14

Chapter 1

THE PROBLEM AND ITS BACKGROUND

Introduction

“When women are empowered to fulfill their potential, they

invest in their families and work for lasting change as they

cannot fully participate in society if they cannot expect to

survive childbirth.”

-Cooperative for Assistance

and Relief Everywhere

Organization (2008)

Truly as it says above, the event of giving birth to a

child is an experience that upholds a woman’s life

experience. It gives an opportunity for nurses to help

develop this important milestone because one’s actions may

be empowered by one’s feelings and ability. It is also

during this time wherein clients may find it critical to

regain full physiological capacity especially after a

caesarean section. In the nursing field, developing a plan

15

is highly essential in the recovery process for these

clients in the process of providing holistic care. It is

also a vocation that defines the importance of dispensing

comfort, knowledge and most of all touching and nurturing

lives.

Caesarean section is described as the surgical removal

of the infant from the uterus through the incision made in

the abdominal wall and incision made in the uterus (Nettina,

2006). Because caesarean and section both refer to an

incision, some prefer the terms caesarean delivery or

caesarean birth to describe the procedure (Gabbe, et. al,

2007).

The origin of the term caesarean is obscureand three

principal explanations have been suggested. In the first

explanation, according to legend, Julius Caesar was born in

this manner, with the result that the procedure became known

as the Caesarean operation. Several circumstances weak this

explanation; First, the mother of Julius Caesar lived for

many years after his birth in 100 B.C and as late as the

16

17th century. The operation was almost invariably fatal.

Second the operation, whether performed on the living or

dead, is not mentioned by any medical writer before the

middle ages. Historical details of the origin of the family

name Caesar are found in the monograph. In the second

explanation, the name of the operation is derived from a

Roman law, supposedly created in the 8th century B.C by Numa

Pompilius, ordering that the procedure be upon women dying

in the last few weeks of pregnancy in the hope of saving the

child. The third explanation is that the word caesarean was

derived sometime in the middle age from the Latin word

Caedere which means “to cut” (Cunningham, 2005)

One in 10 live births was delivered through caesarean

section. Considering this, there may be other factors that

should be recognized (Kho, 2010). Rates of caesarean

section varies in different hospitalsin a national degree,

it can be as high as 50%. Caesarean rates are also twice

as high in urbanized areas than in the provinces. Another

factor is that not all women have access to hospital care.

Twenty percent of wealthier moms are said to give birth

17

through caesarean section, while only 1.7 percent of the

poorer moms do. 

In a study conducted based on 133 countries, it was

calculated that approximately 18.5 million caesarean

sections (CS) are performed yearly worldwide. About 40% of

the countries have CS rates less than 10%, about 10% have CS

rates between 10 and 15%and approximately 50% have CS rates

greater than 15%, 56 countries with CS rates 10% account for

only 25% (4.5 millions) of the global CS but for 60% (77

millions) of the total number of births worldwide. On the

other hand, 73% (13.5 millions) of the total number of CS

are performed in the 65 countries with CS rates greater than

15% were 37.5% (48.4 millions) of the total number of births

occur (Gibbons et al., 2010).

Most women may not anticipate the need for a

complicated childbirth because they believe they are

healthy. This is a clear and helpful recommendation to

determine the necessity of a caesarean section (CS).

Undergoing this type of surgery, increases the risk for

18

complications in both the baby and the mother in comparison

with a vaginal birth.

There may be several reasons why the numbers of those

who undergo CS increases. First, better care has made the

operation safer. There have been improvements in the

way pain relief, antibiotics and blood transfusions are

administered. Babies also experience more monitoring and

increased medical intervention during low-risk labors.

Premature babies are given special care and have greater

chances for survival.

Activities of Daily Living (ADL) are the things or

tasks that most people perform every day. Necessity of

supervision, direction, personal assistance, or total care

for any dependent function can be recorded as parameters to

assess minute declines or increments of patients’ ADL. It

includes bathing, grooming, eating, dressing, toileting and

others. Knowing the individual’s ability to perform the

activities of daily living is important to determine the

specific care that will be rendered to the clients. It is

19

also serves as a guide in measuring the functional status of

the client. People that are unable to perform ADL tend to

be dependent to machines or gadgets or needs to be assisted

by other person or other family members. This can help

evaluate an individual’s ability to do basic tasks

especially in a hospital setting.

The researchers have chosen to proceed with this study

for several particular reasons, one of which is to gain

awareness and deeper understanding about the effects of

caesarean section on the performance of daily activities of

and individual. As there is an increasing necessity for

Cesarean Section (CS) due to the above-mentioned issues

faced by our society today, it is important for nurses to be

able to systematically assess the recovery of these clients

with the means of performing Activities of Daily Living

(ADL).

Theoretical / Conceptual Framework

The study was anchored on Virginia Henderson’s Need

Theory, which is a theory that focuses on the importance of

20

patient independence so that the patient will continue to

progress prior to discharge from the hospital (Henderson,

2007).

According to Henderson’s Need Theory, health is viewed

in terms of the individual’s ability to perform 14

components of nursing care unaided. Health is quality of

life basic to human functioning and requires independence

and interdependence. It is the quality of health rather

life itself that allows people to work most effectively and

to teach their highest potential level of satisfaction in

life. Individuals will achieve or maintain health if they

have necessary strength, will, or knowledge. Henderson

conceptualized the nurse’s role as assisting sick or well

individuals in a supplementary or complementary way. The

nurse needs to be a partner with the patient, a helper to

the patient and, when necessary, a substitute for the

patient. The nurse’s focus is to help individuals and

families to gain independence in meeting 14 fundamental

needs: Breathing normally, eating and drinking adequately,

eliminating body wastes, moving and maintaining desirable

21

position, sleeping and resting, selecting suitable clothes,

maintaining body temperature within normal range, keeping

the body clean and well-groomed, avoiding dangers in the

environment, communication with others, worshipping

according to one’s faith, working in such a way that one

feels a sense of accomplishment, playing or participating in

various forms of recreation, learning, discovering or

satisfying the curiosity that leads to normal development

and health and using available health facilities. She

described the role of the nurse as one of the following: (a)

substitutive, which is doing something for the patient; (b)

supplementary, which is helping the patient do something: or

(c) complementary, which is working with the patient to do

something. These all rely in the goal of helping the person

become as independent as possible. (Henderson, 2007)

In relation to the study, the performance of the daily

activities was theoretically being as unique as their

strength, will, or knowledge and variability. Each and

everyone have been exposed to experiences affirming the

difference of strength, will, or knowledge. This may also

22

influence how they work towards a goal of self independence.

Variability would have include age, family support systemand

parity. Existence of differences imposes significance to

knowing individual performances. Therefore, it is expected

that the performance of the clients involved in the study

regarding caesarean section vary depending on their

experiences and other factors that may affect their

respective viewpoints.

Figure 1. Performance of the Activities of Daily Living

Among Clients Who Have Undergone Cesarean Section in a

Tertiary Hospital

Performance of

Age the Activities of Daily Living

Family Support System Among Clients Who Have

Parity Undergone Caesarean Section

in a Tertiary Hospital

The paradigm above depicts the relationship of

independent variable identified in the study as age, family

23

support system and parity with the dependent variable which

is the performance of the activities of daily living of

patients who have undergone caesarean section.

Statement of the Problem

This study primarily aimed to determine the level of

performance of the activities of daily living among clients

who have undergone Caesarian Section in a tertiary hospital.

Specifically, it sought answers to the following

problems:

1. What is the profile of the respondents in terms of age,

family support systemand parity?

2. What is the level of performance of the activities of

daily living of the respondents?

3. Are there significant differences in the level of

performance of the activities of daily living when the

respondents are grouped according to age, family support

systemand parity?

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Hypothesis of the study

It was hypothesized in this study that there are no

significant differences in the level of performance of the

activities of daily living when the respondents are grouped

according to age, family support systemand parity.

Scope and Delimitation of the Study

This study focused mainly on the performance of the

activities of daily living among clients who have undergone

Caesarian Section in a tertiary hospital.

This study involved 60 clients who have undergone

caesarean section two days post operatively and how many

births have already been undergone by the respondents. This

study was conducted in General Emilio Aguinaldo Memorial

Hospital in Trece Martires City, Cavite, a tertiary

hospital. The respondents were 18-37 years old and were

able to speak, read and write and understand English or

Filipino Language.

This study also included everyday routine, the things

the respondents normally perform for self-care such as

25

feeding, dressing/ undressing, grooming, ambulation, bed

mobility, bathing, use of toilet, continence and meal

preparation.

Significance of the Study

The researchers believed that the results of the study

may benefit the following:

Staff Nurses and Nursing Students. This may provide

both staff nurses and nursing students the awareness on

general abilities of clients who have undergone caesarean

section based on their performance of the activities of

daily living. Consequently, this study may encourage them

to start a careful assessment and provide essential

modifications when making a nursing care plan because they

know which type of daily activity is difficult to perform

individually.

College of Nursing and School of Midwifery.This study

may primarily provide the nursing educators an idea on how

to promote student nurse’s competencies when interacting

with clients who have undergone caesarean section. This may

help them have a better approach with these types of clients

26

because the area wherein they experience the most difficulty

is identified.

Clients who have undergone Caesarean Section.This may

help them have an improved understanding on their condition.

