A Quasi-Experimental Study on Skill Demonstration in Postnatal Care after Emergency LSCS at PGIMS, Rohtak: Empowering Nursing Students' Competencies

Priyanka¹, Sunita Ahlawat², Nidhi Ahlawat², Harsh Deswal³

¹Nursing officer, AIIMS Bhopal, Bhopal, Madhya Pradesh 462026, India.

²College of Nursing, PGIMS Rohtak, Rohtak, Haryana 124001, India.

³Junior Resident in Dr. Baba Saheb Ambedkar Hospital, Delhi, India.

*Corresponding Author Email: priyanka5reply@gmail.com

ABSTRACT:

This study looked at how a teaching method called Skill Demonstration impacts the knowledge and abilities of nursing students, specifically those learning about postnatal care for mothers who have undergone emergency cesarean sections. Conducted at PGIMS in Rohtak, Haryana, the research involved 60 fourth-year nursing students split into two groups: one that received the Skill Demonstration training and another that did not. To assess the students' understanding and practical skills before and after the training, they filled out questionnaires and checklists. The findings showed that the group that participated in Skill Demonstration significantly improved their knowledge and skills—jumping from an average score of about 19.5 to 24.8 for knowledge and from 24.1 to 35.6 for skills. In contrast, the control group saw only minor improvements. The analysis indicated clear differences in test scores before and after the training for the experimental group, and between this group and the control group after the training was complete. Additionally, the study found connections between the students' initial skill levels and certain background factors. In conclusion, the research highlights that Skill Demonstration is an effective teaching method for improving nursing students’ knowledge and abilities related to postnatal care for mothers recovering from surgery. Beyond enhancing specific nursing skills, this training also helps students develop broader professional abilities like teamwork, time management, and communication. By incorporating such programs into nursing education, we can help students transition more smoothly into their roles as professional nurses, ultimately leading to better care for new mothers.

KEYWORDS: Skill Demonstration, Postnatal care, Competencies, Nursing students.

INTRODUCTION:

Common methods of giving birth in the modern era include caesarean sections and vaginal deliveries. To guarantee the safety of mother and child, caesarean birth is an option to vaginal delivery that involves making an incision in the uterine wall. One of the most prevalent obstetric surgical procedures, caesarean sections have greatly enhanced obstetric care worldwide, lowering the rates of mother and foetal mortality.^1,2

New studies from the World Health Organisation (WHO) show that caesarean section use is still rising worldwide, currently responsible for more than 1 in 5 (21%) of all births. Nearly a third (29%) of all deliveries are expected to occur by caesarean section by 2030, so this figure will keep rising over the next ten years.³

Research demonstrates differing degrees of maternal awareness regarding Caesarean sections. In Manipur, India, 92.7% of pregnant women have insufficient understanding about Caesarean sections.⁴ In Nigeria, 82.3% were familiar with Caesarean sections, however many lacked knowledge of precise facts.⁵In Saudi Arabia, 94.2% of women were aware that a Caesarean section could preserve a newborn's life.⁶

At 17.2%, the caesarean rate in India from 2010 to 2016 was only little over the 15% limit suggested by the WHO. These numbers, however, did not match a simple 2.2% over the 15% limit. Among people totally denied access to caesarean births for economic or accessibility concerns, no less than 21.0% of deliveries nevertheless occurred at home. Conversely, 27.1% of deliveries occurred in private clinics with a caesarean rate of 40.4%, far over the WHO criterion.⁷

The postnatal period is a pivotal phase for both moms and newborns. Substantial transformations occur throughout this period that affect the health and wellness of both moms and infants. Moreover, to optimise the utilisation of postnatal health care services, postnatal programs must be periodically tailored to the mother's physical and psychological needs, rooted in traditional cultural practices and beliefs.⁸

Nurse education currently encounters two major challenges. The primary focus is on identifying the most effective methods for enhancing practitioners' skill levels. The second focusses on identifying methods to achieve this within the framework of lifelong learning. Addressing both challenges early, preferably at the collegiate level, is recommended. Numerous studies have demonstrated that a 'skills and drills' instructional approach can significantly enhance the capacities and self-confidence of students and staff within obstetric skills laboratories.

Therefore, this study was conducted with the objective of evaluating the effectiveness of Skill Demonstration by comparing the test scores of competencies among Bachelor of Science in Nursing fourth-year students at PGIMS, Rohtak.

MATERIALS AND METHODS:

The study employed a quasi-experimental, non-randomized control group design within a quantitative research framework. The participants were conveniently recruited B.Sc. Nursing students in their fourth year from the College of Nursing, PGIMS Rohtak, and KVM College of Nursing, Rohtak. The total sample comprised sixty students, divided equally into two groups: 30 students were allocated to the experimental group, while the remaining 30 formed the control group. Inclusion criteria were established to comprise fourth-year B.Sc. Nursing students who were present at the time of the study and expressed willingness to participate.

