“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED OBSTETRIC EMERGENCIES AND THEIR MANAGEMENT AMONG JUNIOR
HEALTH ASSISTANT FEMALE STUDENTS IN
SELECTED JUNIOR HEALTH ASSISTANT
FEMALE TRAINING CENTRE OF
RAICHUR,KARNATAKA.”
PROFORMAFOR REGISTRATION OF SUBJECTS FOR DISSERTATION
SNEHAMATHEW
NAVODAYA COLLEGE OF NURSING
RAICHUR, NOVEMBER - 2008
RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA.
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. Name of the candidate : Mrs. Sneha Mathew
M.Sc. Nursing, 1stYear
Navodaya College of Nursing
Navodaya Nagar
Manthralayam Road, Raichur
2. Name of the Institute : Navodaya College of Nursing
3. Course of Study and Subject : M.Sc. Nursing,1st Year
Obstetrics and Gynaecological Nursing
4. Date of Admission : 13-06-2008
5. Title of the Topic :
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME ON KNOWLEDGE REGARDING SELECTED OBSTETRIC EMERGENCIES AND THEIR MANAGEMENT AMONG JUNIOR
HEALTH ASSISTANT FEMALE STUDENTS IN
SELECTED JUNIOR HEALTH ASSISTANT
FEMALE TRAINING CENTRE OF
RAICHUR,KARNATAKA.”
6. BRIEF RESUME OF THE INTENDED WORK
6.1. NEED FOR THE STUDY
“A mother’s joy begins when a new life is stirring
inside…. When a tiny heart beat is heard from
the very first time and a playful kick reminds
her that she is never alone”
Pregnancy is a unique, exciting and often joyous time in a woman’s life, as it highlights the woman’s amazing creative and nurturing powers while providing a bridge to the future. Pregnancy comes with some cost, however, a pregnant woman also needs to be a responsible woman so as to best support the health of her future child.¹
Pregnancy begins when an egg is fertilized by a sperm, and it continues for a period of nine months and ends when a baby is born. From the beginning of the pregnancy to the next 36 weeks the mother will be on a truly exciting journey as she actively take part in the miracle of creating a new life.
Pregnancy can be the best of times and pregnancy can be the worst of times. Being a joyous time pregnancy can also be a time of uncertainty and worry.² The pit fall of pregnancies can be malpresentation, haemorrhages, emergency situations like cord prolapse, cord presentation, uterine rupture, shoulder dystocia, amniotic fluid embolism etc. These pitfalls of pregnancies can threaten the well being of both mother and child.
Obstetrical emergencies are life threatening conditionsthat occur in pregnancy during labour and after delivery. It is common that approximately 15% of all pregnant womendevelop serious complication from conception to delivery. Among all the emergency situations which may arise across the field of obstetrics, there are small numbers which call urgent practical steps to be taken in order to safeguard the life of the mother or the baby or both.³
Most life threatening obstetric complications require hospital treatment to avert maternal mortality.Some assume that in developing countries, hospital services for the poor must be in government hospitals and health centers and a large proportion of deliveries need to be in these hospitals to provide timely access to emergency care. This presents a major problem in countries like India where almost all deliveries occur at home, government hospitals and health centers, generally where care lacks in emergency situations.
‘Complications related to pregnancy and child birth are among one of the leading causes of mortality and morbidity of women of reproductive age. Most of these deaths, health problems and injuries are preventable through improved access to adequate health care services including emergency obstetric care.’
-United nations 4th world conference of women
The present study includes the obstetric emergencies like cord prolapse, uterine rupture and amniotic fluid embolism.
Umbilical cord prolapse occurs when the baby’s umbilical cord falls into the birth canal. A prolapsed cord is a serious emergency situation and it can be very harmful to the baby.³
Statistical information shows that the incidences of cord prolapse in India is 3/10,000 deliveries and fetal mortality is high i.e. 82% in such conditions. Therefore it is should and must that effective assessment of the knowledge of the health care professionals’ regarding obstetric emergencies has to be done and they should be aware regarding how to tackle such emergency situation in obstetrics.