They may become more aware on their physical capabilities

and allow themselves to reach a new level of self

independence in order to be more active when performing

tasks on a daily basis.

Family of Caesarean Section Clients.They may benefit

from the study because this may increase their knowledge

about the effects of caesarean on the patient’s performance

of the activities of daily living. This may also enhance

their interaction with their relative as they develop a

sense of empathy and an understanding on their condition.

Future Researchers.Knowledge of the study would inform

the future researchers that clients who have undergone

caesarean section may have different responses as every

individual is unique. This study may serve as a road map

for the future researchers as this will provide additional

knowledge and information.

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Definition of Terms

For the purpose of better understanding of the study,

the following terms used in this study are operationally

defined below:

Activities of Daily Living. It refers to the everyday

routine, the things the respondents normally perform for

self-care such as feeding, dressing/ undressing, grooming,

ambulation, bed mobility, bathing, use of toilet, continence

and meal preparation. ADL will be measured using a scale of

1-3 wherein; 1- Dependent, inability to perform the task

either by self of with support from others. This means a

complete dependence on a device or on someone else to

perform a task or has a low level of self-care 2- Needs

Assistance, ability to perform task only if with support

either by a person or a device or has a moderate level of

self-care, 3- Independent, ability to perform task by own

self or has a high level of self-care. The level of

performance of the activities of daily living of the

respondents are categorized into three, based on computed

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mean scores mainly: (a) 1.00 to 1.67 – Performed

Dependently, (b) 1.68 to 2.34 – Performed with Assistanceand

(c) 2.35 to 3.00 – Performed Independently

Age. This pertains to the chronological age of the

respondents. The classifications are (a) 18-22 years old,

(b) 23-27 years old, (c) 28-32 years old, (d) 33-37 years

old. These are the indicators of the study.

Caesarean Section.This pertains to a type of operation

wherein the baby will be delivered through an incision made

in the abdominal wall.

Family Support System. It pertains to the support

given by the family to the clients who have undergone

caesarean section. It will be classified as: (a) with

family support, living with or being visited by family

members, friends, or relative, (b) without family support,

living without or not being visited by family members,

friends, or relatives.

Parity.This refers to the number of times the mother

has been pregnant but not less than 20 weeks of gestation.

It may be grouped into: (a) Primi-para refers to the mother

29

who is given birth for the first time and (b) Multi-para

refers to the mothers who has given birth two or more times.

Chapter 2

REVIEW OF RELATED LITERATURE

This chapter presents the review of both conceptual and

research literature, which were derived from education

books, journals, online sourcesand theses that provide the

researchers with necessary background knowledge to pursue

the study. The conceptual literature contains a brief

discussion of the following topics: Caesarean Section and

Activities of Daily Living.

Caesarean Section

Pliny the Elder theorized that Julius Caesar’s name

came from an ancestor who was born by caesarean section, but

the truth of this is debated. The Ancient Roman caesarean

section was first performed to remove a baby from the womb

of a mother died during childbirth. Caesar’s mother,

Aurelia, lived through childbirth and successfully gave

birth to her son, ruling out the possibility that the Roman

30

Dictator and General was born by caesarean section. The

Catalan saint, Raymond Nonnatus (1204-1240), received his

surname – from the Latin “non natus” (“not born”) – because

he was born by the caesarean section. His mother died while

giving birth to him. In 1316 the future Robert II of

Scotland was delivered by caesarean section – his mother,

Marjorie Bruce, died (Eubel, 2009)

Caesarean Section is defined as the birth of the fetus

trans abdominally after incising the gravid uterus (Daftray,

S.N. & Desai, S.V. 2005). Caesarean section is performed

when awaiting a vaginal birth would compromise the mother,

the fetus or both (McKinney, E. S. et al 2009). Dystocia,

or difficult labor, is the other common cause of c-sections.

The procedure is frequently used in cases where the mother

has had a previous caesarean section. The procedure is

frequently used cases where the mother has had a previous

caesarean section. The procedure is performed in the United

States on nearly one of every four babies delivered-more

than 900,000 babies each year (Heisler, 2009).

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According to the American Congress of Obstetrician and

Gynecologist (ACOG) Practice Bulletin Number 49 (2003),

dystocia in labor (labor dystocia), a protraction disorder

or an arrest disorder, is a very commonly cited indication

for caesarean delivery, but it is not specific. These can

be primary or secondary disorders. Most dystocias are

caused by abnormalities of the power (uterine contractions),

the passage (maternal pelvis), or the passenger (the fetus).

The decision to proceed with a caesarean section for

the term frank breech singleton fetus has been challenged

based on the ACOG Committee Opinion No. 340 (2006).

Although most practitioners will always perform a caesarean

section in this situation, ACOG has left open the option to

consider a breech delivery under appropriate circumstances,

including practitioner experienced in the evaluation and

management of labor and skilled in the delivery of the

breech fetus.

Option of elective caesarean section on maternal

request (CDMR) has causes arise of debate. It is reasonable

to inform the pregnant woman requesting a caesarean section

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of the associated risks and benefits for the current and any

subsequent pregnancies as the evidence shown. The

clinician’s role should be to provide the best possible

evidence-based counseling to the woman and to respect her

autonomy and decision-making capabilities when considering

route of delivery (Hankins, 2006).

A study conducted by Gagnon, Meierand Waghorn,

(2007) involved a representative sample of low-risk women

giving birth in an intrapartum unit at a university hospital

in Quebec, Canada, with approximately 3,700 births per year.

Data on all variables of interest were available for 467

women. These women were cared for the responsibility by 1-

17 nursesand it was range from 10 to 1045 minutes in which

the mean length of labor for which the same nurse was

responsible for a woman. The ratio for the caesarean

section due to the number of nurses was 1.17 (95%Cl 1.04,

1.32) after controlling for length of labor, maternal age,

maternal height, infant weight, gestational age, indication,

type of ruptureand epidural anesthesia. For 2 hours, 1 or

more nurses switch their shifts (i.e., number of times care

33

responsibilities changed hands), 1.04 (95% CL 0.42, 1.30).

In caring for a laboring woman who was at risk of caesarean

section, an association was observed between the numbers of

nurses in which it estimates that the other patterns of

nursing care responsibility on caesarean birth were not

sufficiently precise to draw conclusions.

Activities of Daily Living

ADL’s are defined as “the things we normally do such

as; feeding ourselves, bathing, dressing, grooming, work,

homemaking and leisure” (Wiley, 2012). Activities of Daily

Living can be classified into: basic ADL (e.g., eating,

dressingand toileting), instrumental ADL (e.g., cooking,

shoppingand laundry)and more complex functions requiring

greater intellectual effort (Sadock, B.J & Sadock, V.A.,

2005).

Activities of Daily Living (ADLs) is a term used by

health professionals to refer to activities being done

everyday either inside the house, outdoor, or can be both.

Health professionals refer to the ability in doing ADL to

measure the functional status of a person, especially with

34

people with disabilities and the elderly. Practitioners

conduct evaluations in order to determine how independent

patients are and what skills they would be able to

accomplish independently. It is also used to measure the

degree of independence an indvidual has gained after

performing the interventions prepared by the health

professionals. The goal of performing the evaluation of ADL

is to help the patient become independent using the

appropriate adaptations if needed. Many ADL indexes exist,

such as the Katz Index, Revised Kenny Self-Care

Evaluationand the Barthel Index. These indexes were used to

evaluate the patient’s self-care. Each individual is rated

according to how functional they are. Scoring is based on

how the patient performed with regard to the measure of

dependence or independence in which the patient performed

the tasks (Krapp, 2012).

Since the Katz index of Activities of Daily Living

(ADL) was developed in 1963, it has gained increased

acceptance as an accurate measure of physical functioning.

35

National databases, state long-term care programs, insurers

who offer private long-term care insurance policies, federal

legislationand a body of research literature routinely use

limitations in the ADL identified by Katz et al. (eating,

bathing dressing toileting, transferringand continence) as

appropriate proxies for an individual’s level of cognitive

transferringand continence, as appropriate proxies for an

individual’s level of impairment, depending on the wording

of the assessment instrument. For example, assessing

whether a person requires physical assistance to perform an

ADL primarily measures physical impairment. But assessing

whether a person needs prompting or cueing to initiate and

complete an ADL primarily measures cognitive impairment

(Rothwell, 2007).

An important aspect of the ADL program is the provision

of pain-free alternatives of daily living activities. For

example, if the patient finds it painful to walk for any

distance greater than 200 yards, the patient might be

advised to walk in a poll. The buoyancy of the water

decreases pressure on the joints, reducing the pain. If it

36

hurts the patient to lift things above the head, the patient

should be advised to get a step ladder to assist in reaching

high objects. If it hurts the patient to type, voice

recognition software could be utilized to make sure the

patients understands how to use proper body mechanics in

their daily activities to avoid additional injuries (Clover,

2007).

A functional limitation may include inability to remove

a coat from a hanger, inability to roll over in bed, or

difficulties with dressing, all of which are examples of

basic activities of daily living (ADL). Clients who are

independently incapable of performing ADL experience

problems in the areas of occupation, education, work,

leisure and social preparation. Overlap between physical

and occupational therapy most commonly occur when

facilitating movement or when promoting postural stability

during the performance of activities (Bertoti, 2004).