Description of the Tool:

The tool was developed in accordance with the study's objectives. The instrument comprised four sections. The initial section includes demographic data comprising 12 items: age, gender, religion, place of residence, prior academic performance, family type, mother's educational status, father's educational status, family income, prior knowledge, information sources, and presence of health professionals within the family. The second section comprises a self-structured questionnaire and checklist designed to evaluate the influence of skill demonstration on competencies among fourth-year BSc Nursing students concerning postnatal care for mothers following emergency LSCS. The self-structured knowledge questionnaire will focus on specific postnatal care topics, including postpartum care, postnatal exercise, breastfeeding, caesarean wounds, ambulation, and postnatal diet. The project will consist of six components and thirty items. Section three will present a checklist based on selected procedures of post-natal care, including breastfeeding techniques, wound care, and post-natal exercise. Three skill stations will be established, featuring a total of 44 items. The fourth section provided a description of the OSCE (Objective Structured Clinical Examination). The OSCE aimed to assess students' competencies in postnatal care for mothers who had undergone emergency LSCs following skill demonstrations. The OSCE content will focus on selected skills related to post-natal care, including breastfeeding techniques, wound care, and post-natal exercise. Three skill stations will be established, featuring a total of 44 items. The researcher administered the assessment by instructing students to perform specific skills, subsequently marking their responses with a pen or pencil. This document contains an observational checklist designed to evaluate the competencies related to postnatal care for mothers following emergency lower segment caesarean section (LSCS). The items were presented in a binary format of "yes" or "no."

Content validity:

Five experts were consulted for their insights and recommendations on the relevance, adequacy, and suitability of the items in the tool. This group included 3 nursing specialists and 2 medical professionals. The structured knowledge questionnaire contained 30 items, which were revised as necessary based on the experts' feedback.

Reliability:

A pre-test and post-test were conducted to evaluate the reliability of the tool, focussing on the impact of Skill Demonstration related to postnatal care for mothers with emergency LSCS on the competencies of nursing students who were assessed for reliability. In a pilot study, the Skill Demonstration was administered to six students; three were assigned to the experimental group at the College of Nursing, PGIMS, Rohtak, and three to the control group at K.V.M. College of Nursing. Utilising the split-half method, the reliability coefficient was found to be r = 0.92, indicating that the tool demonstrated strong reliability.

Ethical Considerations:

Institutional Ethics Committee of Pt. B.D. Sharma PGIMS CON Rohtak had approved pursuing this study.

Pilot Study:

With approval from the college administration, a pilot research was conducted from December 8 to December 13, 2021. Six fourth-year nursing students were involved, three from K.V.M. College of Nursing in Rohtak and three from Pt. B.D. Sharma, PGIMS, in Rohtak. All kids gave their informed consent prior to participation. In order to gather data, the researchers had the students complete a 30-minute knowledge assessment and used a checklist to evaluate their skills. Following the collection of data, a demonstration of the skills being learnt was given to the experimental group. A week later, a follow-up test was administered to assess their development. The pilot study revealed that Skill Demonstration improved knowledge (moderately adequate–adequate) and practice.

Data Collection Procedure:

The final study was conducted from March 9, 2022, to April 8, 2022. Formal permission was previously obtained from the institution's higher authorities. Informed consent was obtained from participants. The study's purpose was articulated to students in both groups beforehand. A self-structured questionnaire and checklist were administered to collect demographic data for assessing knowledge and skills related to postnatal care of mothers following emergency lower segment caesarean section (LSCS). Skill demonstration was conducted for the experimental group over three consecutive days, while the control group received no intervention. A post-test was administered after 7 days of intervention in the experimental group, while the control group received no intervention. The data collection period is four weeks.

Data Analysis Procedure:

The study's objectives were met by data collection, organisation, tabulation, and analysis. IBM SPSS was used to analyse data using descriptive and inferential statistics. A 0.05 (p<0.05) statistical significance criterion was maintained throughout the study. The frequency and percentage of demographic data and the mean and standard deviation of postnatal care knowledge and practice scores for moms who had emergency LSCS were assessed using descriptive statistics. The experimental and control groups' post-test mean scores were compared using an unpaired sample t-test. To determine if demographic characteristics affected pre-test scores in both groups, the Pearson chi-squared test was used.

