To compare the morning sickness among the mothers of experimental and control groups before and after the intervention.

• To associate the morning sickness between primi and multi parity mothers of experimental group.

HYPOTHESIS:

H₀₁:

There is no significant relationship between acupressure and morning sickness at 0.05% level of significance.

H₀₂:

There is no significant relationship between morning sickness and parity at 0.05 % level of significance.

LIMITATIONS:

· This study is limited to short period of time i.e 4 days.

· The sample size is limited to 40 subjects.

· The study is limited to selected community areas only.

ETHICAL ASPECTS:

This study proposal has been sanctioned by the institutional ethical committee.

· Informed consent was taken from all subjects.

· Information was handled in a way so that confidentiality and anonymity was maintained.

· Information is not used or released outside the terms of the agreement.

· Subjects were protected from all types of harm.

CONCEPTUAL FRAME WORK:

The investigator adapted Imogene king’s goal attainment model as a basis of conceptual framework which was modified to suit the study and it aims to reduce the morning sickness of antenatal mothers by giving them acupressure and comparing the scores between experimental and control group.

The components of the framework are as follows:

Perception:

In this study investigator perceive antenatal mothers with morning sickness are unable to do their routine activities as they lack of knowledge and practices of interventions for the reduction of morning sickness.

Action:

After assessment of perception, goal was developed to reduce the morning sickness among the antenatal mothers so that they can perform all routine activities smoothly.

Reaction:

In this study the investigator reaction is to pre-test or assess the morning sickness and then set the mutual goal setting between investigator and the participant to reduce the morning sickness.

Intervention:

During this phase investigator administers a rating scale to the antennal mothers with morning sickness and pre-test is done. Half the subjects are given acupressure as an intervention and other half is given no intervention (control group) for 2-3 minutes twice a day with interval of 8 hours or more for 4 days. Post- test is taken after intervention with the same rating scale.

Transaction:

Transaction is improvement in the reduction of morning sickness among the antenatal mothers through the acupressure which improves their ability for routine activities.

Goal attainment:

It is the evaluation of the process if the desired effect is obtained or it has failed to do so. After the practices of acupressure there will be reduction in morning sickness, hence the goal of reducing morning sickness will be achieved.

REVIEW OF LITERATURE:

Coronado PJ (2014) conducted a cohort study of 263 pregnant women with gestational age < 12 weeks to estimate the prevalence and factors associated with the persistence of nausea and vomiting of pregnancy in each trimester of pregnancy. The results showed that the prevalence of nausea in the each trimester was 63.5 %, 33.8 %, 26.2 %, and vomiting was 29.3 %, 22.1 %, 14.1 %, respectively.¹¹

According to Abedian Z et al (2015) a Randomized Control Trial was carried out to evaluate the effectiveness of acupressure on sleep quality of postmenopausal women. The study was performed on 120 qualified menopausal women at the age of 41-65 years. Their sleep quality was measured according to the Pittsburgh Sleep Quality Index (PSQI). Participants were randomly assigned to an acupressure group (n=37), a sham acupressure group (n=36) and a control group (n=32) by two time randomized method (systematic and simple randomized). These interventions were carried out for four consecutive weeks. The study concluded that Acupressure can be used as a complementary treatment to relieve sleep disorders in menopausal women; and is offered as an efficient method to manage sleep quality.¹²

As per Juan Rodriguez- Mansilla et al (2015) a study was performed to assess the effectiveness of ear acupressure and massage vs. control in the improvement of pain, anxiety and depression in persons diagnosed with dementia. The participants were randomly allocated, in three groups. Control group - they continued with their routine activities; ear acupressure intervention group - they received ear acupressure treatment (pressure was applied to acupressure points on the ear); and massage therapy intervention group - they received relaxing massage therapy. The study concluded that Ear acupressure and massage therapy showed better results than the control group in relation to pain, anxiety and depression. However, ear acupressure achieved more improvements.¹³