In a study done by Downs et. al (2009) entitled

“Impact of scoliosis surgery on activities of daily living

37

in females with Rett syndrome”, data from questionnaires

administered to caregivers biennially from 2000 to 2006 were

used to describe functional skill levels in subjects with

Rett syndromeand within-subject change in 16 subjects with

scoliosis surgery were compared with within-subject change

in 186 pairs of data from 86 subjects with conservatively

managed scoliosis. Post surgical assessment was conducted

after a mean of 17.8 months. Scoliosis is a common

orthopedic complication of Rett syndromeand surgery is

commonly used to reduce asymmetry in cases with severe

scoliosis. Surgery was associated with the improved

activities of daily living to those who were wheelchair-

bound. Mobility levels, social interaction, communication

skillsand the frequency of daytime napping remained similar

for the group as a whole.

Browning et. al (2207) explained in their study

entitled, “The Quantity of Early Upright Mobilization

Performed following Upper Abdominal Surgery is Low: An

Observational Study wherein they Quantified Early Upright

Mobilization in Patients following Upper Abdominal Surgery.”

38

Their findings indicate that there is a low duration of

uptime recorded with more than half of the sample dependent

on assistance to mobilize on day 3and a further 22% still

dependent on Day 5.

Another study which used activities of daily living as

a variable was by Meiners et. al (2002). Tetraplegic

patients were tested for hand strength before and after hand

surgery. They also answered questions on how they rated the

results of surgery. The study was conducted in the Werner

Wicker Clinic, Bad Wildungen, Germany, from 1991 to 1998.

The results of reconstruction surgery performed on 23

tetraplegic hands, as reflected in lifting the hand, lateral

gripand cylindrical grip were presented. In a follow-up

study with 22 patients, their management of activities of

daily living 34.1 months (9-51 months) after the surgery is

compared with the preoperative situation. Subjective

satisfaction levels were elicited for each of the 22

patients by means of a questionnaire. The gain in force

corresponded to 893 g (150-1500 g) for cyclindrical grip and

488 g (100-1200 g) for lateral grip, while they were able to

39

develop grade 4 force for lifting the hand. After the

operation, 28 aids/appliances that patients had formerly

used regularly were no longer necessary. There were 75

separate activities listed in the questionnaireand on

average the 22 patients were able to perform 8.7 (0-20) more

of these. Most patients, (19) said they would advise others

to have the operation and the rest,(18) said that they would

have the operation again.

In a study by La Pier et, al (2008) entitled “Analysis

of Activities of Daily Living Performance in Patients

Recovering from Coronary Artery Bypass Surgery”, they

completed the Functional Status Index, a self-report

instrument, at two weeks and two months post surgery. They

used the response frequency for each item of the Functional

Status Index and used chi-square for data analysis. The

purpose of this study was to investigate the impact of

coronary artery bypass grafting surgery (CABG) on the

ability to perform the activities of daily living. A

significant loss of function occurs immediately following

surgery. The number of patients who experienced limitations

40

or difficulty with opening containers, dressing and rising

from a chair increased two weeks after CABG surgery.

The activities of daily living in patients after

rotationplasty surgery with a long term follow up checkup

had a good outcome in the quality of life scores. But only

little is known about the actual level of activity and

distribution of activities in the daily life of this patient

group and whether the activity level remains reduced after

treatment due to a loss of confidence in physical capacity

and fitness. From the results of ADL monitoring, it became

apparent that the locomotion played a lesser role in

everyday life whereas sitting and standing were predominant.

(Winters et. al, 2007)

Synthesis

Most of the acquired literature regarding the chosen

study used experimental approaches and it shows that there

is an evidence of a perceived specific difficulty

demonstrated by each client with different medical

conditions in performing the activities of daily living.

41

The conceptual literature provided information regarding

caesarean section post operative patients, nursing care and

activities of daily living.

Based on the research literature presented, several

studies were conducted focusing on the activities of daily

living, which had a significant effect due to their

particular condition related to orthopedic and heart

surgeries.

Browning et. al (2007) explained in their study

entitled, “The Quantity of Early Upright Mobilization

Performed following Upper Abdominal Surgery is Low: An

Observational Study wherein they Quantified Early Upright

Mobilization in Patients following Upper Abdominal Surgery.”

Their findings indicate that there is a low duration of

uptime recorded with more than half of the sample dependent

on assistance to mobilize on day 3 and a further 22% still

dependent on Day 5. Similar to the study, most of the

respondents needed only a moderate level of care in

performing the activities of daily living.

42

Another study that shows improvement of ADL after

surgery is seen in a study done by Meiners et. al (2002),

entitled “Improvements in activities of daily living

following functional hand surgery for treatment of lesions

to the cervical spinal cord: Self-assessment by patients”.

From the title, the patients may be able to benefit as they

are allowed to assess themselves and therefore, understand

their condition better. This study is also experimental

just like the above mentioned. The study was conducted in

the Werner Wicker Clinic, Bad Wildungen, Germany, from 1991

to 1998. In a follow-up study in 22 patients, their

management of the activities of daily living 34.1 months (9-

51 months) after the surgery is compared with the

preoperative situation. Subjective satisfaction levels were

elicited for each of the 22 patients by means of a

questionnaire. Nineteen patients said they would advise

others to have the operation and eighteen of them said that

they would have the operation again. The age range used was

between 21-57 years old. There were 12 complications in

nine patients. Reconstructive surgery on the hands of

43

tetraplegic patients led to gains in both cylindrical grip

and lateral grip force and to increased manual dexterity.

Patient satisfaction with the procedure was high. This

coincides with our study, as we also allow patients to

assess themselves and as well as using subjective data as a

way of approaching the patients when asked to perform ADL.

Moreover, in the study done by Winters et. al,

entitled “The Activities of Daily Living in Patients after

Rotation plasty Surgery With a Long Term Follow up Checkup”,

there was a good outcome with the quality of life scores

yet, only little is known about the actual level of activity

and distribution of activities in the daily life of this

patient group and if the activity level remained reduced

after treatment due to a loss of confidence in physical

capacity and fitness. Although an experimental approach was

done, this research didn’t utilize questionnaires to assess

improvement when performing activities. The level of

activity was determined by the number of gait cycles

measured with the Step Watch Activity Monitor (SAM) (Cyma,

USA). This device is an ankle-worn accelerometer that

44

reliably assesses the number of gait cycles per day in one

minute intervals. It can be programmed to different gait

parameters and therefore provides a measurement precision of

about 99%. The SAM can store data of several weeks and

measures without providing feedback to the user thus

minimizing test bias. Similar with the study, the

researchers also took in consideration the gait of the

respondent in order to know if the clients are having

difficulty in performing the ADL.

In contrast to the above mentioned research, in this

study by La Pier, et. al (2008) entitled “Analysis of

Activities of Daily Living Performance in Patients

Recovering from Coronary Artery Bypass Surgery”, there was

no improvement when performing ADL. For data analysis, the

response frequency for each item of the Functional Status

Index and used chi-square was used. A significant loss of

function occurred immediately following surgery. Depressed

physical function immediately following surgery may be

related to surgeon-determined activity restrictions, fear of

activity and/or exacerbation of symptoms. In comparison with

45

the study, a few number of respondents expressed fear of

performing activity as they might aggravate negative effects

of surgery. This resulted in low level of activity for the

respondents.

Chapter 3

RESEARCH METHODOLOGY

This chapter presents the research design, population

and sampling, respondents/ participants of the study,

research instrument, validation of the instrument, data

46

gathering procedure and statistical tools utilized in the

treatment of data.

Research Design

The study utilized a quantitative, descriptive and non-

experimental method of research that aimed to observe,

describe and explain the effects of a certain phenomena.

The quantitative research design involved the investigation

of a phenomenon using numeric information, formal

measurement and quantification and was analyzed

statistically. The non-experimental type of quantitative

research explained the critical relationships between

relevant variables in the study and did not entail

introduction of treatment or changes to the variables (Polit

and Beck, 2008).

The researchers used the aforementioned research design

basically to aid in achieving their foremost intent of

describing the performance of the activities of daily living

among clients who have undergone caesarean section. These

variables were formally quantified without the introduction

of changes or alteration so as to make it more objective and

47

appropriate for accurate analysis and interpretation of

results.

Population and Sampling

The researchers utilized convenience and accidental

type of sampling. In convenience sampling, the most

conveniently available people as possible were used as the

participants who qualified for the eligibility criteria of

the study. On the other hand in accidental sampling, a

participant became part of the study because she happened to

be there (Polit and Beck, 2008).

Respondents of the Study

The study was conducted among clients who have

undergone caesarean section in the operating room complex of

General Emilio Aguinaldo Memorial Hospital in Trece Martires

City, Cavite, a tertiary hospital. There were 60 total

numbers of respondents who were two days postoperative, aged

48

18-37 years old and were able to speak, read, write and were

able to understand English or the Filipino language.

Research Instrument

In order to measure the performance of the activities

of daily living (ADL) among clients who have undergone

caesarean section, the researchers used the ADL (Activities

of Daily Living) Multidimensional Evaluation Checklist

(Mateo, 2009) based from Older American Resources and

Services (OARS) ADL Multidimensional Evaluation Checklist

(Bonito, 1998) as an instrument in the conduct of the study.

This tool was modified by excluding the following activities

such as household chores, handling money and personal

shopping. The researchers sent a letter or correspondence

to the originator of the instrument to ask permission to use

the aforementioned instrument. The items were translated in

Filipino.

