I. INTRODUCTION:

PPH is a major cause of morbidity and mortality within the first 24 Hours following delivery PPH is commonly defined as a blood loss of 500 ml or more within 24 hours after birth (WHO).¹ The most common cause of post-delivery hemorrhage, in appropriate order of frequency, is mismanagements of the third stage of labor, uterine atony and laceration of birth canal. Hematological disorders or complications of pregnancy may be factors in postdelivery hemorrhage. Other factors may include tumors of the cervix or uterus, medical complications of pregnancy or infection with genital tract.²

Postpartum haemorrhage is managed by medical, non-medical and surgical interventions. There are two approaches to the clinical management of the third stage labor (the period from the birth of the child until the placenta is delivered): expectant and active management. Expectant management involves allowing the placenta to deliver spontaneously or aiding by gravity, maternal effort or nipple stimulation. Uterotonic agents are given only if there is excessive bleeding, and the cord is clamped later. Active management of third stage of labor involves a prophylactic administration of uterotonics before delivery of the placenta, late cord clamping, and controlled cord traction (in settings where skilled birth attendants are available). These procedures enable the uterus to contract immediately, decreasing the amount of time necessary to deliver the placenta.³

The risk of maternal mortality from haemorrhage is 1 in 1 000 deliveries in developing countries (100 per 100 000 live births). Most deaths (about 99%) from PPH occur in low and middle income countries compared with only 1% in industrialized nations. However, recent studies have shown an increase in the incidence of PPH in developed countries as well.⁴About 830 women die from pregnancy or childbirth-related complications around the world every day. 52% of maternal deaths are attributable to three leading preventable causes-haemorrhage, sepsis, and hypertensive disorders. WHO statistics suggest that 25% of maternal deaths are due to PPH. Postpartum bleeding is the quickest of maternal killers; can kill even a healthy woman within two hours, if not treated.Incidence of PPH is reported as 2% - 4% after vaginal delivery and 6% after cesarean section; with uterine atony being the cause in about 50% cases. Every year about 14 million women around the world suffer from postpartum haemorrhage.⁵

II. MATERIAL AND METHODS:

Research approach:

In order to achieve the desired objectives of this quantitative research comparative approach was adopted.

Research design:

This study is a pre-experimental two group study because there was randomization.

Variable:

· The independent variable: In the present study the independent variable are lecture method and power point presentation on post-partum haemorrhage

· The dependent variable: In the present study the dependent variable is knowledge of b.sc. Nursing fourth year students of R.D. Memorial college of Nursing, Bhopal

Setting of the study:

The setting for the present study is R.D. Memorial college of Nursing, Bhopal.

Population:

The target population for the present study consists of B.Sc. Nursing fourth year students of R.D. Memorial college of Nursing, Bhopal.

Sample and sampling technique:

Simple random sampling technique with lottery method will be used for this study.

Sample size:

The sample for the present study comprises of 40 B.Sc. Nursing fourth year students of R.D. Memorial college of nursing, Bhopal.

Sampling criteria:

The sample selection was based on the following inclusion and exclusion criteria.

Inclusion criteria:

The inclusive criteria for the sample selection are:

· B.sc. Nursing students who are studding in fourth year B.Sc. Nursing.

· Who are willing to participate.

Exclusion criteria:

The exclusive criteria for the sample selection are:

· Who are studying in first, second and third year of b.sc. Nursing.

· Who are absent during pre-test, teaching program or post-test.

Data collection techniques and tools:

In this study data collection tools are:

· Socio demographic variable

· Assessment of assess knowledge of fourth year b.sc. Nursing students R.D. Memorial college of Nursing, Bhopal” on postpartum haemorrhage.

Development of tool:

For the selection of the items and preparation of the tool, the following steps were taken.

· Literature review:-review of research and non-research literature used in the area related to post-partum haemorrhage

· Validity of tool:-opinions and suggestions from experts, helped in determining the important areas to be included.

