RAJIV GANDI UNIVERISTY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
PROFORMA SYNOPSIS FOR REGISTRTAION OF SUBJECT FOR DISSERTATION
1. / NAME OF THE CANDIDATEADDRESS / T.SREEVANI,
D/o. T. VIJAYA MOHAN RAO,
Door No: 12-3-894, Plot No:3,
GROUND FLOOR,VIDYUTH NAGAR,
ANANTAPUR – 515001
ANDHRA PRADESH
2. / NAME OF THE INSTITUTION / GOLDFINCHCOLLEGE OF NURSING, NO.150/24,KODIGEHALLI
MAIN ROAD,
MARUTHI NAGAR,
BANGALORE-560092
3. / COURSE OF STUDY
SUBJECT / IST YEAR M.sc NURSING, OBESTETRICS & GYNAECOLOGICAL NURSING,
DISSERTATION PROTOCOL.
4. / DATE OF ADMISSION
TO COURSE / 15TH JUNE 2008
5. / TITLE OF THE
TOPIC / A STUDY TO ASSESS THE EFFECTIVENESS OF PLANNED TEACHINGT PROGRAMME ON PREVENTION AND MANAGEMENT OF POSTPARTUM HAEMORRHAGE AMONG STAFF NURSES IN SELECTED HOSPITALS AT BANGALORE.
INTRODUCTION:
“A GREATEST GIFT A MOTHER CAN GIVE HER
CHILDERN IS HERSELF”
The post partum period or pueperium includes the first six weeks after delivery of the placenta. This period is a very special phase in the life of a women. She is going through the physiological process of uterine involution at the same time adapting to her new role in the family. Most postpartum complications occur during this period. Among the important obstetric morbidities are postpartum haemorrhage, pregnancy -related hypertension, pulmonary embolism, and pueperial sepsis. The common surgical complications are wound breakdown, breast abscess & urinary fecal incontinence. Medical conditions such as anemia, headache, backache, constipation & sexual problems may also be present.
Post partum care is the most neglected aspect of maternity care & more research is needed on issues related to postpartum maternal health. Early post partum care is essential to diagnose & treat complications. Although there is little evidence to support the timing and content of postpartum visits, there is evidence that this is a time of increased health needs for both mother & baby. Postpartum care visits provide oppurtunities to assess the physical & psychological well - being of the mother. Counsel her on infant care and family planning & give appropriate referrals for pre - existing or developing chronic conditions.
Utilization of reproductive health services, including maternal health care, is related to their availability, and socio-economic, demographic & cultural factors such as women’s age, education, employment & autonomy, & perception of women & their families regarding the need for care. In contrast to relatively high to moderate levels of antenatal care received by women in the Arab region, the coverage of postnatal care is markedly lower. In other regions of Saudi Arabia postnatal care coverage ranged from a very low rate of 6.5% in Northern region (12) & up to 52% in Arabia Region. Postnatal care coverage ranged from 48.88%, at the national level, according to different surveys.
By
ABDEL - HADY EI -GILANY
SABRY HAMMAD
NEED FOR STUDY:
Maternal Morbidity refers to complications that have arisen during pregnancy, delivery or the past partum period. Post partum morbidities continue to be major health issues that need to be looked into critically not only for curative but also for preventive & promotive care. About 5.4% of mothers reported one or more severe postnatal morbidities. A higher percentage of mothers with postnatal morbidities, up to 42.9% was reported from other countries.
There are on estimated 14 million cases for pregnancy related haemorrhage every year: at lest 128,000 of these women bleed to death. Most of these deaths occurs with in four hours of delivery and are a result of problems during the third stage of labour.
Many of the complications leading to postpartum maternal morbidity arise during labour & delivery & in the weeks following delivery; at least 18 million women these morbidities become long term.
Due to the reasons is not only the cause of post partum haemorrhage.Due to risk factors also the mother’s may get the problem of postpartum haemorrhage. The incidence of the PPH is 10-16% & 50 million women’s are affected. Investigator observed during clinical posting in hospital due to risk factors of PPH more number of mother’s are deaths.
So, I planned to assess the effectiveness among the staff nurses. We can find those who are at high risk of having PPH.
The investigator thought that need to improve the effectiveness on preventing PPH & managing the 3rd stage of labour safely.