An experimental study was done in Hong Kongby Y. B Yip et al(2015) to evaluate the effectiveness of acupressure with aromatic lavender essential oil for sub-acute, non-specific neck pain. A course of 8-session manual acupressure with lavender oil over a 3 week period was given to the experimental group. The results show that eight sessions of acupressure with aromatic lavender oil were an effective method for short-term neck pain relief.³⁸

As per Wang S et al (2014) a randomized controlled study was performed to assess the effectiveness of auricular acupressure for QOL improvement in diabetic patients with chronic kidney disease. Sixty-two participants were randomly assigned to an auricular or a control arm in a randomized controlled trial. Participants in the auricular arm were instructed to perform auricular acupressure 3-5 times per day for 3 months, when they were receiving conventional treatments. Participants in the control arm received conventional treatments only. The study concluded that Auricular acupressure was well tolerated in diabetic patients with chronic kidney diseases receiving hemodialysis.³⁹

Sabouhi Fet al (2013) performed a clinical trial study with 96 patients to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures included the form of demographic characteristics, visual analogue scale of fatigue, and Piper Fatigue Scale. Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day, 3 days per week for 4 weeks. In the placebo group, acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site. Patients in the control group received routine unit care only. The results of this study showed that acupressure may reduce fatigue in hemodialysis patients, and use of this non-pharmacologic technique for hemodialysis nurses is suggested.⁴⁰

RESEARCH METHODOLOGY:

RESEARCH APPROACH:

Quantitative approach

RESEARCH DESIGN:

Experimental study Randomized control group design (i.e pre-test- post-test design for two groups)

STUDY SETTING:

Selected communities

TARGET POPULATION:

Antenatal mothers with morning sickness within 20 weeks of gestation

ACCESSIBLE POPULATION:

Antenatal mothers in the nearby communities who are having morning sickness and are within 20 weeks of gestation.

SAMPLING TECHNIQUE:

Simple random sampling

SAMPLE SIZE:

Total number of sample selected were 40 mothers (20 in experimental and 20 in control group)

TOOL FOR DATA COLLECTION:

Modified Rhodes index rating scale

Inclusion criteria:

} Antenatal mothers with morning sickness within the 20th weeks of gestation.

} Mothers who can speak Marathi, English and Hindi.

} Mothers who are willing to participate.

Exclusion criteria:

} Antenatal mothers with high risk pregnancy.

} Antenatal mothers on ante emetic treatment.

TOOL PREPARATION:

The data collection tool was constructed by the investigator (by modifying the Rhodes index) in the light of literature reviewed to ensure the adequacy, relevancy, questions, organization, and validity of the content and measurable tool.

Preparation of tool was done by:

· Review of literature

· Validation of tool by experts

The tool consisted of a rating scale which has two sections: the description of the tool is as follows:

Section I:

Demographic data: using structured questionnaire which has 6 items regarding, age, Qualification, Religion, Occupation, Parity, Practicing any home remedy

Section II:

Assessment of morning sickness: using Modified Rhodes index rating scale having 6 items (scoring from 0-4).

Technique:

The permission was taken from the head of the bachat gat samiti and consent from the antenatal mothers with morning sickness.

Then the demographic data and morning sickness information was collected from the antenatal mothers and the morning sickness score was assessed before and after the intervention. The technique used in present study was structured interview technique.

FEASIBILITY OF THE STUDY:

The purpose of feasibility is to prevent an expensive fiasco. The tool has been tested on 6 antenatal mothers in each group with morning sickness that were eligible for the study and the investigator found that the study is feasible keeping in mind the time, availability of subjects, ethical issues, equipments required and the cost of study. These subjects have been excluded in the main study.

VALIDITY:

To ensure the content validity of the prepared tool, it was given to 15 experts but correction was received only by 10 experts. These experts included 2 obstetricians, 1 statistician, 5 nursing experts from OBGY department and 1 lay person. The tool was found to be valid.

RELIABILITY:

The reliability of the tool was found to be 0.82 by using split half method which confirms that the tool is reliable.