· Reliability

Description of tool:

On modifying the tool as per the expert’s suggestion the final tool consists of two parts.

· Part I: It is designed to obtain general information of the respondents and it consists of demographic variables of fourth year students of R.D. Memorial College of Nursing, Bhopal”. Information on demographic variables of respondents containing items such as Age, Gender, Residential area, Religion, Social class, Source of knowledge regarding Post-partum haemorrhage

· PART II: It consists of 30 items to assess knowledge of fourth year B.Sc. Nursing students of R.D. Memorial College of Nursing, Bhopal” on postpartum haemorrhage.

III. RESULT:

This chapter deals with the analysis and interpretation of data collected using structured multiple questionnaires. Data were collected about the socio demographic profile, pre test knowledge were assessed (Lecture Versus PowerPoint presentation) and after awareness programme post test knowledge were assessed (Lecture Versus PowerPoint presentation) on postpartum hemorrhage. The sample size is of 40B.Sc. Nursing fourth year students. The data has been processed and analysed in a systematic fashion. The data was analysed according to the objective of the study using descriptive and inferential statistics.

The analysis is described in six sections:

Section I: description of demographic characteristics of sample for lecture method and of powerpoint presentation

Analysis of the demographic data of the samples of lecture method.

· Age wide distribution of the demographic variable in Group-I for lecture method reveals that the majority 9 (45%) respondents belongs to the age group of 21-22years, while 2 (10%) in the age group of below-20 years of age 8 (40%) participants respondents in the age group of 22-24 year of age 1(5% )of participants are respondents and in the age group of 24-above.

· Gender wide distribution of the demographic variable in Group-I for lecture method reveals that the majorities 20 (100%) of the respondents were female and none of the respondents were male.

· Residential area wide distribution of the demographic variable in Group-I for lecture method reveals that about 9 (45%) of the respondents are belongs to the urban area and 11(55%) of respondents are belongs to the rural area

· Religion wide distribution of the demographic variable in Group-I for lecture method reveals that shows about 13(65%) students belongs to Hindu Religion, 3(15%) participants belongs to the Muslim , 3(15%) participants belongs to the Christian and 1(5)% participants belongs to the other class.

· Social class wide distribution of the demographic variable in Group-I for lecture method reveals that about 13(65%) students belongs to the middle class , 2(10%) participants belongs to the upper class, and 5(25%) participants belongs to the economic condition between lower class

· Source of previous knowledge wide distribution of the demographic variable in Group-I for lecture method reveals that 5 (25%) of the respondents are have previous source of knowledge is Lecture, 10(50%) respondents are Clinical field experience 2(10%) respondents are mass media and 2(10%) respondents are training programme and 1(5%) of respondents are any other if specify.

Analysis of the demographic data of the samples of powerpoint presentation:

· Age wide distribution of the demographic variable in Group-II for Power point presentation method reveals that the majority 14(70%) percent respondents belongs to the age group of 21-22years, 1(5 %) in the age group of below-20years of age , 5(25%)% participants respondents, in the age group of 22-24 year of age none of participants are respondents and in the age group of 24-above

· Gender wide distribution of the demographic variable in Group-II for Power point presentation method reveals that the majority 20(100%) of the respondents were female and none of the respondents were male

· Residential area wide distribution of the demographic variable in Group-II for Power point presentation method reveals that about 6(30%) of the respondents are belongs to the urban area and same 14(70%) of respondents are belongs to the rural area.

· Religion wide distribution of the demographic variable in Group-II for Power point presentation method reveals that about 15(75%) students belongs to Hindu class 3(15%) participants belongs to the Muslim, 1(5%) participants belongs to the Christian and 1(5%) participants belongs to the other class.

· Social class wide distribution of the demographic variable in Group-I for lecture method reveals that about 14(70%) students belongs to the middle class,2 (10%) participants belongs to the upper class, and 4(20%) participants belongs to the economic condition between lower class.