The following instruments were used in this study:

49

1. Respondent’s Information Sheet – this was used to

gather the profile of the respondents in terms of age,

family support system and parity.

2. The Performance of the Activities of Daily Living –

measurement of the activities of daily living was based

on the ADL Multidimensional Evaluation Checklist

(Mateo, 2009). The ADL instrument contains a physical

ADL section and an instrument ADL section. Respondents

rated each item on a three-point scale based on the

ability to perform the activity independently. A score

of three (3) was given to items performed

independently, score of two (2) to those performed with

assistance, either through a person or device and a

score of one (1) to activities performed with great

dependence or not performed at all.

The activities included the following; (1) Eating,

(2) Drinking, (3) Preparing Meals, (4) Getting clothes

from the closet or bag, (5) Putting on clothes, (6)

Removing clothes, (7) Managing buttons, (8) Bathing

50

from head to toe, (9) Brushing teeth, (10) Moving from

bed to chair or vice versa, (11) Walking to and from

the toilet, (12) Urinating and (13) Defecating.

Validity and Reliability of Instrument

The research instrument was subjected to face and

content validation. The validators of the tool were the

faculty members of the College of Nursing and School of

Midwifery of De La Salle Health Sciences Institute, City of

Dasmariñas, Cavite.

The researchers requested the validators for their time

and consent regarding the validation of the tool. Letters

for the validators were made and were signed by the

researchers’ thesis adviser. The tool, together with the

letter, was given personally to the validators. The

research instrument was left to the validators for comments

and suggestions and was retrieved on the agreed date and

time.

51

It underwent the Cronbach’s alpha reliability testing

and showed 90.4% reliability indicating that the adapted

modified research tool was highly reliable.

Data Gathering Procedure

The following steps were undertaken for data gathering

and begun after pre-testing during the first week of August

until last week of August, 2012.

Social Preparation

Prior to the initiation of this study, permission to

utilize the tool for measuring the performance of the

activities of daily living was secured from the original

author of the tool from whom the instrument was adapted.

This was followed by seeking the approval of the College

Dean and thesis adviser to conduct the study in a Tertiary

Hospital. A letter of permission to conduct the study was

given to the Medical Services Director and Chief Nurse of

tertiary hospital. When permission was granted, the

researchers explained to the potential respondents the

objectives of the study before distributing the research

tool.

52

The whole process of this quantitative-descriptive

research was divided into two phases which were the

following: Phase I, coordination phase; Phase II Actual Data

Gathering

Phase 1: Coordination Phase

1. Formal letter was given to the Dean of College of

Nursing and School of Midwifery, the respective thesis

Adviser and the Medical Services Director and Chief

Nurse of the Tertiary Hospital.

2. The researchers went to a tertiary hospital to explain

to the potential respondents the research study and to

obtain an informed consent.

3. The researchers introduced themselves to the potential

respondents.

4. After the introduction, the researchers explained that

the purpose of why they were there was to conduct a

research study about the performance of the activities

of daily living of clients who have undergone caesarean

section.

53

5. The researcher explained that a participant should be

18-37 years of age who have undergone caesarean section

and at their two days postoperative. The respondents

must be able to speak, read, write and able to

understand English or Filipino language and were

willing to cooperate in the study. The researchers

explained that the process of gathering data needed for

the research study took about 10-15 minutes.

6. When the respondents consented to participate in the

study and when the specific criteria was met, the

researchers asked them to sign an informed consent form

which signified that the respondent agreed to be part

of the research study.

Phase II: Actual Data Gathering

1. The researchers asked the potential respondents to fill

out the Respondent’s Information Sheet for the

determination of the potential respondent’s profile.

2. Once the potential respondent was finished in filling

out the information sheet, the researchers assessed the

level of performance of activities of the daily living

54

of the potential respondents. The researchers used the

ADL Multidimensional Evaluation Checklist (Mateo, 2009)

to know the performance of the activities of daily

living of the potential respondents. In order to

assess the performance of the activities of daily

living of the potential respondents, the researchers

asked the patient if they could perform the items

included in the evaluation checklist. When the

respondent said that they could do it, then the

researchers asked the patient to do it. In cases where

in a respondent said that he/she was not able to

perform an item, the researchers did not force him/her

to do it. The researchers were the ones who filled out

the evaluation checklist as to how the patient

performed an item namely: (a) Independently, (b) Needs

Assistance and (c) Dependently.

Statistical Treatment of Data

55

The following statistical treatments were used to

answer the specific problems and to test the hypothesis of

the study.

Frequency distribution in percentage. This test was

used to organize the numeric data and this determined the

proportion of a part to a whole such as a given number of

respondents in relation to the sample population ( Polit, D.

et al, 2008). This was used to determine the profile of the

clients specifically age, family support system and parity.

Mean. This was the measurement of central tendency,

computed by summing all scores and diving by the number of

subjects (Polit and Beck, 2008). This statistical treatment

was used to determine the level of performance of the

activities of daily living when the respondents are grouped

according to age, family support systemand parity.

T-Test. This test employs the statistic (t), with n-

1degrees of freedom, to a test a given statistical

hypothesis about a population parameter. Usually used with

sample sizes (<30). It was used when the population

standard deviation was unknown (Roth, 2003). The t-test was

56

used to determine the significant differences on the

activities of daily living when the respondents are grouped

according to family support systemand parity.

F-Test. This was a test whether two samples are drawn

from different populations have the same standard

deviations, with specified confidence level. Sample may be

different sizes (Roth, 2003). In this study, the F-test was

used to determine any significant differences in the level

of performance of the activities of daily living when they

were grouped according to age.

57

Chapter 4

PRESENTATION, ANALYSIS and INTERPRETATION OF DATA

This chapter presents, analyzes and interprets the

findings on the specific problems and hypothesis of the

study. The data gathered regarding the profile of the

respondents are presented in graphs and are described,

analyzed and interpreted in narrative.

58

Problem 1. What is the profile of the respondents in terms

of age, family support system and parity?

Figure 2. Profile of the respondents in terms of age

16.7% 23.3%

28.3%

31.7%

33-3718-2223-2728-32

Figure

2 illustrates the profile of the respondents in terms of

age. The age group of the respondents were categorized into

four, namely; (a) 18 to 22 years old, (b) 23 to 27 years

old, (c) 28 to 32 years old and (d) 33 to 37 years old. Out

of 60 total numbers of respondents, 19 or 31.7% are 28 to 32

years old, 17 or 28.3% are 23 to 27 years old, 14 or 23.3%

are 18 to 22 years old and 10 or 16.7% are 33 to 37 years

old.

59

This finding reveals that more of the clients who

have undergone caesarean section in a tertiary hospital are

28 to 32 years old.

Figure 3. Profile of the respondents in terms of family

support system

6.7%

93.3%

Without Family Support SystemWith Family Support System

Figure 3 illustrates the profile of the respondents in

terms of family support system. The family support system

of the respondents was grouped into two, namely; (a) with

family support systemand (b) without family support system.

60

Out of 60 total numbers of respondents, 56 or 93.3% have

family support and 4 or 6.7% have no family support.

This finding shows that majority of clients who have

undergone caesarean section in a tertiary hospital have

family support system.

Figure 4. Profile of the respondents in terms of parity

38. 30%

61.70% Primi Para

Figure 4 illustrates the profile of the respondents in

terms of parity. The parity of the respondents was grouped

into two, namely; (a) primi-para and (b) multi-para. Out of

60 total numbers of respondents, 37 or 61.7% are multi-para

and 23 or 38.3% are primi-para.

61

This finding reveals that most of the clients who have

undergone caesarean section in a tertiary hospital are

multi-para.

Problem 2. What is the level of performance of the

activities of daily living of the respondents?

Table 1

Level of performance of the activities of daily living ofthe RespondentsActivities of Daily Living Mean Standard

DeviationVerbal Interpretation

Feeding

Eating 2.57 0.65 High Level of Self Care

Drinking 2.55 0.65 High Level of Self Care

Preparing Meal 2.05 0.77 Moderate Level of SelfCare

Average 2.39 0.59 High Level of Self Care

Dressing

Managing Buttons 2.60 0.62 High Level of Self Care

Putting on clothes 2.20 0.51 Moderate Level of SelfCare

Removing clothes 2.15 0.61 Moderate Level of SelfCare

Getting clothes from closet orbag

2.00 0.69 Moderate Level of SelfCare

Average 2.24 0.41 Moderate Level of SelfCare

Grooming

62

Combing Hair 2.67 0.64 High Level of Self Care

Brushing teeth 2.43 0.67 High Level of Self Care

Average 2.55 0.53 High Level of Self Care

Ambulation

Moving from bed to chair andvice versa

1.95 0.53 Moderate Level of SelfCare

Walking to and from the toilet 1.88 0.56 Moderate Level of SelfCare

Average 1.92 0.50 Moderate Level of SelfCare

Elimination

Defecating 1.87 0.65 Moderate Level of SelfCare

Urinating 1.58 0.67 Low Level of Self Care

Average 1.73 0.61 Moderate Level of SelfCare

Overall mean 2.17 2.15 Moderate Level of SelfCare

Interpretation: 2.35-3.00 High Level of Self Care/Performs Independently

1.68-2.34 Moderate Level of Self Care/Performs with Assistance

1.00-1.67 Low Level of Self Care/Performs Dependently

Table 1 presents the level of performance of the

activities of daily living of the respondents. The level of

performance of the activities of daily living of the

respondents is classified into three, namely; (a)1.00 to

1.67 – Low Level of Self Care/ Performs Dependently, (b)

1.68 to 2.34 – Moderate Level of Self Care/ Performs with

Assistanceand (c) 2.35 to 3.00 – High Level of Self Care/

Performs Independently.