PILOT STUDY:

The pilot study was conducted from 20.09.15 to 23.09.15 to assess the feasibility and to decide the plan for statistical analysis. Prior permission from the head of bachat gat samiti was taken. Test has been conducted on 12 (6 in each group) subjects. Subjects have been selected using simple random sampling in which randomization was done by lottery method. Data has been collected using modified Rhodes index rating scale. After data collection the data has been analysed. The result showed that there was reduce in morning sickness after giving the intervention. But a significant difference was not seen as the sample size was not adequate. The pilot study did not show any flaw in the study. The findings were reliable, main study was found to be feasible for conduction, based on the findings of pilot study.

DATA COLLECTION METHOD:

· Permission from concerned authority i.e from the head of bachat gat samiti was taken.

· Meeting with the women living in the community was arranged with the help of the head of the bachat gat Samiti. Antenatal mothers were identified from the group and their willingness to participate was considered.

· Antenatal mothers fulfilling the inclusion criteria were randomly assigned to experimental and control group by lottery method.

· Informed consent was taken from the Antenatal mothers fulfilling the inclusion criteria and he procedure for data collection was explained to them.

· According to the women willingness they were requested to gather at one place twice (morning and evening) for 4 days to give acupressure and collect the data.

· Pre intervention morning sickness was assessed for both the groups in the morning.

· Treatment was given to the antenatal mothers of experimental group in the form of acupressure for 4 days twice in a day for five minutes to each mother.

· The mothers who were unable to attend, the data was collected through home visit by the researcher.

· Post intervention morning sickness of experimental and control group was assessed at the end of four days session i.e on the fifth day.

· On the fifth day the data of experimental and control group was compared.

ANALYSIS AND INTERPRETATION OF DATA

The analysis of the collected data was done with the help of descriptive and inferential statistics i.e frequency percentage, mean, standard deviation has been used for descriptive analysis, whereas Wilcoxon "z" test was used for the effectiveness and Man Whitney 'U' test was used for comparison. Descriptive statistics in the form of calculation of frequency percentage have been utilized to analyse demographic variables and the effectiveness of acupressure on morning sickness among the antenatal mothers.

DESCRIPTION OF SUBJECTS ACCORDING TO DEMOGRAPHIC CHARACTERISTICS

Table 4.1 (a): Description of subjects according to age, by frequency and percentage.

Demo-graphic variables	Experimental group		Control group
Demo-graphic variables	Frequency	Percentage	Frequency	Percentage
Age
19-22 yrs.	6	30%	3	15%
23-26yrs	7	35%	7	35%
27-30yrs	7	35%	7	35%
>30yrs	0	0	3	15%

Above table describes about the age of antenatal mothers in experimental and control group.

· In experimental group majority (35%) of the mothers were in the age group of 23-26 and 27-30 years, and 30% of the mothers were in the age group of 19-22 years.

· In control group majority (35%) of the mothers were in the age group of 23-26 and 27-30 years, and 15% of the mothers were in the age group of 19-22 years and >30 years.

Table 4.1 (b): Description of subjects according to educational qualification, by frequency and percentage.

Demo-graphic variables	Experimental group		Control group
Demo-graphic variables	Frequency	Percentage	Frequency	Percentage
Qualification
Up to HSC	15	75%	11	55%
Above HSC	5	25%	9	45%

Above table describes about the educational qualification of antenatal mothers in experimental and control group.

· In experimental group majority (75%) of the mothers were qualified up to HSC and 25% of the subjects were qualified above HSC.

· In control group majority (55%) of the mothers were qualified up to HSC and 45% of the subjects were qualified above HSC.

Table 4.1 (c): Description of subjects according to religion, by frequency and percentage.

Demo-graphic variables	Experimental group		Control group
Demo-graphic variables	Frequency	Percentage	Frequency	Percentage
Religion
Hindu	19	95%	19	95%
Muslim	1	5%	0	0
Christian	0	0	1	5%

Above table describes about the religion of antenatal mothers in experimental and control group.

· In experimental group majority (95%) of the mothers were Hindu and 5% of the mothers were Muslim.

· In control group majority 95% of the mothers were Hindu and 5% of the mothers were Christian.

Table 4.1 (d): Description of subjects according to occupation, by frequency and percentage.

