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INTRODUCTION
Pregnancy is a period of happiness and expectations for a mother, and we the nurses are the people to take care of them In this modern world by the introduction of many instruments, assessment of mother and the fetus became easy. But lack of knowledge among nurses increased the importance of educating them with technologies which will help in easy and early identification of complications.
Perinatal mortality includes both still birth and early neonatal deaths within the first seven days of life. Still birth refers to a fetal death beyond the gestation of viability
(contd.)
Nearly 27 million babies are born in India each year; this accounts for 20% of global births. The current perinatal mortality and still birth rates in India according to NFHS-3 are 48.5 and 19.2 per 1000 pregnancies respectively. .
OBJECTIVES
Objectives of the study are to
1. Compare pre and post interventional level of knowledge and practice of Cardiotocography among staff nurses working in the maternity department 2. Associate pre interventional level of knowledge and practice of Cardiotocography with selected demographic variable of staff nurses working in the maternity department. (contd.)
OPERATIONAL DEFINITIONS
Effect It refers to outcome of computer assisted instruction on knowledge and practice of Cardiotocography among staff nurses working in the maternity department.
(contd.)
Cardiotocography :
In this study it refers to a procedure that is used for assessing the fetal wellbeing, in which the fetal heart rate is continuously monitored for 20 minutes or more by using device called Cardiotocograph
Contd..
Knowledge:
It refers to existing and gained information regarding Cardiotocography by the nurses working in the maternity department and which include procedure, fetal heart rate pattern, interpretation and is assessed by a structured questionnaire
Contd..
Practice
It refers to skill of performing and interpreting Cardiotocography by the staff nurses working in the maternity department which is assessed by observational checklist
Contd..
Staff nurses
It refers to the nurses who are completed GNM or BSc nursing, having license from Kerala Nurses and Midwives Council to practice and working in the maternity department of selected hospitals
ASSUMPTIONS
Nurses working in the Maternity Department are expected to assess the fetal condition when electronic devices are available Early identification of intrauterine fetal distress is an indication for termination of pregnancy
HYPOTHESES H1: Post interventional level of knowledge score is higher than that of pre interventional level of knowledge score among staff nurses working in the maternity department H2: Post interventional level of practice score will be higher than that of pre interventional level of practice score among staff nurses working in the maternity department
(contd.)
H3 : There is significant association between pre interventional level of knowledge and practice of Cardiotocography with selected demographic variables of nurse working in the maternity department at 0.05 level of significance
RESEARCH METHODOLOGY:
RESEARCH APPROACH:
Quantitative Approach.
RESEARCH DESIGN:
The design is Pre-experimental, one group pretest
VARIABLES
a. Independent variable
b. Dependant variable
DAY-1
DAY -2
DAY -5
Population Staff Nurses working in the maternity department of selected hospitals Sample
Sample size- 40
Sampling techniquesimple random sampling
Collection of demographic data and assessment of level of knowledge by questionnair e and practice by observation al checklist
Intervention -. Computer assisted instruction on CTG is given to each sample for a duration of 30 minutes. After 5 days posttest is done.
Assessment of post interventional level of knowledge by questionnaire and practice by observational check list
SETTING
Mother hospital, Thrissur Aswini hospital, Thrissur Elite hospital, Thrissur
POPULATION:
Population for the study are staff nurses working in the maternity department of selected hospitals
SAMPLING
SAMPLE
Exclusion criteria Nurses working in the maternity department who are not available at the time of conduction of study
SAMPLE SIZE:
40 staff nurses who are working in the Maternity Department
SAMPLING TECHNIQUE:
Simple random sampling
DESCRIPTION OF TOOL:
Tool consist of part I and II, III, IV I:Structured Questionnaire to
III:- Observational check list to assess the observed practice of cardiotocography IV:InterventionComputer assisted
instruction on Cardiotocography
CONTENT VALIDITY
Validation of the tool was done by 5 experts in the field of Obstetrics and gynecologic Nursing and modifications were done
PILOT STUDY
STUDY PERIOD Pilot study was conducted from 19th November 2012 to 24th November 2012. STUDY SETTING Labour room, antenatal, postnatal wards of Westfort hospital, Thrissur SAMPLE SIZE 4 staff nurses in the maternity ward were taken for the study
ETHICAL CONSIDERATION
Obtained approval from Principal of College of Nursing, Institution Review Board, Ethical Committee West fort college of nursing The researcher obtained formal permission from Westfort hospital Thrissur and conducted pilot study by selecting the samples according to the inclusion criteria
Contd
Obtained written informed consent from the subjects. Confidentiality and privacy will be maintained
After getting permission to conduct the study ,samples were selected using simple random method Informed consent obtained from the participant Demographic data was collected by using questionnaire
. (contd.)
Questionnaire was administered to assess knowledge regarding cardiotocography to the staff nurses and pre interventional level of practice was assessed by observational checklist .
(
contd.)
Computer assisted instruction on Cardiotocography had given to each subject for a time duration of 30 minutes at a time convenient to them . On the 5th day, post test level of knowledge is assessed by using questionnaire and post test level of practice is assessed by observational check list
Section IIIanalysis of significance of difference of knowledge of nurses regarding cardiotocography before and after computer Assisted instruction on cardiotocography Section IV- association of pretest level of knowledge and practice with selected demographic variables
1. Age
a. 20-25 years a. 26 -30 years 2.Educational qualification a. General Nursing
75%
25%
100%
Contd..
