INTRODUCTION:

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality. Postpartum hemorrhage is blood loss from genital tract exceeding 500ml within twenty-four hours of delivery and is a leading cause of maternal deaths in many countries causing very high maternal mortality. Ante partum hemorrhage (APH) and Postpartum hemorrhage (PPH) are the leading causes of direct Obstetric death and are unpredictable.

Two-thirds 2 of PPH occur in women with no identifiable risk factors. Without proper management, PPH can rapidly progress to cause life threatening blood loss, often within few hours.¹

The most common cause of PPH is uterine atony. Active management of the third stage of labour, which is an evidence-based intervention for the prevention of uterine atony, has been promoted in developing countries. However, both accurate knowledge about preventive measures of PPH during intranatal period and its correct use remain low in developing countries. Since approximately 65% of deliveries in developing countries are now supervised by a skilled health-care provider, it should be possible to expand the use of preventive measures of PPH during intranatal period.²

Maternal mortality in India continuous to remain unacceptably high since the last 6 years. Major cause of these deaths have been identified as hemorrhage (29%), anaemia (19%), puerperal sepsis (16%), obstructed labour (10%), unsafe abortion (9%), toxemia of pregnancy (8%) and others (8%)³.

According to WHO estimates, about 65% of all births in India occur at home of which 35% are attended by dais (Traditional birth attendants), 11% by nurses and 30% by doctors. Preventive measures of PPH during intranatal period is recommended for, every women, every birth and for every skilled provider. Every birth attendant must have access to needed supplies and equipment and acquired knowledge, skills, and critical judgment to carry out preventive measures of PPH during intranatal period⁴.

NEED OF THE STUDY:

Every minute of every day, somewhere in the world and most often in a developing country, a woman dies from complications related to pregnancy or childbirth. That is 515,000 women, at a minimum, dying every year. Nearly all maternal deaths (99 percent) occur in the developing world--making maternal mortality the health statistic with the largest disparity between developed and developing countries. Pregnancy related complications are among the leading causes of death and disability for women age 15-49 in developing countries⁵.

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide with a prevalence rate of approximately 6%; Africa has the highest prevalence rate of about 10.5%. Maternal Mortality Rate (MMR) in India is estimated as 200/100000 LB (2010-12) and PPH accounting for 30–35% of these deaths but in Rajasthan 264/100,000 live birth (2011-12)⁶.

Staff nurses should have both the privilege and responsibility of caring for women during labour and birth in hospital setting. The goal during the intranatal period is to promote that well-being of the women, her baby. Nurses caring for women during labour and childbirth should have the knowledge about the normal andabnormal processes of labour and birth have a mastery of appropriate technical skills, communicate and collaborate well to cope with emergency conditions⁷.

The investigator during her clinical experience in labour and maternity wards at Mahila Chikitsalya, Jaipur had found that the nurses are not fully aware of the components and advantages of preventive measures of PPH during intranatal period and its importance in preventing postpartum haemorrhage.

OBJECTIVES:

1. To assess the existing level of knowledge regarding preventive measures of PPH during intranatal period among staff nurses working in selected hospital.

2. To evaluate the effectiveness of structured teaching programme on knowledge regarding preventive measures of PPH during intranatal period among staff nurses working in selected hospital.

3. To compare pre-test knowledge score and post-test knowledge score.

4. To find out the association between post-test knowledge scores and selected demographic variables of staff nurses.

HYPOTHESES:

H1_:The mean post–test knowledge scores of staff nurses will be higher than their mean pre-test knowledge scores at 0.05 level of significance.

H2: There will be a significant association between pre-test knowledge scores of staff nurses and selected demo graphic variables at 0.05 level of significance.

MATERIALS AND METHODS:

Research approach:

In view of the nature of the problem selected for the present study and the objectives to be accomplished a quantitative research approach was considered appropriate for the present study.

Research design:

The research design used for the present study is pre experimental: one group pre –test post-test design.

Research setting:

The setting planned for this particular study was selected hospital that was Mahila Chikitsalaya, Sanaganeri Gate, Jaipur, Rajasthan, India.

Research population:

In this study the population consists of staff nurses who were working in selected hospital.

Sample size:

The samples for the present study were 60 staff nurses and selected according to inclusion and exclusion criteria.

Sampling technique:

Sampling is the process of selecting a portion of population to represent it. Based on the criteria of the study, convenient sampling was used to select the sample.

Tool of the study:

Tool of the study comprised of questionnaire which consists of demographic variables questionnaire and structured knowledge questionnaire to assess the pre and post test knowledge of staff nurses. Tool was developed after review of literature and validated by nursing experts. Structured teaching programme was also developed after thorough review of literature and also validated by nursing experts.

Data Collection:

Data was collected from staff nurses after pilot study and reliability of the tool. Data was collected between March 9, 2016 to April 9, 2016 at Mahila Chikitsalaya Jaipur and collected after formal permission from competent authority. Informed consent was taken from the samples and ethical consideration was followed. First pretest was conducted then implemented structured teaching programme and after 7 days, post test was conducted. Data was organised in master data sheet after collection.

Data analysis and interpretation:

Descriptive and inferential statistic was used to analyse and interpret the data.