Demo-graphic variables	Experimental group		Control group
Demo-graphic variables	Frequency	Percentage	Frequency	Percentage
Occupation
Housewife	20	100%	20	100%
Working	0	0	0	0

Above table describes about the religion of antenatal mothers in experimental and control group. In experimental and control group 100% subjects were housewife by occupation.

SECTION II

Table 4.2: Description of data related to assessment of morning sickness among the antenatal mothers of experimental and control group.

Morning sickness	Experimental group		Control group
Morning sickness	Frequency	Percentage	Frequency	Percentage
0 (No)	0	0	0	0
1 – 8 (Mild)	1	5	3	15
9 – 16 (Moderate)	16	80	14	70
17 – 24 (Severe)	3	15	3	15
Total	20	100	20	100

Above table describes about the assessment of morning sickness among the antenatal mothers of experimental and control group.

In experimental group majority, (80%) of the mothers were having moderate morning sickness, 15%of the mothers were having severe morning sickness and 5%of the mothers were having mild morning sickness.

In control group70%of the mothers were having moderate morning sickness, 15%of the mothers were having severe morning sickness and 15%of the mothers were having mild morning sickness.

TABLE 4.3: Analysis of data related to effectiveness of acupressure on morning sickness among the antenatal mothers of experimental group.

Morning

sickness score

Pre-test (n=20)

Post-test (n=20)

Wilcoxon

Z Value

P Value

Mean

SD

Mean

SD

12.35

2.996

9.05

2.724

3.96

<0.0001

Above table describes about the comparison of morning sickness score according to parity among the antenatal mothers of experimental group. Man whitney “U” test was used to compare the sickness score among the primi and multi mothers of experimental group before and after acupressure. The mean score of morning sickness was almost close to same in both primi as well as in multi mothers before (13 and 11.38) and after ( 9.67 and 8.13) acupressure. Thus, the null hypothesis is accepted and there is no significant relation between morning sickness and parity.

DISCUSSION:

Findings of the study have been discussed with the reference to the objectives and hypothesis stated and with the findings of the other studies.

Azza Ali et al (2015) performed a quasi-experimental study to assess the effect of acupressure wristband on reducing the symptoms of nausea and vomiting during pregnancy. A simple random sample of 200 pregnant women were recruited for this research according to the following criteria: age not exceed 35 years old, singleton pregnancy; not exceeding gravid 4, suffer from nausea and vomiting , free from medical disorder, gestational age 4th weeks gestation. Tools, data were collected by applying two tools developed by the researcher the first was structured interview and the second was nausea and vomiting assessment and follow up. Results indicated that, no statistically significant differences between both groups were found in relation to nausea and vomiting.⁶⁰

According to this review acupressure was effective in reducing nausea and vomiting which is the same result of present study.

Festin M(2014) conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatment for nausea and vomiting in early pregnancy? What are the effects of treatments for Hyperemesis gravidarum? He searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organizations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). He found 32 studies that met his inclusion criteria. He performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review he present information relating to the effectiveness and safety of the following interventions: acupressure; acupuncture; corticosteroids; ginger; metoclopramide; ondansetron; prochlorperazine; promethazine; and pyridoxine (vitamin B6).Thus the conclusion of the review was that all the interventions were effective and safe for the treatment of nausea and vomiting in pregnancy.⁶¹

The present study also showed that acupressure is an effective treatment for nausea and vomiting in pregnancy.

Can Gürkan et al O (2008) conducted a cohort study to assess the effectiveness of acupressure in reducing the symptoms of nausea and vomiting during pregnancy in which the treatment group comprised 26 women; and 25 in the control arm. The study occurred over a 6-day period. During this time, the treatment group applied acupressure bands to P (6) acupressure point on days 4-6 of the study. The study revealed that acupressure would appear to be effective in symptom control, and in reducing the symptoms of nausea and vomiting during pregnancy.⁴⁹

The present study also showed that acupressure is effective in reducing nausea and vomiting during pregnancy.