63

In terms of feeding, the computed mean score ranging

from 2.55 to 2.57 means that the respondents had high level

of self care in terms of drinking and eating. The mean

score of 2.05 signifies that they have a moderate level of

self care in terms of meal preparation. The computed

average means score of 2.39 means that the clients who have

undergone caesarean section have a high level of self care

in terms of feeding.

Moreover, in terms of dressing, the computed mean score

of 2.60 indicates that the respondents have a high level of

self care in terms of managing buttons. The computed mean

scores ranging from 2.00 to 2.20 signifies that the study

participants have a moderate level of self care with regards

to putting on clothes (2.20), removing clothes (2.15) and

getting clothes from closet or bag (2.00). The computed

average mean score of 2.24 suggests that the clients who

have undergone caesarean section in a tertiary hospital have

a moderate level of self care.

64

Whereas, in terms of grooming, the computed mean score

ranging from 2.43 to 2.67 indicate that the respondents have

a high level of self care in terms of combing of hair and

brushing of teeth. The computed average mean score of 2.55

indicates that the clients who have undergone caesarean

section have a high level of self care in terms of grooming.

Likewise, in terms of ambulation, the computed mean

score ranging from 1.88 to 1.95 indicates that the

respondents have a moderate level of self care as to moving

from bed to chair and vice versa and walking to and from the

toilet. The computed average mean score of 1.92 suggest

that the clients who have undergone caesarean section have a

moderate level of self care in terms of ambulation.

Furthermore, in terms of elimination, the computed mean

score of 1.87 means that the respondents have a moderate

level of self care in terms of defecation and the computed

mean score of 1.58 signifies that they have a low level of

self care as to urination. The computed average mean score

of 1.73 indicates that the clients who have undergone

65

caesarean section have a moderate level of self care in

terms of elimination.

Overall, the computed mean score of 2.17 with the

standard deviation of 2.15 suggest that the clients who have

undergone caesarean section in a tertiary hospital have a

moderate level of self care in terms of their activities of

daily living and they are homogenous in terms of their

responses.

This result is supported by Lee (2011), wherein she

explained that mobility is an important phase after surgery.

Within 8-12 hours, the client must be able to sit up on the

side of the bed. And by the first morning after the

surgery, they should be able to be up their room and do

walking along the halls. Furthermore, this coincides with

the study done by Browning et al in 2007, wherein they

quantified early upright mobilization in patients following

upper abdominal surgery. Their findings indicate that there

is a low duration of uptime recorded with more than half of

the sample dependent on assistance to mobilize on day 3

66

while in a study by Mackay and Ellis (2002), 52% of the

respondents needed assistance to mobilize on day 5. Early

mobilization has no standard definition neither can it be

quantified but the activities included are: moving in bed,

sitting out of bed and standing, ambulating on the spot,

hallway ambulation and low intensity exercises (Dean 2006,

Kirkeby-Garstad et al 2005).

Problem 3. Are there significant differences in the

performance of daily living when respondents are grouped

according to age, family support system and parity?

Hypothesis: There are significant differences in the

performance of activities of daily living according to age

and parity and no significant difference in the performance

of activities of daily living when grouped according to

family support system.

67

Table 2.

The level of performance of the activities of daily livingof the respondents when grouped according to age.

Age Mean SD F-ratio P-value Interpretation18-22 years old 2.00 0.40

23-27 years old 2.10 0.35

28-32 years old 2.32 0.35

33-37 years old 2.36 0.29 3.204 0.030 SLegend: SD – Standard Deviation

S – Significantly Different at 0.05 level of significance using 3and 56 degrees of freedom

Table 2 shows the comparison of performance of the

activities of daily living when the respondents are grouped

according to age.

In terms of the age of the respondents, the statistical

results revealed that the F-ratio of 3.204 with a

probability (significance) value of 0.030 is higher than the

tabular F-ratio 0.05 level of significance using 3 and 56

degrees of freedom. This means that the level of performance

of activities of daily living of the respondents vary when

grouped according to age.

68

The null hypothesis stating that there are no

significant differences in the level of performance of the

activities of daily living when the respondents are grouped

according to age is rejected and that the alternative

hypothesis which states that there are significant

differences in the level of performance of the activities of

daily living when the respondents are grouped according to

age, is accepted.

These findings confirm that the level of performance of

the activities of daily living of the respondents aged 18 to

37 years old vary. The clients who have undergone caesarean

section who were 33 to 37 years old are more likely to

exhibit better performance of the activities of daily living

in terms of feeding compared to the respondents in other age

groups.

Table 3.

The level of performance of the activities of daily living

of the respondents when grouped according to family support

system.

Family Support System Mean SD T- P- Interpretati

69

ratio value onWithout Family Support

System

2.40 0.54

With Family Support System

2.18 0.36 1.710 0.246 NS

Legend: SD– Standard DeviationNS–Not Significantly different at 0.05 level of significance using58 degrees of freedom.

Table 3 shows the comparison of performance of the

activities of daily living when the respondents are grouped

according to family support system.

The statistical results revealed that the computed T-

ratio of 1.710 with a probability (significance) value of

0.246 is lower than the tabular t-ratio 0.05 level of

significance using 58 degrees of freedom.

The null hypothesis stating that there are no

significant differences in the level of performance of the

activities of daily living is accepted. These findings

confirm that the levels of performance of the activities of

daily living of the respondents are the same regardless of

family support system.

Table 4.

70

The level of performance of the activities of daily living

of the respondents when grouped according to parity

Parity Mean SD T-

ratio

P-value Interpretatio

nMultipara 2.30 0.38 2.920 0.005 SPrimipara 2.02 0.31Legend: SD – Standard Deviation

S – Significantly Different at 0.05 level of significance using 58degrees of freedom.

Table 4 shows the comparison of performance of the

activities of daily living when the respondents are grouped

according to parity.

In terms of parity, the statistical results revealed

that the T-ratio of 2.920 with a probability (significance)

value of 0.005 is higher than the tabular T-ratio of 0.05

level of significance using 58 degrees of freedom.

The null hypothesis stating that there are no

significant differences in the level of performance of the

activities of daily living in terms of feeding when the

respondents are grouped to parity is rejected. The

alternative hypothesiswhich states that there are

71

significant differences in the level of performance of the

activities of daily living in terms of feeding when the

respondents are grouped according to parity is likewise

accepted.

This finding confirms that the level of performance of

the activities of daily living of the respondents who are

primi paras and multi paras vary. The clients who have

undergone caesarean section who were multi paras are more

likely to exhibit better performance of the activities of

daily living in terms of feeding compared to the respondents

who were primi paras.

Chapter 5

SUMMARY, FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

This chapter presents the summary of the study,

findings, conclusions and recommendations.

Summary

72

This study was undertaken to determine the level of

performance of the activities of daily living among clients

who have undergone caesarean section in a tertiary hospital.

Specifically, it sought answers to the following

problems:

1. What is the profile of the respondents in terms of age,

family support system and parity?

2. What is the level of performance of the activities of

daily living of the respondents?

3. Are there significant differences in the performance of

daily living when the respondents are grouped according

to age, family support system and parity?

Hypothesis of the Study

Specifically, this study tested the hypothesis that

there are no significant differences in the level of

performance of the activities of daily living when the

respondents are grouped according to age, family support

system and parity.

The study utilized a quantitative, descriptive and non-

experimental approach in order to observe, describe and

analyze the level of performance of the activities of daily

73

living of the respondents. The respondents of the study

were composed of 60 post-caesarean clients ages 18-37 year

old admitted in a tertiary hospital. The respondents were

selected using the criteria set by the researcher.

The following research instruments were used for the

data gathering. Respondent’s information sheet was used to

determine the profile of the clients who have undergone

caesarean section. The ADL Multidimensional Evaluation

Checklist in Mateo (2009) was used in identifying the level

of performance of the activities of daily living of clients,

two days after the caesarean section.

Prior to the actual gathering, permission was solicited

from the Medical Director and the Nursing Service Department

Administrator of the selected tertiary hospital. Upon

approval, the researcher proceeded with the data gathering.

In this study a standard script was utilized. The data

gathering started by evaluating the patients who were

admitted in the selected tertiary hospital after two days of

their post-operative caesarian section and ensuring they are

qualified for the study. The respondents were then asked to

74

sign the informed consent form and fill out the Respondent’s

Information Sheet. Using the ADL Multidimensional

Evaluation Checklist, the respondents were assessed.

The following statistical treatment utilized by the

researcher to be able to answer the problem stated and to

test the hypothesis of the study. This includes (a.)

Frequency distribution, (b.) meanand (c) t-test and (d) f-

test.

Frequency distribution was used to determine the

profile of the clients specifically age, family support

system and parity. The mean was used to measure the level

of performance of activities of clients who have undergone

caesarean section. The t-test and f-test was used to test

the significant difference in activities of daily living

when respondents are grouped according to age, family

support systemand parity.