Frequency Percentage
2 2
50% 50%
6.Previous
exposure
to
Section II :- Description of level of knowledge and practice of nurse before and after computer assisted instruction regarding cardiotocography
PERCENTAGE DISTRIBUTION OF PRE TEST AND POST TEST KNOWLEDGE SCORE 80% 70% 60% 50% 40% 30% 20% 10% 0% <13 inadequate 13 -18 moderatly adequate 19 -25 1dequate Fig 2
Fig 2 shows that 75% of samples had inadequate knowledge and 25 %had moderately adequate knowledge in the pre test. 25 % of samples had inadequate knowledge and 75% had moderately adequate knowledge in the post test
MEAN SCORE DISTRIBUTION PRE TEST AND POST TEST PRACTICE SCORE
16 15.5 15 14.5 14 13.5 MEAN SCORE
13
12.5 PRE TET SCORE POST TEST SCORE Fig 3
Fig 3 shows that mean pre test practice score of cardiotocography was 13. 5 and mean post test practice score was 15.5 after computer assisted instruction
Section III Analysis of significance of difference of knowledge and practice of nurses regarding cardiotocography before and after computer Assisted instruction on cardiotocography
Mean 10.5
13.5
t value 3.93
With regard to the pre test and post test ,the calculated t value is 3.93 which showed high statistical significance at p<0.005 level.
With regard to the pre test and post test ,the calculated t value is 3.47 which showed a statistical significance at p<0.005 level.
Section IV Association of pretest level of knowledge and practice of cardiotocography with selected demographic variables
In pilot study as sample size is small it is difficult to do the association Association of pretest level of knowledge and practice with demographic variables such as age, education, experience, experience in maternity ward and area of work can be done chi square in the main study
INFERENCE
There is a statistically significant difference in pre and post interventional level of knowledge and practice among staff nurses working in the maternity department The study is found to be feasible
THANK YOU
REFERENCES
1. Bobak.M.F. Maternity nursing, 4th edition, Missouri,
Mosby Publication;2007 2 Electronic fetal monitoring, http://medicaldictionary.the free dictionary.com/electronic+fetal+monitoring 3 Cardazo L.D,Kean L.Obstetric and gynaecology, first edition,.London:Arnold publication;2004
Essentials
of
fetal
monitoring,
http://www/espring
id=32634(oct-2006
erpub/com/prod.aspx?prod
5.Newborn
health
in
India.
http://www.newbornwhocc.org//teaching aids/2010/Newborn-health-in-India
http://www.newbornwhocc.org/pdf/teaching aids/2010/Newborn-health-in-India.
Educational qualification All the samples were belonging to general nursing and midwifery
Age
25%
21-25 years 26 -30years
75%
Fig 1 From fig 1 it is evident that 75% of staff nurses belong to21 -26 years and 25 % belong to 26 -30 years age group
Experience
PERCENTAGE
60% 40% 20% 0% 1- 2 years years 2-3 3-4 years Fig 2 - EXPERIENCE
Fig 2 shows that 2 samples have 1-2 years of experience and 50% have 3 -4 years of experience
50% PERCENTAGE
40%
30%
20%
10% 0%
0 - 1 year 1 - 2 years
0 - 1 year
Fig 3 shows that50% sample belong to 0-1 year experience category and 50% belongs t0 1-2 years category
Area of work
labour room
50%
50%
ward
Fig 4
Form the fig 4 the conclusion can be drawn that 50% samples belong to labour room category and 50% belongs to ward category
STUDY A descriptive study was conducted on obstetrical nurses regarding knowledge and attitude towards fetal monitoring in Florida
RESULT 80% nurses felt that fetal surveillance would be achieved by monitoring electronic fetal wellbeing
Studies which are aiming in enhancing the knowledge of nurse will help the nurses to empower themselves. This study will help the nurses to acquire knowledge and skill regarding fetal monitoring
INPUT
THROUGHPUT
OUTPUT
Pre test Assessme nt of existing level of knowledge and practice of cardiotoco graphy
A process of change in knowledge and understandin g about various aspects of CTG, which include definition, indication, procedure, Fetal Heart Rate Patterns and its interpretation FEEDBACK
Education program on CTG which include procedure, Fetal Heart Rate patterns and interpretatio n
REVIEW OF LITERATURE
A stydy conducted by Lu Yao- feng in the year 2007 to assess the clinical value of fetal monitoring in pregnancy. Study results showed that it can be used as a method to make timely decision of terminating pregnancies, and can decrease perinatal mortality.
A study conducted by Beckley S, Stenhouse E, Greene K in the year 2007 evaluate the effect of computer training programme on cardiotocography among 107 midwifery personnel and found that training programme was effective and mean score improved from 50% to 70% after the teaching programme
A study conducted by Herbert groeller in the year 2008m to examine the knowledge and practice on electronic fetal monitoring among midwives in Northern Ireland. The result showed that 50% of nurses had