6.2REVIEW OF LITERATURE:
According to path (2001) states that – A WHO multi – center study found that misprostol was not effective as oxytocin in reducing maternal bleeding when administered as part of active management of the third phase of labour in hospital setup.5
According to joyce primo carpenter (1996) states that - The USP expert committee concluded that misprostol is safe & effective in preventing PPH & considered this indication as an accepted off - label use. They recommended it as an alternative agent especially where oxytocin & other uterotonic drugs are not available. The suggested single dose is 400-600micrograms orally or rectally immediately following delivery of the child.5
According to Gulmezoglu AM, Forna F, villar J, Hofmeyr GJ (2007) states that - Misoprostol orally or sublingually at a dose of 600 micrograms shows promising results when compared to placebo in reducing blood loss after delivery. The margin of benefit may be affected by whether other components of management of the third stage of labout are used for not. A side effects are dose – related, research should be directed towards establishing the lowest effective dose for routine use, & the optimal route of administration.
Neither intramuscular prostaglandins nor misoprostol are preferable to conventional injectable uterotonics as part of the management of the third stage of labour especially for low-risk women.2
According to V A Mategrano and MP Gabay (1996-2001) states that – In situations where conventional oxytocins are not readily available, storage requirements for oxytocics cannot be met, or the equipment for parenteral administration is not obtainable misoprostal may be acceptable prophylactic option.4
According to suLL,Clong ys, Samuel M(2007) states that - There is insufficient evidence that 100 micrograms of intravenous carbetocin is as effective as oxytocin to prevent PPH. In comparision to oxytocin, carbetocin was associated with reduced need for additional uterotonic aents, and uterine massage. There was limited comparative evidence on adverse events.6
According to suellen Miller (2004) states that - New strategies to prevent & mange postpartum haemorrhage in developing countries, such as community based use of misoprostol, oxytocin in the uniject delivery system, the non-inflatable antishock garment to stabilize & resuscitate hypovolemic shock, & the balloon condom catheter to treat intractable uterine bleeding are reviewed. New directions for clinical & operations research are suggested.8
According to G.Justus Hofmeyr and A.Metin gulmezoglu (2008) states that - Misoprostol has powerful uterotonic effects &, because it is well absorbed orally and sublingually, has the potential to be used more widely than would be possible with injectable uterotonics alone. Misoprostol is clearly less effective than oxytocin.7
According to Magnn EF, Evans S, Hutchinson M, Collins R, Lanneau G, Morrison JC (2006) states that – Non elective cesarean deliveries have a higher risk of PPH than women deleivered electively. Risk factor identification & prevention should be a priority.
According to Silver RM, Landon MB, Rouse DJ, Leveno KJ, Spong CY (2003) states that – Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labour & when debating the merits of elective primary cesarean delivery.10
According to Bouwmeester FW, Jonkhoff AR, Verheijen RH, Van Geijn Hp (2006) states that - Recombinant factor VII a may be an alternative hemostatic agent in a patient with life - threatening post partum haemorrhage unresponsive to conventional therapy.9
PROBLEM STATEMENT:
A study to assess the effectiveness of planned teaching programme on prevention and management of post partum hemorrhage among staff nurses in selected hospitals at Bangalore.
6.3 OBJECTIVES OF THE STUDY:
To assess the pre-Test knowledge of the staff nurse regarding prevention & management of post partum haemorrhage.
To assess the post-Test knowledge of the staff nurses regarding prevention & management of post partum haemorrhage.
To evaluate the effectiveness of planned teaching programme regarding prevention & management of post partum hemorrhage.
To find out the association of knowledge among staff nurses regarding on prevention & management of post partum hemorrhage with selected demographic variables.
6.4 OPERATIONAL DEFINATIONS:
STUDY:The devotion of time and attention to gain knowledge.
ASSESS:The process by which a persons condition is appraised or evaluated.
EFFECTIVENESS: It reefers to the desired change brought about by the planned teaching programme & measured in terms of significant knowledge gain in the mean post test scones.
PLANNED TEACHING PROGRAMME: It refers to consisted well planned & informative teaching programme that will be given to staff nurses.
PREVENTION: Its easier to stop some thing happening I the 1st place than to repair damage after it has happened.
MANAGEMENT: The process of managing.
POST PARTUM HAEMORRHAGE: Loss of blood estimated to be 500ml from the genital tract with in 24 hours of delivery.
6.5 HYPOTHESIS:
H1→ These will be significance difference between the mean, pretest & post test knowledge score of staff nurses regarding on prevention & management of post partum haemorrhage.
H2→There will be significant association between the demographic variables & the mean knowledge scores of the staff nurses regarding on prevention & management of post partum hemorrhage.
6.6 ASSUMPTIONS:
→ Staff Nurses in postnatal ward will have interest to participate in the study.
→ Staff Nurses in postnatal will not have adequate knowledge.
→Planned teaching programme will enhance the knowledge regarding prevention & management of post partum haemorrhage.
