RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE KNOWLEDGE ON OBSTETRICS EMERGENCIES AMONG DIPLOMA NURSING INTERNSHIP STUDENTS OF SELECTED NURSING SCHOOLS AT TUMKUR”
SUBMITTED BY:
ARLINE BESHRA
1STYEAR, M.Sc. NURSING
(OBSTETRICSAND
GYNAECOLOGICAL NURSING)
SRI RAMANA MAHARSHI
COLLEGE OF NURSING,
TUMKUR - 06
2008-2009
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES BANGALORE, KARNATAKA
SYNOPSIS PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATE AND ADDRESS / ARLINE BESHRA1ST YEAR M.Sc, NURSING
SRI RAMANA MAHARSHI
COLLEGE OF NURSING,
SIRA ROAD, TUMKUR.
2. / NAME OF THE INSTITUTION / SRI RAMANA MAHARSHI
COLLEGE OF NURSING
3. / COURSE OF STUDY AND SUBJECT / 1ST YEAR M.Sc, NURSING OBSTETRICS AND GYNAECOLOGICAL NURSING
4. / DATE OF ADMISSION TO COURSE / 30/06/2008
5. / TITLE OF THE STUDY / “A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE KNOWLEDGE ON OBSTETRICS EMERGENCIES AMONG DIPLOMA NURSING INTERNSHIP STUDENTS OF SELECTED NURSING SCHOOL AT TUMKUR”
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION:
Maternal death is a tragedy for individual women, for families and for their
Communities. World wide nearly 600,000 women between the age of 15 and 49 die every
Year, due to complications arising from pregnancy and childbirth. THIS MEANS ALMOST
EVERY MINUTE OF EVERY YEAR, THERE IS A MATERNAL DEATH. 99% of which
occur in the developing countries. Majority (80%) of these deaths are preventable. Expert
from WHO, UNICEF, World Bank, the population council and other National and
International agencies concerned with SAFE MOTHERHOOD concluded that it is possible
to reduce maternal mortality significantly with limited investment and effective policy
Intervention. Therefore, it is considered that maternal death is reflection of “Social
Disadvantage” not merely a “health disadvantage”. ¹
Most complications of pregnancy allow time for transfer to specialized obstetric units, but a few women present as emergencies where successful outcome depends on prompt recognition of the problem and rapid stabilizing management. It is not uncommon for staff with no formal obstetric training to be facing these situations in the Accident & Emergency or general practice setting.
The obstetric emergencies can divided into two groups.
1. ANTEPERTUM OBSTETRIC EMERGENCIES like Pre Eclampsia and Eelampsia, Antepartum haemorrhage, Diabetic coma, Motor vehicle accidents etc.
2. INTRAPARTUM OBSTETRIC EMERGENCIES like undiagnosed twin, undiagnosed breech, cord prolapse, uterine rupture, shoulder dystocia etc.
6.1. NEED FOR THE STUDY
The health of women represents the health status of any country. Women’s health assumes importance because her status directly affects children’s health.
More women die in India during childbirth than anywhere else in the world. About 5.36 lakh women who died during pregnancy or after childbirth in 2005 globally, India accounted for 1.17 lakh.
This was followed by Nigeria (59,000), Congo (32,000) and Afghanistan (26,000). India along with other countries accounted for almost 65% of global maternal deaths in 2005.
This maternal mortality ratio (MMR) in India 450 death per 100,000 live births. In comparison, Congo had an MMR of 740, Nigeria 1,1000 and Afghanistan 1,800 per 100,000 births. India’s neighbors are better off.
Worldwide, toxemia accounts for approximate 10% of maternal death (Duely 1992) or 5000 maternal death per year. Toxemia will occur 6% of first and 2% of subsequent pregnancies. APH occurs in 3 percent of all pregnancies. Vasa Previa occurs in less than 0.2 percent of pregnancies. Shoulder Dytocia occur between 0.37 – 1.1 (Bahar, 1996).
Many experts have produced encourage truth regarding causes, prevention and treatment of obstetrics emergencies. But in spite of their immense work, it shows that the unexperience nurses need more skill and knowledge to handle obstetric emergencies promptly. Hence the investigator is determined to assess the knowledge of 4th year B.Sc. nursing students regarding obstetric emergencies.