Findings

The following findings were drawn from this study:

1. Out of 60 respondents in this study, their profileshowed that most of them are: (a) 28- 32years old

75

(31.7%), (b) with family support system, living with orbeing visited by family members, friends or relatives(93.3%), and (c) multi-para (61.7%).

2. The level of performance of the respondents who

have undergone caesarean section is moderate. This

evidenced by an overall mean score of 2.17 with a

standard deviation of 2.15 which signifies that the

respondents are able to perform activities of daily

living with assistance and they are homogenous in terms

of their respondents.

3. There is no significant differences in the level

of performance of activities of daily living when the

respondents are grouped are grouped according to family

support system as evidenced by a computed T-ratio of

1.710 that is lower than the tabular t-ratio at 0. 05

level of significance using 58 degrees of freedom.

There are significant differences however in the

level of performance of activities of daily living of

the respondents when grouped according to age and

parity. This is evidenced by an F-ratio of 3.204 and T-

76

ratio of 2.920 which are greater than the tabular as F-

ratio and T-ratio using 3 and 56 degrees of freedom and

58 degrees of freedom respectively.

Conclusions

Based on findings, generated by the study, thefollowing conclusions were drawn:

1. Most of the respondents are 28 to 32 years old, withfamily support system, and multi-para.

2. The clients who have undergone caesarean section in atertiary hospital were able to perform activities ofdaily living with assistance.

3. There are significant differences in the performance ofactivities of daily living according to age and parityand no significant difference in the performance ofactivities of daily living when grouped according tofamily support system.

Recommendations

Clients who have undergone Caesarean Section. Findingsof the study recommend the continuity of educating theclients regarding caesarean section to enhance theirperformance of activities of daily living. This would alsohelp them have an improved understanding of their condition;

77

they would become more aware of their physical capabilityand would be able to allow themselves to reach a new levelof self-independence in order to be more active inperforming their tasks on a daily basis.

Family of Clients who have undergone Caesarean Section.Families should be the primary providers of care to theclients as they would be more knowledgeable on their physicaland emotional needs. Therefore, family members arerecommended to collaborate with the nurses when providingcare and performing interventions as this would help theclients' recovery.

Future Researchers. The researchers encourage futureresearchers to contribute or to expand on this body ofknowledge. The researchers also recommend that the futureresearchers conduct further research and in-depthinvestigation regarding the study. Added factors such astheir past health history and lifestyle could be included toobtain a precise and unambiguous study. Other activities ofdaily living can be integrated as well. A replication ofthis study is recommended with longer time allocated in theprovision of intervention and with greater number ofrespondents.

78

REFERENCES

A. Books

Bertoti, D. (2004) Functional Neurorehabilitation Through The

Lifespan. Philadelphia. Davis Company

Clover, J. (2007) Core Concepts in Athletic Training and Fitness

Instruction (2nd. Ed.) New York. Thomson Delmar Learning

Cunningham, et. al, (2005). Williams Obstetrics (22nd ed.)

McGraw-Hills Companies, Inc.

Daftray, S.N. & Desai, S.V. (2005). Selected Topics in

Obstetrics and Gynecology- 1. B I Publications Pvt Ltd.

Gabbe, et. al, (2007). Obstetrics Normal and Problem

Pregnancies (5th ed.). Churchill Livingstone Publication.

Henderson, V. (2007). The Nature of Nursing in New York. New

YorkMacmillan Publishing

Krapp, K.. (2012) Activitiesof Daily Living Evaluation.

MichiganGale Group

79

McKinney, E. S. et al (2009) Maternal Child Nursing.

Missouri. Saunders Elsevier

Polit, D. & Beck C.T. (2008). Nursing Research: Generating

and Assessing Evidence for Nursing Practice (8th ed).

Philadelphia Lippincott Williams & Wilkins Publisher

Rothwell, P. et al (2007). Stroke Management (3rd ed).

USA: Blackwell Publishing

Sadock, B.J. & Sadock, V.A. (2005) Kaplan & Sadock's

Comprehensive Textbook of Psychiatry (8th ed.) Philadelphia.

Lippincott Williams & Wilkins

B. Periodicals and Other Materials

ACOG Committee Opinion No. 340.(2006) Mode of term

singleton breech deliveryObstet Gynecol; Vol. 108,

No.1

ACOG Practice Bulletin No. 49(2006) Dystocia and

augmentation of labor Obstet Gynecol; Vol. 108, No.1

ACOG Practice Bulletin Number 49, (2003): Dystocia and

augmentation of labor.. Obstet Gynecol.; Vol. 102 No.

6

80

Browning. et al (2007): The quantity of early upright

mobilisation performed following upper abdominal

surgery is low: an observational study Australian Journal

of Physiotherapy Vol. 53

Eubel C, (2009) St. Raymond Nonnatus. Hierarchia Catholica,

Vol. I

Hankins., et al (2006) .Cesarean section on request at 39

weeks: impact on shoulder dystocia, fetal trauma,

neonatal encephalopathyand intrauterine fetal

demise. Semin Perinatol.Vol. 30 No 5

Kirkeby-Garstad I, Sellevold OFM, Stenseth R, Skogvoll E

(2005) Mixed venous oxygen desaturation during early

mobilization after coronary artery bypass surgery.

Acta Anaesthesiologica Scandinavica Vol. 49: 827–834.

Mackay MR and Ellis E (2002) Physiotherapy outcomes and

staffing resources in open abdominal surgery

patients. Physiotherapy Theory and Practice Vol. 8: 75–

93.

C. Online Sources

81

Cooperative for Assistance and Relief Everywhere, Inc.

(CARE), (2007) Mothers Matter, Healthy Mothers, Healthy

Societies. Retrieved October 24, 2012 from.

http://www.care.org/getinvolved/advocacy/pdfs/agenda

2008/sp_mothersmatter.pdf

Downs et. al (2009) Impact of scoliosis surgery on activities of daily

living in females with Rett syndrome. Retrieved May 20,

2012. from.

http://www.ncbi.nlm.nih.gov/pubmed/19461379

Gagnon A.J, Meier K.M. & Waghorn K. (2007) Continuity of

nursing care and its link to caesarean birth rate. Retrieved

January 28, 2012 from

http://www.ncbi.nlm.nih.gov/pubmed/17324175

Gibbons., et al (2010) The Global Numbers and Costs of

Additionally Needed and Unnecessary Caesarean

Sections Performed per Year: Overuse as a Barrier to

Universal Coverage. Retrieved January 25, 2012,

from

http://www.who.int/healthsystems/topics/financing/he

althreport/30C-sectioncosts.pdf

82

Heisler, J. (2009) Do You Really Need Surgery. Retrieved

January 25, 2012, from

http://surgery.about.com/od/beforesurgery/a/NeedSurg

ery.htm

Kho, P. (2010) Labor complications.  Retrieved from March

26, 2012 from

http://www.babycenter.com.ph/pregnancy/labourandbirt

h/labourcomplications/caesarean-rate/

La Pier et, al (2008) Analysis of Activities of Daily Living Performance

in Patients Recovering from Coronary Artery Bypass

SurgeryRetrieved May 20, 2012. from

http://informahealthcare.com/doi/abs/10.1080/0270318

0802206215

Meiners et. al (2002) Improvements in activities of daily living

following functional hand surgery for treatment of lesions to the

cervical spinal cord: Self-assessment by patient. Retrieved May

20, 2012. from

http://www.nature.com/sc/journal/v40/n11/full/310138

4a.html

83

Wiley. J. (2012) Definition of ADLs (activities of daily living)

Retrieved January 28,2012. from

http://www.medterms.com/script/main/art.asp?

articlekey=2152

Winters et. al,(2007) The Activities of Daily Living in Patients after

Rotationplasty Surgery With a Long Term Follow up Checkup

Retrieved May 20, 2012. From

http://www.isols2007.org/abstract.php?_IDA=431

D. Thesis

Mateo, J. (2009). Enhancement of performance of the

activities of daily living of Clients after

Cerebrovascular Accident Through Health Education

Intervention. Unpublished Master’s Thesis. De La

Salle Health Sciences Institute, Dasmariñas, Cavite.

84

APPENDICES

Appendix – A

Letter of Request for Actual Data Gathering

85

De La Salle Health Sciences InstituteCollege of Nursing and School of Midwifery

Dasmariñas City, Cavite

Naomi M. De Aro, RN, MAN, EdD

Dean, College of Nursing & School of Midwifery

De La Salle Health Sciences Institute

Dear Dr. De Aro:

Greetings in St. La Salle!

We, the third year nursing students of De la Salle

Health Sciences Institute, would like to inform you that we

are currently working on our thesis entitled “Performance of

the activities of daily living Among Clients who have

Undergone Caesarean Section in a Tertiary Hospital”.

In line with this, we would like to request from your

good office to allow us to distribute questionnaires to the

selected students of the college. Attached herewith are

parts of our research study consisting of the statement of

the problem, scope and delimitation, hypothesis and research

tool. The said data will be used in partial fulfillment of

the requirements in the nursing research. Attached here are

the statement of the problem and the tool to be used for our

thesis.

Hoping for your favorable response. More power and God

Bless!

86

Sincerely yours,Fatima Mae S. Baaclo Analen D.