Advances in the knowledge of the forthcoming health assistants and staff nurses regarding the management of umbilical cord prolapse, hold promise for reducing maternal and fetal morbidity and mortality.⁶
6
The most dangerous and untreatable emergency situation in obstetrics is amniotic fluid embolism. It is a rare condition and occurs when the uterus contracts strongly. When the uterus is contracting strongly, there will be an opening between the amniotic sac and the uterine vein, a bolus of the amniotic fluid is pumped into the circulatory system of mother.
Statistical evidences show that the incidence of clinically detectable amniotic fluid embolism is low and is estimated to be 1 in 20,000 to 80,000 live births. Maternal mortality rate is high as 86% and neonatal survival is reported as 70%. In India from the year 1970 – 2000 amniotic fluid embolism contributed to 8.2% of maternal mortality.
Even though amniotic fluid embolism is a disastrous and untreatable condition, sometimes it is managed with success.
A severe case of amniotic fluid embolism has managed successfully in AlexandraGeneralHospital,Athens in the year 2006. A healthy 29 year old primigravida mother developed amniotic fluid embolism during labour. The patient underwent an urgent caesarian section and atotal hysterectomy was performed to save the life of the patient.
The patient in the reported case was under normal labour processand she developed sudden dysponea and production of frothy sputum. The symptoms was first noticed by the nurse midwife and reported immediately. The outlines of management for amniotic fluid embolism by the nurse practitionersaved the life of the mother.
Training thehealth assistants and the staff nurses in the management of obstetric emergency like amniotic fluid embolism will enhance the reduction of maternal and fetal mortality.
Uterine rupture is uncommon but potentially fatal to both mother and baby.Uterine rupture results when there is a weak spot in the uterus such asscar or when the uterine wall is thinned by multiple pregnancy.³
The incidence of uterine rupture is 0.05% of all pregnancies, occurring between 1 in 140 to 1in 300 of women with pre existing scar. It is a common obstetric event and care and management by nursing personnel is important because it continuous to be associated with maternal mortality rate, maternalmorbidity and peripartum hysterectomy.It is associated with high incidence of perinatal mortality that is ten times that of maternal mortality.⁹
Statistical information shows that there was reduction in occurrence of uterine rupture in Central India. The incidence of uterine rupture between 1983 and 1988 was 1.45 per 1000 births and 1989 to 2000 it was .62 per 1000 births.¹º
To reduce the incidence of uterine rupture still more, the health assistants, the nurses, general practitioners and paramedics should gain adequate knowledge and training in the management of uterine rupture.⁹
The management of emergencies is usually the responsibility of hospital obstetricians. As more maternity care is now given in the community, however, health assistants, general practitioners and paramedics may be involved and must know the outlines of management of obstetric emergencies and the possible side effects.
When obstetric emergencies occur, effective and efficient care by the health care professionals is essential for good outcome and safety.As a care giver the junior health assistant females play an important role in managing obstetric emergencies. Soto give effective and efficient care the knowledge of thejunior health assistant females regarding obstetric emergencies should be improved.Employing teaching programme regarding obstetric emergencies can facilitate the knowledge of the junior health assistant females. The teaching strategy helps thejunior health assistant females to develop decision making and working skills when dealing with an obstetric emergency.¹¹
Hence the researcher felt the need to assess the effectiveness of structured teaching programme on knowledge regarding selected obstetric emergencies and their management among junior health assistant female students in selected junior health assistant female training centre of Raichur.