RESULTS:

Table 1: Frequency and Percentage Distribution of Samples According to Socio-Demographic Variables

S. No	Socio-Demographic Variables		Experimental Group	Control Group
1	Age (Years)	20 – 22	17 (56.6 %)	21 (70.0 %)
		23 – 25	36 (43.4 %)	9 (30.0 %)
		Above 25	0 (0.0 %)	0 (0.0 %)
2	Gender	Male	0 (0.0%)	0 (0.0%)
2	Gender	Female	30 (100.0 %)	30 (100.0 %)
3	Religion	Hindu	30 (100.0 %)	30 (100.0 %)
		Muslim	0 (0.0 %)	0 (0.0 %)
		Christian	0 (0.0 %)	0 (0.0 %)
4	Residential Status	Rural	15 (50.0 %)	18 (60.0 %)
		Urban	15 (50.0 %)	12 (40.0 %)
		Others	0 (0.0 %)	0 (0.0 %)
5	Previous Academic Performance (%) in Annual Exam	60 – 70 %	4 (13.33 %)	4 (13.33 %)
		71 – 80 %	26 (86.7 %)	26 (86.7 %)
		81 – 90 %	0 (0.0 %)	0 (0.0 %)
		91 – 100 %	0 (0.0 %)	0 (0.0 %)
6	Type of Family	Nuclear	15 (50.0 %)	17 (56.6 %)
		Joint	15 (50.0 %)	13 (43.3 %)
		Extended	0 (0.0 %)	0 (0.0 %)
7	Educational Status of Father	Illiterate	0 (0.0 %)	0 (0.0 %)
		Primary	4 (13.3 %)	4 (13.3 %)
		Secondary	13 (43.3 %)	8 (26.6 %)
		Graduate and above	13 (43.3 %)	18 (60.0 %)
8	Educational Status of Mother	Illiterate	3 (10.0 %)	3 (10.0 %)
		Primary	11 (36.6 %0	9 (30.0 %)
		Secondary	10 (33.3 %)	10(33.3 %)
		Graduate and Above	6 (20.0 %)	8 (26.6 %)
9	Family Income Per Month	Rs 5000 – 10000	7 (23.3 %)	7 (23.3 %)
		Rs 10001 – 20000	5 (16.6 %)	5 (16.6 %)
		Rs 20001 – 30000	5 (16.6 %)	5 (16.6 %)
		Rs 30000 and above	13 (43.3 %)	13 (43.3 %)
10	Health Professionals in Family	Yes	11 (36.6 %)	11 (36.6 %)
10	Health Professionals in Family	No	19 (63.3 %)	19 (63.3 %)
11	Previous Knowledge	Yes	23 (76.6 %)	23 (76.6 %)
11	Previous Knowledge	No	7 (23.3 %)	7 (23.3 %)
12	Source of Information	Books	18 (60.0 %)	18 (60.0 %)
		Journals	0 (0.0 %)	0 (0.0 %)
		Classroom Teaching	7 (23.3 %)	7 (23.3 %)
		Any Other	5 (16.6 %)	5 (16.6 %)

The study involved a sample of participants aged 20-22 years, predominantly Hindu, and focusing on primi-postnatal mothers. The majority were female, with no representation from Muslim or Christian communities. The participants were equally distributed between rural and urban areas, with a slightly higher proportion residing in rural areas. The majority scored between 71-80% in their annual exams, with 86.7% achieving moderate to high academic scores. The experimental group had an equal distribution of nuclear and joint families, while the control group leaned slightly toward nuclear families.

Fathers' education was evenly distributed between secondary and graduate or above, with 13.3% having primary education. No fathers were illiterate, and the control group had a higher proportion of fathers with graduate-level education. Mothers' education varied, with 36.6% having primary education, 33.3% having secondary education, 20.0% graduate or above, and 10.0% illiterate.

Family income was highest in the Rs 30,000 and above category, followed by Rs 5,000-10,000 and both Rs 10,001–20,000 and Rs 20,001–30,000. Both groups had identical income distributions, indicating a socio-economically diverse sample. Both groups had health professionals in their families, suggesting similar exposure to healthcare-related knowledge or support.

The primary source of information was books, followed by classroom teaching and other sources. No participants cited journals, indicating similar educational exposure.

Table 2 presents the distribution of knowledge levels in both experimental and control groups, assessed before and after the intervention. Knowledge categories were classified as inadequate, moderately adequate, and adequate. The experimental group showed a marked improvement, with the proportion of participants possessing adequate knowledge rising substantially from 16.6% pre-intervention to 83.3% post-intervention, highlighting the intervention's efficacy. In contrast, the control group demonstrated minimal change, with adequate knowledge increasing marginally from 3.3% to 6.6% post-test, suggesting that without intervention, no significant impact on knowledge levels occurred.

The table-3 illustrates the distribution of practice levels among participants in both the Experimental Group and the Control Group at two key stages: Pre-Test and Post-Test. Initially, in the Experimental Group, a significant majority (73.3%) demonstrated a Good level of practice, while only 3.3% achieved an Excellent rating. Following the intervention, there was a substantial improvement, with 83.3% reaching an Excellent level, highlighting the effectiveness of the intervention. Conversely, the Control Group exhibited minimal changes between the two stages, as 86.6% consistently maintained a Good level, with only 3.3% attaining Excellent status both before and after testing. This noteworthy distinction between the groups emphasizes the positive impact of the intervention on enhancing practice levels, whereas the absence of such an intervention in the Control Group resulted in no significant changes.