Cagalpin

Emil John A. Medina Effienet Chioma

G. Onuh

Jeremiah Gael A. Stone

Noted by:

Rommel L. Salazar, RN, MAN, DrPH Naomi M. De Aro, RN, MAN, EdDThesis Adviser Dean, College of Nursing &

School of MidwiferyAppendix – B

Letter to the Medical Services DirectorDE LA SALLE HEALTH SCIENCES INSTITUTE

SCHOOL OF NURSING

George R. Repique Jr., MD, FPSRS, FPCSMedical DirectorGeneral Emilio Aguinaldo Memorial HospitalIndang Rd, Trece Martirez City, Cavite

Dear Sir,

Greetings in St. La Salle!

We are, Fatima Mae S. Baaclo, Analen D. Cagalpin,Emil John A. Medina, Effienet Chioma G. Onuh and JeremiahGael A. Stone, 4th year nursing students of the College ofNursing and School of Midwifery De La Salle – HealthSciences Institute School and currently conducting a studyentitled “Performance of the activities of daily livingAmong Clients who have Undergone Caesarean Section in aTertiary Hospital” in partial fulfillment of therequirements for the degree of Bachelor of Science inNursing.

87

In line with this, we would like to seek permissionfrom your good office to please allow us to have the pre-testing and data gathering of our research questionnairedone at your hospital.

We assure your good office that confidentiality anddata of findings will be upheld and with assurance thatclients who are post Caesarean Section will be handled withutmost care.

Your kind approval regarding our request will be agreat help in our present endeavor. Thank you very much.Respectfully Yours,

Fatima Mae S. Baaclo Analen D.

Cagalpin

Emil John A. Medina Effienet Chioma

G. Onuh

Jeremiah Gael A. Stone

Noted by:

Rommel L. Salazar, RN, MAN, DrPH Naomi M. De Aro, RN, MAN, EdDThesis Adviser Dean, College of Nursing &

School of MidwiferyAppendix – C

INFORMED CONSENT FORM

I, ___________________________, am being asked to

participate in a research entitled, “performance of the

88

activities of daily living among Clients who have Undergone

Caesarean Section in a Tertiary Hospital”. This research is

being conducted under the supervision of BSN students Ms.

Fatima Mae S. Baaclo, Ms. Analen D. Cagalpin, Mr. Emil

John A. Medina, Ms. Effienet Chioma G. Onuhand Ms.

Jeremiah Gael A. Stone.

The investigators hope to determine the performance of

the activities of daily living among clients who have

undergone caesarean section from this research.

While participating in this study, I will fill up the

Respondent’s Information Sheet. The researchers will assess

the level of performance of the activities of daily living

using the ADL Multidimensional Checklist by letting me

perform the said activity. The researchers are the ones to

fill up the evaluation checklist as to how the respondent

performed the item, Independently, Needs Assistance,

Dependently.

The nature of this study has been explained to me by

Ms. Baaclo, Ms. Cagalpin, Mr. Medina, Ms. Onuh and Ms.

Stone. I understand that the benefits of my participation

will be for my awareness on my physical capabilities and

allow myself to reach a new level of self independence in

order to be more active when performing tasks on a daily

basis.

The researchers will make every effort to safeguard the

confidentiality of the information that I will provide. Any

89

information obtained from this study that can be identified

with me will remain confidential and will not be given to

anyone without my permission.

If at anytime I would like additional information about

this project I can contact Ms. Onuh at 0915-835-55-56 or

(046) 416-4532.

I understand that I have the right to refuse to

participate in this study. I also understand that, if I do

agree to participate, I have the right to change my mind at

any time and stop participating in the above described

project. My signature also indicates that:

I have given opportunity to ask any and all questions

about the described project and that all of my

questions have been answered to my satisfaction.

I have been permitted to read this document and I have

been given a signed copy of it.

To the best of my knowledge and belief, I have no

physical or mental illness or weakness that would be

adversely affected by my participation in the described

project.

_____________________________ ________________

Signature of Participant Date

90

_____________________________ _________________

Signature of Witness Date

Appendix – D

PAHINTULOT NG KATUGON

Ako, si ______________________________________________,

ay hinilingang makilahok sa isang pananaliksik na

pinamagatang "Pagganap ng Mga Gawain sa Pang-araw-araw na

Pamumuhay sa Mga Kliyente Na Nakaranas ng Cesarean Section

sa Tersiyaryong Ospital." Ang pananaliksik na ito ay

isinasagawa sa pangangasiwa ng mga estudyante ng BSN na

sina: Bb. Fatima Mae S. Baaclo, Bb. Analen D. Cagalpin,

91

G. Emil John A. Medina, Bb. Effienet Chioma G. Onuh, at

Bb. Jeremiah Gael A. Stone.

Ninanais ng mga tagapagsiyasat na malaman mula sa

pananaliksik na ito ang pagganap ng mga gawain ng pang-araw-

araw na pamumuhay sa mga kliyente ng mga nakaranas na ng

Cesarian section.

Habang ako ay nakikilahok sa pag-aaral na ito,

sasagutan ko ang mga katanungan sa "Respondent Information

Sheet". Tatayahin ng mga mananaliksik ang antas ng aking

pagganap sa mga gawaing pang-araw-araw na pamumuhay sa

pamamagitan ng paggamit ng "ADL Multidimensional Checklist".

Ang mga mananaliksik ang siyang sasagot ng tseklist ng

pagsusuri kung paano gumanap ang katugon sa isang gawain:

ito ba ay kaya kong gawin ng mag-isa, kinakailangan ng

tulong, o umaasa nang husto sa tulong ng iba.

Ang uri ng pag-aaral na ito ay ipinaliwanag sa akin

nina Bb. Baaclo, Bb. Cagalpin, G. Medina, Bb. Onuh at

Bb. Stone. Naintindihan ko na ang mga benepisyo ng aking

paglahok sa pag-aaral na ito ay para sa aking kamalayan ng

aking pisikal na kakayahan at upang mapahintulutan ang aking

sarili na maabot ang bagong baitang ng pagiging

independente, upang maging lalong aktibo sa pagganap ng mga

pang-araw-araw na gawain.

Lubusang sisikapin ng mga mananaliksik na pangalagaan

ang pagiging kompidensyal ng mga impormasyong aking

92

ibabahagi. Ano mang impormasyong nakamit mula sa pag-aaral

na ito patungkol sa akin ay mananatiling kompidensyal at

hindi ibibigay kaninuman ng walang pahintulot mula sa akin.

At anumang oras na ninanais kong magkaroon ng

karagdagang impormasyon patungkol sa proyektong ito, maaari

kong kontakin si Bb. Onuh sa 0915-835-55-56 o(046) 416-

4532.

Naintindihan ko na may karapatan akong tanggihang

makilahok sa pag-aaral na ito. Naiintindihan ko rin na,

kung ako ay sumang-ayong makisali, may karapatan akong

magpalit ng aking desisyon anumang oras at ihinto ang

pakikilahok sa naturang proyekto. Ipahihiwatig ng aking

lagda na:

Binigyan ako ng pagkakataong magtanong ng kahit anumang

katanungan patungkol sa naturang proyekto at ang lahat

ng aking katanungan ay sasagutin ayon sa aking

kasiyahan.

Binigyan akong permiso na basahin ang dokumentong ito

at ako ay binigyan ng nilagdaang kopya.

Abot sa aking kaalaman at paniniwala, ako ay walang

pisikal o mental na sakit o kahinaan na makasasama sa

aking pakikilahok sa naturang proyekto.

93

__________________________________________Lagda ng Katugon

Petsa

__________________________

________________

Lagda ng Saksi

Petsa

Appendix - E

RESPONDENT’S INFORMATION SHEET

Name:___________________________ (optional)

Age: ( ) 18-22 years old

( ) 23-27 years old

( ) 28-32 years old

( ) 33-37 years old

Parity: number of times the mother has been pregnant but not

less than 20 weeks of gestation

( ) Primi para- has given birth for the first time

94

( ) Multi para - has given birth two or more times

Family Support System: (Please check if any of the following

support is available)

_____ With family support - living with or being

visited by family members, friends, or relative

_____ Without family support, living without or not

being visited by family members, friends, or relatives

Appendix - F

TALAAN NG IMPORMASYON NG RESPONDE

Pangalan : _______________________________

Edad: ( ) 18 – 22 taong gulang

( ) 23 – 27 taong gulang

( ) 28 – 32 taong gulang

95

( ) 33 – 37 taong gulang

Pagkakapareho : bilang ng pagkakataong nabuntis ang isang ina ngunit

hindi bababa sa dalawangpung linggong pagbubuntis

( ) Primipara – nakapagsilang sa unang pagkakataon

( ) Multi para – nakapagsilang ng dalawa o higit pang beses

Sistema ng Pagsuporta ng Pamilya : ( Lagyan ng tsek () kung ang mga

sumusunod na suporta ay matatagpuan )

____ sinusuportahan ng pamilya – kapisan ng pamilya o dinadalaw ng

miyembro ng pamilya

kaibigan, kamag-anak

____ walang suporta ng pamilya – hindi kapisan ng pamilya o hindi dinadalaw

ng pamilya, kaibigan,kamag-anak

Appendix - G

ADL Multidimensional Evaluation Checklist(Mateo, 2009)

96

Name (Pangalan): ______________________________

Direction: The following are the Activities of Daily Living(ADL). Place a check mark ( / ) on the box appropriate foreach ADL.Panuto : Ang mga sumusunod ay mga gawain sa pang-araw-araw na pamumuhay (ADL). Lagyan ng tsek ( ) ang kahon na angkop para sa bawat ADL.

