A study to assess the effectiveness of a structured teaching programme on knowledge regarding assessment and observation of women in labour among IVth year B.Sc Nursing students at selected nursing colleges in gulbarga
PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION
Ms. Sarita rawal
MSc. NURSING – IST YEAR
AL- KAREEM COLLEGE OF NURSING GULBARGA
2010-2011
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA
BANGALORE
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1 / Name of the Candidate and Address(In Block Letters) / Ms. Sarita rawal
Ist YEAR M.Sc. NURSING
AL- KAREEM COLLEGE OF NURSING,
GULBARGA
2 / Name of Institution / Al- Kareem College of Nursing
BAREY HILLS, NEAR ADARSH NAGAR, GULBARGA-585105
3 / Course and study subject / MSc. NURSING
OBSTETRICAL AND GYNAECOLOGICAL NURSING
4 / Date OF Admission / 31-03-10
5 / TITLE OF THE TOPIC / “A study to assess the effectiveness of a structured teaching programme on knowledge regarding assessment and observation of women in labour among IVth year B.Sc Nursing students at selected nursing colleges in gulbarga”
6. Brief resume of the intended work
Introduction
“Child birth is more admirable than conquest, more amazing than self defense and as courageous as either one”
“Gloria Steinem”
Labour is a process, where women give birth to the child. The most wonderful moment in women’s life is during labour, as most women and their families experience greatest excitement during labour. The anticipated period of uncertainty, anxiety and fear, ends with beautiful birth of the baby. Clearly, the support and care they receive during this time is critical. Thus the overall aim of caring for women during labour and birth is to engender, a positive experience for the women and her family, while maintaining their health, preventing complications and responding to emergencies1.
Global observation shows that more than 50 million women suffer from a serious pregnancy related illness or disability. At least 1.2 million newborn infants die due to inadequate and unskilled care that they receive during delivery and it is estimated that every year more than 585,000 women die Worldwide from pregnancy and childbirth related complications2.
Recent epidemiological evidence from a range of developing countries suggests that skilled care during child birth may help to prevent maternal deaths3 As for which, the nursing education has undergone major transformation along with the change in concept of health and disease.
Labour room and operation theater nurses have very specific roles in the childbirth. These nurses are responsible for the care of the mother and fetus with guiding the patient throughout the delivery process4.
Various environmental elements influence a woman’s care during labour and birth which includes maternal monitoring, fetal monitoring and partograph. Partograph is basically a graphic representation of the events of labour plotted against time in hours. It consists of three components, that is monitoring and managing of (a) Fetal condition (b) Maternal condition (c) Progress of labour5.
Hence an initiative is taken to improve the quality of available services through, better management, development of knowledge and skills among student nurses, nurses and other health care professionals.
6.1. Need for the study
Every year, out of an estimated 120 million pregnancies that occurs Worldwide, about half a million women die from the complications of pregnancy and child birth and 90% of women suffers from a serious pregnancy related illness or disability in developing countries. India ranks very high on the list of countries with high maternal mortality at 420 per 10,000 live births6. Hence skilled assistance during labour is the most important and key service for reduction of maternal morbidity and mortality rates2.
The women in labour requires a continuous support by health care professionals who play a significant role in achieving beneficial maternal and infant outcome7.Thus,the global safe Motherhood initiative was launched in 1987 to address this major public health problem. The initiative, led by the safe motherhood inter-agency group (IAG) works to raise awareness and stimulate action at the global and national levels to make pregnancy and childbirth safer for women and newborn infants. Current data indicates that only 53% of women in developing countries deliver with a skilled health care provider present. In order to improve this situation, the IAG has developed a multi-step strategy, which includes conducting of workshops for student nurses, nurses and various health professionals. Thus, the student nurses also play a major role in providing care to women in labour, by their prompt assessment and observation skills.3
A study was conducted to assess the level perception among N=18 perinatal nurses regarding their knowledge and assessment skills for women in labour. The samples were selected using purposive sampling technique. The data was collected by conducting an interview using structured knowledge questionnaire. After the analysis, the results showed that nurses had inadequate knowledge regarding assessment of women in labour. Nurses in this study reported multiple challenges in the provision of supportive care for their patients. Thus their is a need for providing nurses with more of interventional studies documenting innovative method of teaching, orienting and continuing education to provide adequate care to women in labour8.