6.2 REVIEW OF LITERATURE
CROFTS JF et al, (2007) conducted a study at Brsiton, UK. To explore the effect of obstetric emergency training on knowledge. Further more to assess if acquisition of knowledge is influence by training setting or teamwork training. A total 140 participants (22 Junior and 23 senior doctors, 47 Junior and 48 senior midwives) were studied. Participants were randomized to one to four obstetric emergency training interventions 1) 1 day course at local hospital 2) 1 day course at simulation centre. 3) 2 – day teamwork training at local hospital 4) 2 day course with teamwork at simulation centre. Changes in knowledge was assessed by a 185 question Multiple – choice questionnaire completed upto 3 weeks before and 3 weeks after the training intervention. The study showed there was a significant increase in knowledge following training: mean MCQ score increased by 20.6 points. Overall, participants increased their MCQ score. ²
BAILEY P et al (2006) conducted a research at USA on the availability of life-saving obstetric services in developing countries: an in-depth look at the signal functions for emergency obstetric care. The basic signal functions include parenteral antibiotics, anticonvulsants and oxytocics, and the procedures of manual removal of the placenta, removal of retained uterine products, and assisted vaginal delivery. Comprehensive functions include the six basic functions, cesarean delivery and blood transfusion. Data collected from 1906 health facilities in 13 countries indicate that the most likely functions tobe reported are antibiotics and oxytocics. The basic function least likely to be reported is assisted vaginal delivery. Many of the facilities surveyed did not have the infrastructure to perform operation or provides blood transfusion. ³
SAIZONOU J et al (2006) conducted study on, to evaluate emergency obstetric care and the perceptions and expectations of women who experienced “near miss” events to improve maternal health in Benin. Qualitative survey done in seven hospitals at the three-referral levels of the health pyramids from July to October 2003. They used two methods: 557 women near miss events were interviewed in hospital and a standard questionnaire completed; then semi- structured individual interviews were conducted at home with 42 of these 557 women. The study showed provided care, accommodation, facilities, costs and modalities of recovery, hygiene of the premises, dynamism, expertise, social support, behaviors and attitude of staff were the criteria used to express patients’ satisfaction. Most women interviewed in hospital happy with physical access, organization, functioning and environment. However excessive costs and coercive recovery of the expenses, failure of the referral system, lack of empathy and discrimination of the nursing staff, lack of resources for emergencies, lack of hygiene and comfort of the premises were criticized by the women interviewed at home. 4
ONAH HE et al (2005) conducted a study on, in order to assess the current level of maternal mortality in health institutions with comprehensive emergency obstetric care in Enugu state, south Easter, Nigeria, a retrospective analysis of maternal deaths for the year 1999-2003 was carried out to establish the maternal mortality ratios in the eligible health institutions. Each maternal death was studied in detail to establish the socio-demographic characteristics of the women who died; their referral sources, type of delay (If any), medical causes of death and their preventability. In depth interviews of the service provides were carried out to throw more light on the maternal mortality situation in the state. Five out of seven eligible health institutions were studied. Within five-year period (1999-2003) there were 141 maternal deaths and 18,257 live births giving a maternal mortality ratio of 772 maternal deaths per 100,000. The folders of 89 out of 141 women who died were retrieved. Of these 89 maternal deaths, 51.7% of them were unemployed, 52.4% were referred from private hospital’s; type 3 delay was the commonest type of delay encountered in the care of the women. It also showed some discrepancies between reality and the health provider perception of the magnitude of maternal mortality situation in the state. Maternal mortality remains high due to type 3 delays. Most of the reference comes from private hospitals, hence the need to retain the private practitioner in emergency obstetric care. 5
Filippi V, et al (2005) conducted study on, to examines near – miss obstetric events in African hospital as to the frequency, nature, and ratio of near miss to death and considers whether these could become useful indications for monitoring the performance of obstetric services in Africa. Prospective or the retrospective reviews of the medical records were conducted in nine referral hospitals in three countries (Benin, Cote d’Ivoire, & Morocco). They calculated the incidence of near miss, obstetric events, near miss cases and maternal deaths related to hemorrhage, hypertensive disease of pregnancy, dystocia, infections and anemia and analyzed these according to hospital and timing relative to admission. In this study they found that the incidence of near – miss cases was varied, and some hospitals extremely large; from 1% to almost a quarter of all deliveries were near misses. Near – miss cases were 15 times more common than deaths. The most frequent types of NMEs were hemorrhage and hypertensive diseases of pregnancy, but anemia was the leading cause in three first referred level hospital in Benin and cote d’Ivoire. Near miss events due to infections were rare. 6