6.2 REVIEW OF LITERATURE
A review of literature on the research topic makes the researcher familiar with the existing studies and provides information which helps to focus on a particular problem, lays a foundation upon which to base new knowledge. It creates accurate picture of the information found on the subjects.¹²
A study was conducted to assess the knowledge of health care practitioners regarding village based care in obstetric emergencies in West Java. The study consists of 100 samples and data were collected by using check list. The findings showed that only 48% 0f health care practitioners had adequate knowledge regarding community based care in managing obstetric emergencies. The study concluded that health care practitioners should receive appropriate support for the management of obstetric emergencies.¹³
A study was conducted to assess the effectiveness of obstetric emergency training programme on knowledge regarding obstetric emergencies among medical graduates in Bristol Medical Simulation Centre, England. One hundred and fortysamples have selected by non-random method for the study. Data were collected by using questionnaire. The result of the study showed significant difference between pre-test and post-test. Post-test score was (23.1) more while comparing to pre-test score (18.1) and P < 0.001.¹
A study to evaluate the risk factors, management, maternal and perinatal outcome of uterine rupture was conducted in Department of Obstetrics and Gynaecology, JIPMER, Pondycherry between January 1995 and December 2004. A Two fifty three case of uterine rupture was managed between the 10 years. The result showed that 128 cases (50.8%) of uterine rupture occurred in a scared uterus and 125 (49.40%) occurred in unscarred uterus. The predisposing factors include cephalo pelvic disproportion in 69 cases (27.25%), malpresentation in 20 (7.90%), labour induction in 14 cases (11.64%) and multiparity in 20 cases (7.90%). Repair of uterus was done in 147 cases (58.33%) and hysterectomy in 105 cases (41.51%). The study concluded that there were 7 maternal deaths (2.76%) and perinatal mortality was 94.07%.¹
A study was conducted to assess the effectiveness of simulation based training programme among midwives and obstetric doctors in IsraeliCenter for Medical Simulation, United Kingdom. One hundred and sixty five samples have selected by random method. Among the samples 77 were obstetric doctors and 88 were midwives. Questionnaire responses showed that post-test score (79.4±4.3) were more than pre-test score (70 ±5.3). The study concluded that employing high fidelity simulations of obstetric emergencies has great teaching and learning potential and simulation can provide a learning experience that facilitates knowledge application to midwifery practise.¹⁶
A systematic review of training in obstetric emergencies to describemodels used for the training of labour ward personnel in obstetric emergencies was conducted in JohnRadCliffeHospital, Oxford, United Kingdom. The sample consists of 100 labour ward personnel who were selected randomly. A data collection form was used to extract relevant information. The result showed that out of 32 relevant papers, 22 were editorials, 6 were descriptions of training programme and 4 papers involved an evaluation of such programme. The study concluded that only few training programme had been described to train the nurses in obstetric emergencies and few more training method need to be developed.¹
A population based study to assess the pregnancy outcomes associated with amniotic fluid embolism was conducted in California between January 2001 to December 2002. The study covered all singleton deliveries occurred in 328 hospitals in California and the data were obtained from a computerized data base. The result showed that among 1,094,248 deliveries, 53 singleton gestations had the diagnosis of amniotic fluid embolism and maternal mortality rate is 26.4%. The study concluded that the maternal mortality rate is less than the previous reports.¹
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching programme on knowledge regarding selected obstetric emergencies and their management among junior health assistant female students in selected junior health assistantfemale training centreof Raichur, Karnataka.”
6.3 OBJECTIVES OF THE STUDY
To assess the existing level of knowledge of junior health assistant female students regarding selected obstetric emergencies and their management.
To implement structured teaching programme on selected obstetric emergencies and their management.
To analyse the effectiveness of structured teaching programmeon selected obstetric emergencies and their management.
To identify the relationship between the knowledge of junior health assistant female students regarding selected obstetric emergencies and their managementwith selected variables.