· Source of previous knowledge wide distribution of the demographic variable in Group-I for lecture method reveals that about that 7(35%) of the respondents are Lecture, none of respondents are Clinical field experience 10(50%) respondents are mass media and 3(15%) of the respondents are training programme.

Section II: It deals with the analysis of the data related to knowledge of B.Sc. Nursing fourth year students after and before administering the lecture method:

Figure 1. Bar graph distribution showing score for pretest knowledge of B.Sc. Nursing fourth year students for lecture method

The data presented in the figure no. 1 indicates that 14(70%) B.Sc. nursing forth year student have poor knowledge and 6(30%) have average knowledge and none have good knowledge .The mean (10.15) and SD (1.3) also justify the knowledge of B.Sc. Nursing fourth year in the pretest.

Figure 2. Bar graph distribution showing score for pretest knowledge of B.Sc. Nursing fourth year students for lecture method

The data presented clearly indicates that 15(75%) B.Sc. nursing forth year student have average knowledge and 5 (25%) have good knowledge and none have poor knowledge. The mean (18.68) and SD (1.37) also justify the knowledge of B.Sc. Nursing fourth year in the posttest

Section III: It deals with the analysis of the data related to knowledge of B.Sc. Nursing fourth year students after and before administering the power point presentation

Figure 3. Bar graph distribution showing score for pretest knowledge of B.Sc. Nursing fourth year students for power point presentation

The data presented in the figure no. 3 full fill the objective (1) clearly indicates that 11(55%) B.Sc. nursing forth year student have poor knowledge and 9(45%) have average knowledge and none have good knowledge .The mean (10.45)and SD (1.53) also justify the knowledge of B.Sc. Nursing fourth year in the pretest.

Figure 4. Bar graph distribution showing score for post test knowledge of B.Sc. Nursing fourth year students for power point presentation

The data presented clearly indicates that none B.Sc. nursing forth year student have poor knowledge and 4(20%) have average knowledge and 16(80%) have good knowledge. The mean (21.56)and SD (1.9) also justify the knowledge of B.Sc. Nursing fourth year in the post test.

Section IV:-It deals with the effectiveness knowledge of B.Sc. Nursing students by comparing knowledge score before and after administration of lecture method and PowerPoint presentation

Figure 5. Bar graph distribution showing comparison score for knowledge of B.Sc. Nursing fourth year students for lecture method

The figure no.5 shows the comparison between pretest and posttest knowledge made by t-test. (t value = 5.37) The pretest and posttest knowledge was statistically tested by applying t-test method at the level of 0.05%. Hence there will significant difference in the mean pre- test and posttest knowledge score is accepted.

Figure 6. Bar graph distribution showing comparison score for knowledge of B.Sc. Nursing fourth year students for Powerpoint presentation

The figure no.6 shows the comparison between pre and post knowledge made by t-test.(t value = 5.2) The pretest and posttest knowledge was statistically tested by applying t-test method at the level of 0.05%. Hence there will significant difference in the mean pre- test and posttest knowledge score is accepted.

Figure 7. Bar graph distribution showing comparison of effectiveness of lecture method and powerpoint presentation of B.Sc. Nursing fourth year students

The comparison between lecture method and PowerPoint presentation (tvalue= 5.37) of lecture method and (t value = 5.2) of PowerPoint presentation. Hence PowerPoint presentation is more effective than lecture method.