1.) Dependent – inability to perform the task either by selfor with support from others. This means a completedependence on a device or on someone else toperform a task or has a low level of self care.

(Umaasa– Kawalan ng kakayahang makagawa ng gawain sa ganang sarili o maging sa tulong ng iba. Nangangahulugan ito ng ganap na pag-asa sa aparato o sa sinuman para gumawa ng gawain o may mababang antas ng pangangalaga sa sarili).

2.) Needs Assistance – ability to perform task only if withsupport either by a person or a device or has amoderate level of self-care.

(Nangangailangan ng Tulong – Kakayahang makagawa ng gawain basta may tulong ng ibang tao ng aparato o may katamtamang antasng pangangalaga sa sarili.)

3.) Independent – ability to perform task by own self or hasthe high level of self- care.

97

(Hindi Umaasa sa Iba– Kakayahang makagawa ng gawain sa ganang sarili o may mataas na antas ng pangangalaga sa sarili).

Activities of DailyLiving (ADL)

(Gawain sa Pang-araw-arawna Pamumuhay)

Dependent(Umaasa)

1

NeedsAssistance

(Nangangailangan ng Tulong)

2

Independent(Hindi Umaasa

sa Iba)

3

Feeding (Pagkain)

1. Eating

(Nakakakain)

2. Drinking

(Nakakainom)

3. Preparing meals

(Nakakapaghanda

ng pagkain)

Dressing (Pagbibihis)

4. Getting clothes

from the closet

or bag

98

(Nakakakuha ng

damit mula sa

aparador o bag)

5. Putting on

clothes

(Naisusuot ang

damit)

6. Removing clothes

(Nakakapaghubad

ng damit)

7. Managing buttons

(Nakapagsasara

ng butones)

Grooming (Pag-aayos)

8. Bathing from

head to toe

(Nakakaligo mula

ulo hangang paa)

9. Brushing teeth

99

(Nakapagsisipily

o)

Ambulation

(Paglalakad)

10. Moving from

bed to chair and

vice versa

(Nakakalipat

mula sa kama

patungo sa upuan

at upuan patungo

sa kama)

11. Walking to

and from the

toilet

(Nakakapunta sa

palikuran)

Elimination

100

12. Urinating

(Pag-ihi)

13. Defacating

(Pagdumi)

Appendix – H

Letter of Permission to Use the Instrument

DE LA SALLE HEALTH SCIENCES INSTITUTESCHOOL OF NURSING

March 2012

To: Johnathan Mateo, RN, MAN

Dear Sir,

Greetings in peace!

The undersigned are currently enrolled in Research I as a requirement for the degree of Bachelor of Science in Nursingat De La Salle Health Sciences Institute. The thesis is entitled: “Performance of the activities of daily living Among Clients who have Undergone Caesarean Section in a Tertiary Hospital”.

In this regard, we respectfully ask permission from you thatwe will be allowed to adopt and use the ADL MultidimensionalAssessment Tool in your master’s thesis to be utilized in our study.

Hoping that this request will merit you favorable response.

101

Thank you very much and God bless you.

Respectfully Yours,

Sgd.Fatima Mae S. Baaclo Emil John A. MedinaAnalen D. Cagalpin Effienet Chioma G. Onuh

Jeremiah Gael A. Stone

Noted by:Rommel L. Salazar, RN, MAN, DrPHThesis Adviser

Approved:Naomi M. De Aro, RN, MAN, EdDDean, College of Nursing & School of Midwifery

APPENDIX I

CERTIFICATION FROM THE STATISTICIAN

CERTIFICATION

This is to certify that the undergraduate thesis

entitled, “Performance of the Activities of Daily Living

Among Clients who have Undergone Caesarean Section in a

Tertiary Hospital” prepared by Fatima Mae S. Baaclo, Analen

D. Cagalpin, Emil John A. Medina, Effienet Chioma G. Onuh

and F. Jeremiah Gael A. Stone, has been treated by the

undersigned.

102

_____________________________

Mr. Jerome Buhay

Statistician

APPENDIX J

DE LA SALLE HEALTH SCIENCES INSTITUTESCHOOL OF NURSING

CERTIFICATION OF TOOL VALIDATION

103

This is to certify that the main tool for the study of

Fatima Mae S. Baaclo, Analen D. Cagalpin, Emil John A.

Medina, Effienet Chioma G. Onuh, and Jeremiah Gael A. Stone

entitled, “Performance of Activities of Daily Living among

Clients who have Undergone Caesarean Section at Tertiary

Level Hospital” has been edited, critiqued and validated by

the undersigned.

Daisy H. Alberto, RN, MANFaculty, College of Nursing and School of Midwifery

Julieta M. Damian, RN, MSNFaculty, College of Nursing and School of Midwifery

Ma. Rodelyn T. Giron, RN, RM, MAEdFaculty, College of Nursing and School of Midwifery

The validated tool was checked and approved to be used bythe student researchers.

Rommel L. Salazar, RN, MAN, DrPHThesis Adviser

104

APPENDIX K

CERTIFICATION FROM THE FILIPINO EDITOR

CERTIFICATION

This is to certify that the undergraduate thesis

entitled, “Performance of the Activities of Daily Living

Among Clients who have Undergone Caesarean Section in a

Tertiary Hospital” prepared by Fatima Mae S. Baaclo, Analen

D. Cagalpin, Emil John A. Medina, Effienet Chioma G. Onuh

and F. Jeremiah Gael A. Stone, has been treated by the

undersigned.

105

_____________________________

Mrs. Emily Legaspi

Filipino Editor

APPENDIX L

CERTIFICATION FROM THE ENGLISH EDITOR

CERTIFICATION

This is to certify that the undergraduate thesis

entitled, “Performance of the Activities of Daily Living

Among Clients who have Undergone Caesarean Section in a

Tertiary Hospital” prepared by Fatima Mae S. Baaclo, Analen

D. Cagalpin, Emil John A. Medina, Effienet Chioma G. Onuh

and F. Jeremiah Gael A. Stone, has been treated by the

undersigned.

106

_____________________________

Ms. Dorothy Alforque

English EditorAPPENDIX M

CURRICULUM VITAE

107

PERSONAL DATA

Name: Fatima Mae S. Baaclo

Address: 16 Governor’s drive, Paliparan I, City of

Dasmariñas, cavite

Date of Birth: April 17, 1993

Civil Status: Single

Sex: Female

Religion: Roman catholic

Citizenship: Filipino

E-mail Address: franchescabaaclo@yahoo.com

Father’s name: Francis M. Baaclo

Occupation: Civil Engineer

Mother’s name: Merlinda S. Baaclo

Occupation: Housewife

EDUCATIONAL BACKGROUND

Tertiary De La Salle Health Sciences Institute

City of Dasmariñas, Cavite

2009 - 2013

108

Secondary Jabez Christian School

City of Dasmariñas, Cavite

2005 - 2007

Cavite Institute

Silang, Cavite

2007 - 2009

Elementary Jabez Christian School

City of Dasmariñas, Cavite

1999 - 2005

SEMINAR AND ACTIVITIES ATTENDED

109

SEMINARS/ TRAININGS

Study Habits and Stress

Management Seminar

Community Organizing

Participatory Research

(COPAR) Seminar

Integrated Management of

Childhood Illness Seminar

Research Seminar

Basic Life Support-

Cardiopulmonary

Resuscitation and Advanced

Cardiac Life Support

Training

VENUE

De La Salle Health Sciences

Institute

De La Salle Health Sciences

Institute

De La Salle Health Sciences

Institute

De La Salle Health Sciences

Institute

De La Salle Health Sciences

Institute

YEAR

2009

2010

2011

2011

2012

110

ORGANIZATION AND COMMITTEE

Lasallian Youth Lifeliner 2011-2012

Member

CURRICULUM VITAE

PERSONAL DATA

Name : Analen D. Cagalpin

Address : Brgy. Bignay 1 Pontor, Sariaya, Quezon

Email Address : acagalpin@yahoo.com

Date of Birth : September 21, 1991

Age : 21 years old

111

Gender : Female

Civil Status : Single

Citizenship : Filipino

Religion : Roman Catholic

Father’s Name : Deceased

Mother’s Name : Leonora D. Cagalpin

Occupation : Housewife

EDUCATIONAL BACKGROUND

Tertiary Level : Bachelor of Science in Nursing

De La Salle Health Sciences Institute

Dasmariñas City, Cavite

2009 – 2013

Secondary Level : Lutucan National High School

Sariaya, Quezon

2004 – 2008

Primary Level : Bignay 1 Elementary School

112

Sariaya, Quezon

1998- 2004

SEMINARS AND ACTIVITIES ATTENDED

SEMINARS/ TRAININGS

Study Habits and Stress

Management Seminar

Integrated Management of

Childhood Illness

Seminar

Research Seminar

Job Search Tool Kit:

Winning Resume..

Winning Interview

Seminar

VENUE

De La Salle Health

Sciences Institute

De La Salle Health

Sciences Institute

De La Salle Health

Sciences Institute

De La Salle Health

Sciences

YEAR

2009

2010

2011

2012

113

Institute

ORGANIZATIONS AND COMMITTEE

CNSM LINGHAP 2011 Member