→Staff Nurses having adequate knowledge will give good post test scores.
6.7DELIMITATIONS: The study is delimited to
→The staff Nurses
→The staff nurses in post natal wads in selected hospitals at Bangalore.
→The staff nurses available during the time of data collection.
- MATERIALS & METHODS:
- SOURCES OD DATA:
Staff Nurses in the postnatal ward in selected hospitals at Bangalore.
7.2METHODS OF DATA COLLECTION:
7.2.1 TYPE OF STUDY:Evaluative study.
7.2.2 RESEARCH DESIGN: 1 group pre test & post test design(quasi Experimental design)
7.2.3 SAMPLING TECHNIQUE: Purposive sampling technique.
7.2.4 SAMPLE SIZE: The sample size is 45
7.2.5 VARIABLE UNDER STUDY:
DEPEMDEMT VARIABLE: Prevention and Management of post partum haemorrhage.
INDEPENDENT VARIABLE: Planned teaching programme.
7.2.6 FOLLOW UP: Pretest assessment will be alone for staff nurses. Post test will be done 1 week after the preliminary assessment with planned teaching programme.
7.2.7 DURATION OF THE STUDY : 6 WEEKS
7.2.8 INCLUSION CRITETIA & EXCLUSION CRITERIA:
INCLUSION CRITERIA:
→Staff Nurses who are in postnatal ward during data collection.
→staff Nurses who are willing to participate in the study.
EXCLUSION CRITERIA:
→ Staff Nurses not present at the time of study.
→Staff Nurses not willing to participate in the study.
7.2.9 INSTRUMENTS: Planned teaching programme will be used to assess the knowledge regarding prevention & management of post partum haemorrhage.
7.2.10 DATA COLLECTION PROCEDURE: After obtaining prior permission from the concerned authorities & subjects. A brief introduction will be given to the subjects about self & the study. Pretest will be conducted for the staff nurses. 1 week after giving the planned teaching programme again posttest will be conducted for the same staff Nurses.
7.2.11 STATISTICAL METHOD USED:
DESCRIPTIVE STATISTICS:
→Frequency & percentage distribution of socio-demographic variables.
INFERENCIAL STATISTICS:
→Paired ‘t’ test to compare pre test & post test finding.
→Student ‘t’ test to compare post test assessment.
→Chi square test to find associated between findings of study & selected socio – demographic variables.
7.3=> Does study require any investigation intervention to be conducted on junior staff Nurses ?
Yes. Assessment on prevention & management of post partum haemorrhage will be done for staff Nurses by giving planned teaching programme.
7.4=>Has ethical clearance obtained ?
Yes.
→ Confidentiality & anonymity of the subjects will be maintained.
→consent will be obtained from the staff Nurses before conducting the study.
→ A written permission from institutional authority will be obtained.
- LIST OF REFERENCES:
1)Gulmezoglu A M, “The text book of Cochrane date base systemic reviews, 2007, issue 3, Art No: CD000494, DOi:10,1002/14651858. CD000494. Pub.3.”
2)Magann EF “The text book of obstetric Gynecology, 2006,107(6)published by lippincott P.No:1226-32.
3)Myles, “The text book for midwifes, 14th edi, 2003, published by Churchill Living stone P.No:512.
4)BjOG, 2001 Sep,108(9) P.No:927-930
5)MJA, 2007,187 (7) P.No:391-393
6)South med J, 2005,july,98(7) P.No.681-685
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9. / SIGNATURE OF THE CANDIDATE10. / REMARKS OF THE GUIDE / POST PARTUM HAEMORRHAGE IS ONE OF THE LEADING CAUSE FOR MATERINAL DEATHS AFTER DELIVERY. PLANNED TEACHING PROGRAMME ON PREVENTION AND MANAGEMENT OF PPH AMONG STAFFS WILL HELP US TO REDUCE THE MMR TO MINIMAL . STUDY LIKE THIS CAN BE ENCOURAGED
11. / NAME & DEIGNATION
OF GUIDE
(IN BLOCK LETTERS) / Mrs. JULIE JESTIN.A,
ASST PROFESSOR,
OBSTETRICS & GYNAECOLOGICAL NURSING,
GOLDFINCHCOLLEGE OF NURSING,
BANGLORE.
11.1
11.2 / GUIDE
SIGNATURE
11.3
11.4 / CO-GUIDE (IF ANY)
SIGNATURE
11.5
11.6 / H.O.D
SIGNATURE
12 / REMARKS OF THE
CHAIRMAN
& PRINCIPAL
12.1 / SIGNATURE