Table 2: Frequency and Percentage Distribution of Samples According to level of Knowledge (N = 60)

Knowledge	Experimental Group			Control Group
Knowledge	Inadequate	Moderately Adequate	Adequate	Inadequate	Moderately Adequate	Adequate
Pre-Test	5(16.6 %)	20(66.6 %)	5(16.6 %)	9(30.0%)	20 (66.6 %)	1 (3.3 %)
Post-Test	1(3.33%)	4(13.3 %)	25(83.3 %)	9(30.0%)	19 (63.3 %)	2 (6.6 %)

Table 3: Frequency and Percentage Distribution of Samples According to level of Practice (N = 60)

Practice	Experimental Group			Control Group
Practice	Average	Good	Excellent	Average	Good	Excellent
Pre-Test	7 (23.3 %)	22 (73.3 %)	1 (3.3 %)	3 (10.0%)	26 (86.6 %)	1 (3.3 %)
Post-Test	1 (3.33%)	3 (10.0 %)	26 (83.3 %)	3 (10.0%)	26 (86.6 %)	1 (3.3 %)

Table 4: Comparison of the Mean and Standard Deviation of Post-Test Knowledge Between the Experimental and Control Groups (N=60)

Post-Test Knowledge	Mean	SD	‘t’ test	‘p’ value
Experimental	24.77	2.33	8.89	0.01
Control	17.67	3.70	8.89	0.01

Level of significance at p value < 0.05

The table displays a comparative evaluation of post-test knowledge scores for both the experimental and control groups, emphasizing statistical significance. The total sample size is 60, with the experimental group obtaining a higher average score (24.77) in contrast to the control group (17.67). The experimental group's standard deviation is 2.33, while the control group's is 3.70. The 't' test result is 8.89, with a related 'p' value of 0.01, demonstrating a statistically significant difference at p < 0.05. This indicates that the intervention implemented for the experimental group had a notable effect on enhancing knowledge when compared to the control group.

Table 4: Comparison of the Mean and Standard Deviation of Post-Test practice Between the Experimental and Control Groups (N = 60)

Post-Test practice	Mean	SD	‘t’ test	‘p’ value
Experimental	35.63	1.87	14.97	0.01
Control	26.47	2.78	14.97	0.01

Level of significance at p value < 0.05

The table provides a statistical analysis of post-test practice scores for both the experimental and control groups, based on a total sample size of 60 participants. The experimental group had a mean post-test practice score of 35.63, with a standard deviation of 1.87. In contrast, the control group recorded a mean score of 26.47 and a standard deviation of 2.78. The t-test value was found to be 14.97, with a p-value of 0.01. This indicates a statistically significant difference between the two groups at the p < 0.05 level, suggesting that the intervention was effective in improving post-test practice outcomes for the experimental group.

DISCUSSION:

In this study, knowledge and practice levels among the samples in the experimental group increases after the Skill Demonstration in Postnatal Care After Emergency LSCS. In control group there was no changes in the level of knowledge and practice regarding Skill Demonstration in Postnatal Care After Emergency LSCS.

Traditional live demonstrations greatly enhance students' practical abilities in obstetric and postnatal care, resulting in higher scores on post-tests compared to video-assisted or digital approaches. Students who participate in live demonstrations demonstrate improved skill acquisition and retain their skills better over time. While both live and video-based demonstrations contribute to knowledge enhancement, live demonstrations generally lead to more significant advancements in practical skill performance. Students express high levels of satisfaction with live demonstrations, and the inclusion of peer instruction or interactive components further increases motivation and skill retention.^8,9

The results align with those of a prior study¹⁰ involving nursing students, where the control and experimental groups received traditional, lecture-based ACLS training and simulation-based ACLS training, respectively. The findings indicated that simulation training was more effective for acquiring and retaining ACLS knowledge compared to lecture-based education.¹⁰

CONCLUSION:

This study concludes that demonstration methods effectively enhanced nursing students' knowledge and practice regarding postnatal care following emergency lower segment caesarean section (LSCS). Consequently, demonstration is recommended as a teaching method for instructing nursing students in psychomotor skills within postnatal care units. Further studies are necessary to assess the impact of demonstrating various obstetrics and gynaecological nursing skills, including antenatal care, delivery procedures, and the management of obstetrical emergencies, on nursing students and staff nurses.

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Received on 22.05.2025 Revised on 12.06.2025

Accepted on 26.06.2025 Published on 13.08.2025

Available online from August 20, 2025

Asian J. Nursing Education and Research. 2025;15(3):143-148.

DOI: 10.52711/2349-2996.2025.00030

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.