6.4 OPERATIONAL DEFINITIONS
a.Effectiveness :
It refers to the extent to which the structured teaching programme improves the knowledge of junior health assistant female studentsregarding selected obstetric emergencies and its management.
b.Structured teaching programme :
It refers to the type of teaching programme on selected obstetric emergencies and their management prepared by the Investigator to enhance the awareness of junior health assistant female students.
c.Knowledge :
Refers to the level of understanding of thejunior health assistant female students with regard to selected obstetric emergencies and their management as measured by their correct response to knowledge items of the questionnaire.
d.Obstetric emergencies :
Refers to severe life threatening condition that related to pregnancy or delivery which requires urgent medical intervention.¹¹
In present study the obstetric emergencies includedare cord prolapse, uterine rupture and amniotic fluid embolism.
e.Management :
Refers to health care activities which will be practised by thejunior health assistant female students in treating the emergency situations in obstetrics.
f.Junior health assistant female :
Refers to the students who are studying in junior health assistant female training centre, Lalbahaddur Shastri Nagar, Raichur.
6.5 HYPOTHESES
On the basis of the objectives of the study the following hypotheses have been formulated.
H :There will be significant difference between the pre-test and post-test knowledge scores of junior health assistant female studentswith regard to obstetric emergencies and their management.
H₂ :There will be significant relationship between the knowledge scores of junior health assistant female students on selected obstetric emergencies and their management with selected variables.
7. MATERIALS AND METHODS
7.1 SOURCES OF DATA
Design :
One group pre-test and post-test pre-experimental design is adopted for the present study.
O1 X O2
Setting of the study :
The present study will be conducted in a junior health assistant female training centre. The junior health assistant female training centre of Raichur has been selected purposively for the present study, which is functioning under Government of Karnataka
The junior health assistant female training centre of Raichur was established in 1963. It is situated in Raichur Institute of Medical Sciences compound, Lalbahaddur Shastri Nagar of Raichur. The present batch consists of 30 students and each batch is circulated for every 18 months.
Population :
The population included in this study are the students who are studying in junior health assistant female training centre of Raichur.
Sample :
Sample for the study consists of 30 junior health assistant female students who are studying in junior health assistant female training centre of Raichur.
Sampling Technique :
Non- random purposive sampling technique will be used to selectjunior health assistant female training centre and complete enumeration method will be used to select the sample.
Inclusion Criteria :
The study includes junior health assistant female students who are
studying in junior health assistant female training centre, Raichur
willing to participate in the study
available at the time of data collection
Exclusion Criteria :
The study excludes junior health assistantfemale studentswho are not
studying in junior health assistant female training centre, Raichur
willing to participate in the study
available at the time of data collection
Selected Variables :
Variables includes in the present study are
Dependant Variable :
Knowledge of junior health assistant female students regarding selected obstetric emergencies and their management.
Independent Variable :
Structured teaching programme regarding selected obstetric emergencies and their management.
Extraneous Variables :
(a) Age :
Refers to the chronological age of the junior health assistant students. For the present study age was categorized as
15 – 19 years
20 – 24 years
25 – 29 years
Above 30 years
(b) Basic Educational Qualification :
It refers to the previous education of the junior health assistant female students. It categorized as:
S.S.L.C
P.U.C
(c) Religion :
Refers to the system of faith of worship, the junior health assistant female students follows. For the present study the religion is categorized as :
Hindu
Muslim
Christian
(d) Exposure during clinical postings :
Refers to whether the student had any opportunity to witness or to assist any case of obstetric emergencies during their clinical postings.
Yes
No
(e) Sources of Information :
Refers to the information which can shed light on the knowledge of junior health assistant female students.
Journals
Television
News paper
Relatives
Friends
7.2 METHODS OF DATA COLLECTION
Data Collection Instrument :
Data collection will be done through structured self-administered questionnaire. It consists of two parts :
Part 1 – Deals with sample characteristics
Part2– Represents knowledge related items regarding selected obstetric emergencies and their management.
Data Collection Method :
After obtaining priorpermission from concerned authorities and consent fromthe samples, the Investigator will assess the knowledge of junior health assistant female students regarding selected obstetric emergencies and their management by using structured self-administered questionnaire.
Data collection will be carried out in 3 phases :
First phase : Pre-test will be given to assess the initial knowledge of junior health assistant female students regarding selected obstetric emergencies and their management.