Section- V:-This section deals with the association of knowledge score of B.Sc. Nursing forth year students with selected demographic variables for lecture method

Table 1. Association of pretest knowledge of B.Sc. Nursing forth year students with selected demographic variables for lecture method (n=40)

S.NO	Variables	Poor	Average	Good	Total	df	Chi-value	P-value	Inference
1	Age (Yrs)
	<20 Yrs	0	1	0	1
	>20-22 Yrs	10	4	0	14	6	60	0	S
	>22-24 yrs	4	1	0	5
	>24 Yrs	0	0	0	0
2	Gender
	Male	0	0	0	0
	Female	14	6	0	20	2	3.25	0.521	NS
3	Residential area
	Urban	4	2	0	6
	Rural	10	4	0	14	2	10.57	0.0025	S
4	Religion
	Hindu	13	2	0	15
	Muslim	1	2	0	3	6	6.325	0.125	NS
	Christian	0	1	0	1
	Other	0	1	0	1
5	Social Class
	Upper	0	2	0	2
	Middle	12	2	0	14	4	15.56	0.0002	S
	Lower	2	2	0	4
6	Source of knowledge
	Lecture	2	5	0	7
	Clinical field	0	0	0	0
	Media	9	1	0	10	8	14.52	0.00015	S
	Training	3	0	0	3
	Other	0	0	0	0

Section VI: this section deals with the association of knowledge score of B.Sc. Nursing forth year students with selected demographic variables for power point presentation

Table 2. Association of pretest knowledge of B.Sc. Nursing forth year students with selected demographic variables for power point presentation (n=40)

S.NO	Variables	Poor	Average	Good	Total	Percentage	df	Chi-value	P-value	Inference
1	Age( Yrs)
	<20 Yrs	2	0	0	2	10
	>20-22 Yrs	6	3	0	9	45	6	80	0	S
	>22-24 yrs	2	6	0	8	40
	>24 Yrs	1	0	0	1	5
2	Gender
	Male	0	0	0	0	0
	Female	11	9	0	20	100	2	4.68	0.3254	NS
3	Residential area
	Urban	8	4	0	9	45
	Rural	6	5	0	11	55	2	12.62	0.0037	S
4	Religion
	Hindu	6	7	0	13	65
	Muslim	3	2	0	3	15	6	5.14	0.214	NS
	Christian	3	0	0	3	15
	Other	1	0	0	1	5
5	Social Class
	Upper	1	1	0	2	10
	Middle	7	6	0	13	65	4	12.7	0.0003	S
	Lower	3	2	0	5	25
6	Source of knowledge
	Lecture	3	2	0	5	25
	Clinical field	8	2	0	10	50
	Media	0	2	0	2	10	8	11.3	0.0001	S
	Training	0	2	0	2	10
	Other	0	1	0	1	5

(Result significant at 0.05% level of significance)

Description:

Table No 1 and 2 reveals that the association between knowledge of B.Sc. Nursing fourth year students regarding post-partum haemorrhage with selected demographic variables is statistically tested by applying chi-square test all the variables age, residential area, social class sources of knowledge was found significant.

Hence objective no. 5 and 6 associate mean pre-test knowledge score with selected demographic variables is fulfilled, H2 significant association between mean pre- test knowledge score with selected demographic variables. is accepted.

Significant:

Age, residential area, Social class and sources of knowledge

Not significant:

Gender and religion

IV. DISCUSSION:

Section I- It deals with analysis of the demographic data of the samples of lecture method.

· Gender wide distribution of the demographic variable in Group-I for lecture method reveals that the majorities 20 (100%) of the respondents were female and none of the respondents were male.

Section II-It deals with analysis of the demographic data of the samples of powerpoint presentation

Section III – It deal with the analysis of the data related to knowledge of B.Sc. Nursing students before and after administering the lecture method

In analysis of data related to knowledge of B.Sc. Nursing students before and after administering the lecture method reveals that:

· In pretest knowledge score of the lecture method 14(70%) B.Sc. nursing forth year student have poor knowledge and 6(30%) have average knowledge and none have good knowledge. The mean (10.15)and SD (1.3 ) also justify the knowledge of B.Sc. Nursing fourth year in the pretest.

· In posttest knowledge score of the lecture method 15(75%) B.Sc. nursing forth year student have average knowledge and 5 (25%) have good knowledge and none have poor knowledge. The mean (18.68) and SD (1.37) also justify the knowledge of B.Sc. Nursing fourth year in the posttest.