RESULT:

Table 1: Socio-demographic variable of staff nurses working in selected hospital (N=60)

S. No.	Demographic variable	Criteria	Frequency (F)	%
1	Agein years	20-30	10	16.7
		31-40	25	41.6
		41-50	15	25
		Above50	10	16.7
2	Gender	Male	6	10
2	Gender	Female	54	90
3	Religion	Hindu	42	70
		Muslim	3	5
		Christian	15	25
		Any other specify	-	-
4	Qualification	ANM	5	8.3
		GNM	45	75
		B.Sc.(Nursing)	10	16.7
		In other discipline	-	-
5	Source of information	Health personnel’s	30	50
		Mass media	20	33.4
		Family members	5	8.3
		Others	5	8.3
6	Total years of experience	<5Years	20	33.3
		5-10Years	15	25
		10-15Years	15	25
		>15Years	10	16.7

Table 2: Level of pre –test knowledge of staff nurses regarding preventing measures of postpartum haemorrhage during intranatal period (N=60)

S. No.	Levels of knowledge	Frequency (f)	Percentage (%)
1	Moderate	43	71.67
2	Adequate	17	28.33
3	Total	60	100

The data presented in the table 2 described that in the pre-test, majority of the respondents (71.67%) had moderate knowledge level and 28.33% respondents had adequate knowledge level on preventing measures of postpartum haemorrhage during intranatal period.

Table 3 overall mean, mean% and standard deviation of pre-test knowledge scores of staff nurses on preventing measures of postpartum haemorrhageduringintranatal period (N=60)

TEST	MEAN	MEAN %	SD
PRE-TEST	17.87	68.72	3.17

Table 4 Level of post –test knowledge of staff nurses regarding preventing measures of postpartum haemorrhage during intranatal period (N=60)

S. No	Levels of knowledge	Frequency (f)	Percentage (%)
1	Moderate	10	16.67
2	Adequate	50	83.33
3	Total	60	100

The data presented in the table 4 described that in the post-test, majority of the respondents (83.33%) had adequate knowledge level; while, 16.67% respondents had moderate knowledge level on preventing measures of postpartum haemorrhage during intranatalperiod.

Table 5: overall mean, mean% and standard deviation of post-test knowledgescores of staff nurses on preventing measures of postpartum haemorrhageduringintranatal period. (N=60)

TEST	MEAN	MEAN %	SD
POST-TEST	23.12	88.91	2.29

Fig. 1: comparison of pre-test and post-test knowledge level of staff nurses.

Table 6: Effectiveness of structured teaching programme in terms of comparing overall pre and post-test knowledge scores (N=60)

		Pre- test	Post- test	Mean Difference	t-value*	Df	Paired t-test tabulated value	Level of Significance
Overall Knowledge	Mean	17.87	23.12	5.25	16.43	59	2.00	Significance
	SD	3.17	2.29	-
	Mean %	68.72	88.91	20.19%

Table 7: association between post-test knowledge score and selected demographic variables N=60

S. No	Variable	Categories	Level of Knowledge		df	χ2 Value	Table value	LOS
			Moderate	Adequate
1.	Agein years	20-30	1	9	3	1.741	7.815	NS
		31-40	6	19
		41-50	2	13
		Above50	1	9
2.	Gender	Male	1	5	1	0.068	3.841	NS
		Female	9	45
3	Religion	Hindu	5	37	3	2.365	7.815	NS
		Muslim	1	2
		Christian	4	11
		Any other specify	0	0
	Qualification	ANM	2	3	3	2.32	7.815	NS
		GNM	7	38
		B.Sc (N)	1	9
		Other	0	0
	Source of Information	Health Personnel	2	28	3	5.16	7.815	NS
		Mass media	5	15
		Family members	2	3
		Other	1	4
	Total years of experience	<5	3	17	3	1.56	7.815	NS
		5-10	2	13
		11-15	2	13
		>15	3	7

Table 6 and Bar diagram 1 shows that the pre-test mean score is 17.87(68.72%)and post test mean score is 23.12 (88.91%). Hence, the mean difference of the pre-test and post-test knowledge scores was 20.19% means knowledge of staff nurses was increased by 20.19%. The data also reveals that, there was a significant gain in the post-test scores. The gain in the knowledge score is significant (t=16.43). Therefore findings revealed that the structured teaching programme on preventing measures of postpartum haemorrhage during intranatal periods was effective.

DISCUSSION:

The result of pre test knowledge score of staff nurses revealed that the majority of respondents 43(71.67%) had moderate level knowledge; while, 17(28.33%) had adequate knowledge level regarding preventive measures of PPH during intranatal period. The mean score of participants was 17.87, mean percentage was 68.72% and standard deviation was 3.17.

The result of post test knowledge score of staff nurses revealed that majority of respondents 50(83.33%) had adequate knowledge level; while 10(16.67%) had moderate knowledge regarding preventive measures of PPH during intranatal period. The mean score of participants was 123.12, mean percentage was 88.91% and standard deviation was 2.29.

The results of association between post test knowledge score of staff nurses and their demographic variables i.e. age, gender, religion, qualification, source of information and total years of working experience revealed that the calculated value of chi square is smaller than the tabulated value at degree of freedom 3 and 1 at 0.05 LOS. Hence, there was no significant association between post test knowledge score of staff nurses regarding preventive measures of PPH with selected demographic variables. So research hypotheses is rejected and null hypotheses is accepted.

CONCLUSION:

It was analysed that28% subjects had adequate knowledge in the pre-test whereas 83.33% of the subjects had adequate knowledge in post-test. The mean Post-test percentage scores and the modified gain scores in all areas were found to be high. The ‘t’ test, which was computed between pre-test and post-test knowledge scores, indicated a true gain in the knowledge. Hence it was concluded that STP was effective as a method to improve knowledge among staff nurses.

CONFLICT OF INTEREST:

The authors have no conflicts of interest regarding this investigation.

ACKNOWLEDGMENTS:

The authors would like to thank God Almighty first and then authority who grant permission to conduct the study and last to participants who actively involved in study with cooperation.

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Received on 24.03.2024 Modified on 29.05.2024

Asian J. Nursing Education and Research. 2024;14(3):183-187.

DOI: 10.52711/2349-2996.2024.00036