A cross sectional study was conducted among N=100 final year Nursing Students, with an objective of assessing an improvement of knowledge and skills on “Labour and partograph”. Assessment tool selected for predefined objectives were feedback forms, pre and post test questionnaire, pre and post training assessment of skills, after the analysis of data. The results showed that about 80% of the students improved their knowledge and 70% had improved in their skills. This reveals that there is a significant improvement in both knowledge and skills of the students after the session of structured training programme5.
A descriptive co-relational study was conducted among N=145 nurses with an objective to evaluate their attitude towards intermittent maternal and fetal monitoring and the effect of selected demographic variables. The studying finds showed that 72.4% respondent agreed the fetal monitoring should be standard care, where as 87% respondents said that they provide intermittent monitoring and 53.9% indicated that nurse/patient ratios was the problem in providing this service. Thus it is found that nurse’s attitudes were significantly influenced by education they have received. Lack of knowledge regarding the current evidence and other barriers are contributing to errors. Hence the study findings conclude that through education when given to nurses the outcome of skills will lead to higher quality of fetal monitoring9.
A study was conducted among N=60 students nurses who were posted in delivery room during their course with an objective to evaluate the effectiveness of an educational programme regarding partograph. The data was analyzed using descriptive and inferential statistics. The result showed that there was a significant higher mean post knowledge score (0.15) when compared to mean pretest knowledge score of (0.7). Thus the study concludes that, there was an significant increase in the level of knowledge and practices of student nurses regarding the use of partograph after implementation of the educational programme. This suggests the need for implementing various educational programmes for student nurses10.
From the above literature review, the investigator found that, as the good foundation lays the basic step towards building a strong tower. The knowledge received by the student nurse during their course lays significant step towards developing higher skills of assessment and observation of women in labour. The crucial role of nurses, in use of partograph, fetal monitoring and maternal monitoring in management of labor has motivated the investigator to conduct a structured teaching programme on patograph among IVth year B.Sc Nursing student who are near to finish their nursing course and will be serving community shortly.
6.2. Review of Literature
A study was done to evaluate the competence of nurses while assessing the women during labour using partograph (maternal and fetal monitoring). About N=16 nurses were selected for study using convenience sampling. Data was collected by administering 49 questions through multiple choice tests. The finding revealed that 55.8% of knowledge questions were correctly answered and about 48.2% of the skills steps were correctly performed. Thus the study shows there is a wide gap existing between current evidence-based practice standards and current levels of provider competence. This gap may be reduced by providing basic knowledge to nurse for caring of women in labour11.
A cross-sectional study was conducted for assessing the knowledge and utilization of the partograph among nurses and other health care workers. Respondents were selected by multi-stage sampling method from primary, secondary and tertiary levels of care. About N=700 respondents comprising of 100 auxiliary nurse, 300 staff nurse and 300 student nurse. It is found that only 32.3% used the partograph to monitor women in labour. Partograph use was reported significantly more frequently by respondents in only tertiary levels when compared with respondents from primary, secondarily levels of care (82.4% vs 19.3%, X2=214.6, P<0.0001). Thus it was seen that knowledge about the partograph is poor. Hence the study concludes that there is greater requirement for conducting education for nurses regarding use of partogarph12.