Shin HS et al (2007) conducted a randomized control study to examine the effect of Nei-Guan point acupressure on nausea, vomiting and ketonuria levels in women diagnosed with hyperemesis gravidarum. The pre-test-post-test design was implemented using three groups: a Nei-Guan point acupressure group, a placebo group and a control group which received only conventional intravenous treatment. The participants were 66 women admitted to two general hospitals in Korea with Hyperemesis gravidarum. The study resulted that the degree of nausea and vomiting was statistically significantly lower in the Nei-Guan point acupressure group in comparison with the placebo and control groups. Ketonuria levels were reduced over time and, on days three and four of hospitalization, levels in the treatment group was statistically significantly lower than in the placebo or control groups (P < 0.05).

The conclusion made from this study was that the Nei-Guan point acupressure is a useful treatment for relieving symptoms experienced by women with hyper emesis gravidarum.⁵⁰

The present study also states that acupressure is effective in reducing nausea and vomiting in pregnancy.

Similarly in the present study acupressure at p6 point is effective in reducing the nausea and vomiting in pregnancy.

CONCLUSION:

The finding of the present study is that acupressure is effective in reducing morning sickness among the antenatal mothers.

NURSING IMPLICATION:

Clinical Practice:

· This study will enhance the nurses to practice complementary therapies like acupressure to evaluate the morning sickness in antenatal mothers and reduce it.

· This study will help nursing practice into a new scope of complementary therapies and its usage in day to day life.

· This study will promote nursing personnel to give evidence based nursing care in a cost effective manner with the help of complementary therapies like acupressure.

· This study will boost up the knowledge and skill of nurses in giving complementary therapies like acupressure.

Community based nursing practice:

· This study will provide a channel to community health nurse to spread awareness about morning sickness and how it can be relieved by acupressure.

· This study will give a way for community health nurse to spread awareness and also teach the community about simple pressure point (p6) on the wrist and how to use acupressure to relieve morning sickness.

Nursing education:

· A nurse educator can train the community health nurse about such complementary therapies which can in turn help the antenatal mothers by giving them acupressure sessions to relieve morning sickness.

· This study can help the nurse educator to plan workshops for nurses at clinical or community set up in which they will have opportunity to develop their skills, gain knowledge and practice such complementary therapies to help the patients to have optimal health.

Nursing administration:

· This study will help the nurse administrator to conduct in service programmes and workshops to train nurses in complementary therapies.

· This study will add information to administrators about allowing practice of this complementary therapy in clinical and community set up.

Nursing research:

· The findings of this study will add to the existing body of knowledge in the profession of nursing.

· Other researches may utilise the suggestions and recommendations for conducting further study.

· The tool and technique used has added to the body of knowledge and skill that can be used for further references.

SUMMARY:

This chapter deals with the summarization of the research study, it brings forth the major findings of the study, conclusion and recommendations given at the end of the study.

REFERENCES:

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Morning sickness score	Experiment (n=20)		Control (n=20)		MW test U Value	P Value
Morning sickness score	Mean	SD	Mean	SD	MW test U Value	P Value
Pre test	12.35	2.996	12.55	3.790	0.41	>0.05
Post test	9.05	2.724	14.00	7.732	3.31	<0.001

Morning sickness score	Parity				MW test U Value	P Value
	Primi (n=12)		Multi (n=8)
	Mean	SD	Mean	SD
Pre test	13	3.46	11.38	1.92	1.09	>0.05
Post test	9.67	3.26	8.13	1.36	1.23	>0.05

Pre-test (n=20)

Post-test (n=20)

SD

Mean

SD

Experiment (n=20)

Control (n=20)

SD

Mean

SD

Parity

Primi (n=12)

Multi (n=8)

SD

Mean

SD

10. Smith C, Crowther C, Beilby J, Dandeaux J. The impact of nausea and vomiting on women: A burden of early pregnancy.Aust N Z J Obstet Gynaecol. 2000 Nov; 40(4):397-401. Review available from: Pub Med PMID: 11194422

11. Coronado PJ, Fasero M, Álvarez-Sánchez Á, Rey E. Prevalence and persistence of nausea and vomiting along the pregnancy. Rev EspEnferm Dig. 2014 May; 106(5):318-24. Available from:http://www.ncbi.nlm.nih.gov/pubmed/25287234.