BOYLE JJ (2005) conducted a study on, to assess the incidence risk factors and outcomes of umbilical cord prolapse in current obstetrics practice. The study was a retrospective chart review at both a community hospital and a tertiary referral center. Study shows there were 52 cases of cord prolapse in patient population. Of viable singleton pregnancies with frank prolapse. The rate was 1.6/1000. In this series they found an approximately 40% higher rate of frank cord prolapse in induced patients at the community hospital than in general population. Other than 2 fetal deaths related to extreme prematurity, all mother and infant did well. 7
Mc CORD C et al (2001) conducted a study on efficient and effective emergency obstetric care in a rural Indian community where most deliveries are at home. The study was conducted in a part of rural Maharastha. India. 2905 pregnancies were identified and followed to term to learn the number and types of complications, where these complications treated, how many women received Emoc and how these services affected outcome, The outcome or the study was 85%of 2861 deliveries after 24 weeks were at home. A total of 14.4%of deliveries, 78.9% were in a hospital, 48% of hospital deliveries were in a private hospital, 35% in project hospital and 18% in the government hospital, total obstetric complication hospitalized was 11.4%. Overall case fatality was 0.5%. However there were only two maternal deaths from obstetric complication. These outcome and process indicators are better than those reported in most of India, but both maternal deaths can be prevented by early referral to hospital. 8
Gilbert WM, Danielsen B (1999) conducted a study on to examine the risk factors and pregnancy outcome associated with 53 cased of amniotic fluid embolism that occurred in California during the 2 year period January 1, 1994 to December 31st, 1995. Data were obtained from a computerized database that contains linked records from the vital statistics birth certificate and hospital discharge summaries of both mother and newborn. The study shows that there were 1,094,248 deliveries during that 2-year period. 53-singleton gestation had the diagnosis of amniotic fluid embolism, for a population frequency of one per 20,646 deliveries. 14 women with amniotic fluid embolism died, for a maternal mortality rate of 26.4%. There were 35 diagnosed of disseminated intravascular coagulation (DIC), 38 diagnosis of hemorrhage, and 25 diagnoses of obstetric shock. Among 14 women who died, the frequency of DIC and hemorrhage was not different compared with that of then survivors. The average maternal length of stay for survivors was 6.5days. 9
ZIADEH SM et al (1996) conducted a research on, to determine the etiological factors of uterine rupture during labor, and propose preventive measures in north Jordan. This retrospective study was performed between February 1989 and July 1994, to analyze the cases of rupture uterus in relation of causes, age, parity, maternal and fetal mortality and morbidity. The study shows there were 37 cases of uterine rupture at institutions. Obstructed labor by malpresentation and disproportion was the main cause. The presence of previous caesarean section scar, dysfunctional labor, injudicious use of uterine stimulant, were the other causes. There was no maternal death and fetal loss was 17 (46%). 10
STATEMENT OF THE PROBLEM
“A STUDY TO ASSESS THE EFFECTIVENESS OF STRUCTURED TEACHING PROGRAMME REGARDING THE KNOWLEDGE ON OBSTETRICS EMERGENCIES AMONG DIPLOMA NURSING INTERNSHIP STUDENTS OF SELECTED NURSING SCHOOLS AT TUMKUR”
6.3 OBJETIVES OF THE STUDY
1. To assess the knowledge of diploma nursing internship students regarding obstetric emergencies before administering the structured teaching program in the selected schools of nursing.
2. To develop structured teaching program on obstetric emergencies among diploma nursing internship students of selected nursing schools at Tumkur.
3. To assess the effectiveness of structured teaching program on obstetric emergencies among diploma nursing internship students of selected nursing schools at Tumkur.
4. To associate the pre and post Score regarding obstetric emergencies among diploma nursing internship students of selected nursing schools at Tumkur.
6.4 OPERATIONAL DEFINITION
ASSESSMENT – It refers to the organized systematic variables process of collecting information about pre test and post test knowledge from diploma nursing internship students regarding obstetric emergencies.
EFFECTIVENESS-
It refers to the extent to which the structured teaching programme on obstetric emergencies achieves desired effect in improving the knowledge of diploma nursing internship students as evident from gain in knowledge scores.
STRUCTURED TEACHING PROGRAMME-
It refers to the systematically developed institution method and teaching aids designed for diploma nursing internship students to provide information on obstetric emergencies.
KNOWLEDGE- It refers to correct responses of the diploma nursing internship students to knowledge items on obstetric emergencies as achieves by knowledge scores.
DIPLOMA NURSING INTERSHIP STUDENT - In this study it refers to all diploma nursing students who already appeared final year examination on obstetrics and gynecological nursing and are gained practical experience in the field.