A study was conducted among N=20 nurses, with an objective to assess the effectiveness of promoting the use of the WHO partograph by nurses for labour in a maternity unit by comparing outcomes after birth. Cluster randomized control trial research design was used in this study. Under supervision from a team of obstetrician, nurses in the intervention group were introduced to WHO partograph, trained in its use. After the analysis of the collected data the result findings revealed that only 70% of partograph were correctly completed and 30% were referred to hospitals. This suggests that training programme with follow up supervision and monitoring may promote the nurses in developing their skills while they care for women in labour13.
A study was conducted among N=100 graduates of nursing training courses with an objective for evaluating the improvement in the quality of care given by them during emergencies in pregnancy (maternal and fetal monitoring). The results showed that 81% of respondents reported these training courses had resulted in improving their knowledge on assessment technique and observation skills for monitoring also it gave a better availability or use of supplies at their units. Thus the study concludes that introduction of structured training programme of emergencies in pregnancy has helped students learn better14.
A quasi experimental research was conducted to assess, effects of instructional videos on the knowledge and labour practical skills of nursing students with an objective to compare the nursing skills during labour among N=104 IVth year Nursing Students. The results of the study revealed that there were statistically significant difference between both control and experimental group. The post test obstetric nursing knowledge of the experimental group was statistically higher than control group (t=4.50, p<.001). Thus study suggests that learning material were useful for improving students knowledge during labour (maternal and fetal monitoring) 15.
A study was conducted on nurses (N=120) during intrapartum stage in various settings. A descriptive survey research design was used in this study. A structured questionnaire was administrated to nurses regarding various assessment and management technique in care of women during labour. The results found that nurses had moderately adequate knowledge in their pretest, which emphasized the need for training to make them adequately skilled which was achieved by significant post test knowledge score. Thus the findings suggest that nurses can improve the skills of assessment by attending teaching programmes16.
A study was conducted among N=22 health care professional (12 nurses, 10 auxiliary nurse) with an objective to assess their competency in monitoring fetal heart rate and maternal conditions. A training programme was arranged for nurses in the form of conference which included topics fetal heart rate monitoring, maternal monitoring and perinatal patient’s safety. After the analysis the results revealed that their was a significantly higher difference found in their post test (98%) knowledge score when compare to pre test (70%). The study finding concludes that active participation from the nurses has highlighted the importance of team work and communication. The nurses evolved the utilizing their skill in fetal monitoring17.
6.3. Statement of the problem
“A study to assess the effectiveness of a structured teaching programme on knowledge regarding assessment and observation of women in labour among IVth year B.Sc nursing students at selected nursing colleges in Gulbarga.”
6.4. objectives of the study
The objectives of the study are to,
1. Assess the level of knowledge regarding assessment and observation of women in labour.
2. Develop and implement structured teaching programme
3. Assess the effectiveness of a structured teaching programme on knowledge regarding assessment and observation of women in labour.
4. Determine the association between the knowledge of IVth year B.Sc nursing students on assessment and observation of women in labour with selected socio demographic variables.
6.5 Operational definitions
Effectiveness: It refers to desirable changes brought about by the structured teaching programme, as measured in terms of significant knowledge gain in the post test and guided as adequate knowledge, moderately adequate knowledge and inadequate knowledge.
Knowledge: It refers to awareness and understanding of IVth year B.Sc nursing student regarding knowledge on assessment and observation of women in labour which is expressed as a response towards the items listed in structured knowledge questionnaire pertaining to partograph, maternal monitoring and fetal monitoring.
IVth year B.Sc nursing student:
It refers the students who are studying in the IVth year B.Sc Nursing course.
Assessment and observation
It refers to the critical analysis and evaluation of status or quality of a particular condition and situation which includes,
· Partograph
· Maternal monitoring
· Fetal monitoring
Structured Teaching Programme
In this study it refers to the time bounded teaching programme in English, prepared by the investigator regarding labour which includes detail information pertaining to assessment and observation of partograph, maternal monitoring, and fetal monitoring.
6.6. Assumptions
The study has following assumptions,