Section IV – It deals with the analysis of data related to knowledge of B.Sc. Nursing students before and after administrating the PowerPoint presentation.

In analysis of data related to knowledge of B.Sc. Nursing students before and after administering the Power point presentation reveals that:

· In pretest knowledge score of the Power point presentation 11(55%) B.Sc. nursing forth year student have poor knowledge and 9(45%) have average knowledge and none have good knowledge .The mean (10.45) and SD (1.53) also justify the knowledge of B.Sc. Nursing fourth year in the pretest.

· In posttest knowledge score of the Power point presentation none B.Sc. nursing forth year student have poor knowledge and 4(20%) have average knowledge and 16(80%) have good knowledge. The mean (21.56) and SD (1.9) also justify the knowledge of B.Sc. nursing fourth year in the post test.

Section V –It deals with the assessment of effectiveness knowledge of B.Sc. Nursing students by comparison of knowledge score before and after administration lecture method and PowerPoint presentation

· In lecture method the study found pretest mean 10.15 and SD 1.3 and Posttest mean 18.68 and SD 1.37. The comparison between pre and post knowledge made by t-test.(t value = 5.37) The pretest and posttest knowledge was statistically tested by applying t-test method at the level of 0.05%. Hence there will significant difference in the mean pre- test and posttest knowledge score is accepted.

· In power point presentation method the study found pretest mean 10.45 and SD 1.53 and Posttest mean 21.56 and SD 1.9. The comparison between pre and post knowledge made by t-test.(t value = 5.2) The pretest and posttest knowledge was statistically tested by applying t-test method at the level of 0.05%. Hence there will significant difference in the mean pre- test and posttest knowledge score is accepted.

Section VI –It deals with the assessment of effectiveness knowledge of B.Sc. Nursing students by comparison of knowledge score after administration lecture method and PowerPoint presentation

· The study found that in lecture method the mean score 18.68 and SD 0.98 and in power point presentation the mean score 21.56 and SD 1.9. The comparison between lecture method and PowerPoint presentation (t-value= 5.37) of lecture method and (t value = 5.2) of PowerPoint presentation. Hence Power Point presentation is more effective than lecture method.

Section VII- It deals with the association of knowledge score of B.Sc. Nursing students with selected demographic variables.

· The association between knowledge of B.Sc. Nursing fourth year students regarding post-partum haemorrhage with selected demographic variables is statistically tested by applying chi-square test.

· The study reveals that the variables like age, residential area, social class and sources of knowledge was found significant. Other variables like gender and religion were not found significant. Hence significant association between mean pre- test knowledge score with selected demographic variables found.

V. CONCLUSION:

The conclusion of study found that in lecture method the mean score 18.68 and SD 0.98 and in power point presentation the mean score 21.56 and SD 1.9. The comparison between lecture method and PowerPoint presentation (t-value= 5.37) of lecture method and (t value = 5.2) of PowerPoint presentation. Hence PowerPoint presentation is more effective than lecture method.

VI. REFERENCES:

1. DC Dutta’; Text Books of Obstetrics; Eighth Edition; Jaypee Brothers Medical Publishers (P) Ltd; 474-484.

2. Bobak- Jensen; Essential of Maternal Nursing; 3rd Edition; mosby Year Book; 682-85.

3. World Health Organization. WHO recommendations for the prevention and treatment of postpartum haemorrhage [Internet]. World Health Organization; 2012 [cited 2013 Jan 14]; http://apps.who.int/iris/bitstream/10665/75411/1/9789241548502_eng.pd

4. https://www.who.int/medicines/areas/priority_medicines/Ch6_16PPH.pdf

5. https://www.who.int/medicines/areas/priority_medicines/Ch6_16PPH.pdf

Received on 28.01.2020 Modified on 19.02.2020

Asian J. Nursing Education and Research. 2020; 10(2):175-182.

DOI: 10.5958/2349-2996.2020.00038.5