RAJIVGANDHIUNIVERSITY OF HEALTH ANDSCIENCES

BANGALORE, KARNATAKA,

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / MRS. MANJU JOSEPH
I YEAR M.Sc. NURSING
INDIRACOLLEGE OF
NURSING.
2. / NAME OF THE INSTITUTION / INDIRACOLLEGE OF
NURSING,
FALNIR,MANGALORE.
3. / COURSE OF THE STUDY AND
SUBJECT / M.Sc. NURSING
OBSTETRIC &GYNAECOLOGICAL NURSING.
4. / DATE OF ADMISSION / 18-7-08
5. / TITLE OF THE TOPIC
EFFECTIVENESS OF PLANNED TEACHINGPROGRAMMEREGARDING PREVENTIONOFPOSTPARTUMHAEMORRHAGEAMONGJUNIORHEALTHASSISTANTFEMALES OF SELECTED PRIMARY HEALTHCENTRES ATMANGALORE.

6.BRIEF RESUME OF THE INTENDED STUDY:

6.1 NEED FOR THE STUDY:

Pregnancy and childbirth are a happy and joyous time for most women.” The moment a child is born, the mother is born. She never existed before;the woman existed, but the mother never did. The mother is something absolutely new. Childbearing is a natural physiological event and the most unforgettable experience in a woman’s life. The postpartum period or puerperium starts soon after the delivery of placenta. This period covers a critical transitional time for the woman, her newborn and her family on a physiological, emotionaland social level. The woman and the newborn need special attention during this period. 1

The International Confederation of Midwives (ICM) and theInternational Federationof Gynaecology and Reduce Maternal Death and Disability Obstetrics (FIGO) are key partners in the global effort around the world. Their mission statements share common commitment in promoting the health, human rights and wellbeing of all women, especially those at greatest risk for death and disability associated with childbearing. FIGO and ICM promote evidence-basedinterventions that, when used with properly informed consent, can reduce the incidence of maternal mortality and morbidity.1 Pregnant women may face life-threatening blood loss at the time of delivery. Anaemic women are more vulnerable to even moderate amount of blood loss.Fortunately,most postpartum haemorrhages can be prevented. Different approaches may be employed depending on the setting and availability of skilled birth attendants and supplies.3

This statement reflects the current (2006) state of the art and science of prevention and treatment of postpartum haemorrhage in low resource settings. It incorporates new research evidence that has become available since 2003 Publication of the first FIGO/ICM joint statementmanagement of third stage of labour to prevent postpartum hemorrhage’.1Approximately 30%of direct maternal deaths worldwide are due to haemorrhage, mostly in the postpartum period.2Most maternal deaths due to PPH occur in developing countries in settings (both hospital and community) where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent and manage PPH and shock. The millennium development goal of reducing the maternal mortality ratio by 75%by 2015 will remain beyond our reach unless we confront the problem of PPH in the developing world as a priority..3

According to WHO primary postpartumhaemorrhage is loss of blood >500 ml from the genital tract within 24 hrs of delivery. According to WHO report 2005 the worlds total maternal deaths are 400/100,000 live births. In developed countries it is 20 and in developing countries it is 440/100,000 live births. The Maternal Mortality Rates (MMR) in India is 407 per 100,000 live births (2004) . Studies done by WHO in selected states of India show that majority 38% of maternal deaths occur due to hemorrhage.4

A prospective cohort study was conductedin Guinea (2001) to describe the causes of maternal mortality in a multiethnic population in rural Guinea among 15,844 women aged 15-45years, a structuredquestionnairemethod is used for data collection. this study revealed that the common causes of maternal mortality includingpostpartumhaemorrhage (42%) ,ante partum haemorrhage (21%) ,obstructed labour (19%) ,puerperal infection (11%) and others (9%) .6

“Community BasedEmergency Care – Home Based Life Saving Skills (HBLSS) ”,anyone who attends a delivery can be taught simple home based life saving skills. Community based obstetric first aid with home based life saving skills is a family and community focused programme that aims to increase access to basic life saving measures and decrease delays in reaching referral facilities. Family community members are taught techniques such as uterine fundal massageand emergency preparedness. Field tests suggest that HBLSS can be a useful adjunct in a comprehensive PPH prevention and treatment programme.key to the effectiveness of treatment is the early identification ofhaemorrhageand prompt initation of treatment.7

Investigator during in her community postings come across home delivery along with junior health assistant females. In that occasionshe noticed they are lack of training in complicated situations. During those days the survey shows more than 30% of maternal mortality among deliveries conducted byJunior Health Assistant Females, this motivate the investigator to deliver a planned teaching programme regardingprevention of postpartumhaemorrhageamong Junior Health Assistant Females.

6.2 REVIEW OF LITERATURE

A comparative prospective study was conducted inAngola at 2005 to evaluate the prevailing pathology and partially to develop safer routine in obstetric care with the focus on avoiding andtreatingcomplications.The study tests a new disposable device uninject TM for a routine administration of oxytocin and compared postpartum blood loss of 782 women with exceptive management to 814 active management of third stage of labour while evaluative effect of uninjectTM.a prospective control design was used for study. The study revealed that active management of third stage of labourand unijectTM reduced postpartum blood loss by 50% and women of 1000 reduced by 80%.8

A population –based case control study was conducted in rural areas of Bihar (2007) to identify the risk factors associated with postpartum haemorrhage,for sampling women’s were selected randomly and grouped in two, one group consist those with postpartumhaemorrhage after a normal vaginal delivery and other group of women with normal unassisted vaginal delivery without postpartum haemorrhage.The method of data collected from medical records. The study findings shows that low parity, advanced maternal age, anaemia and prolonged labour were high risk factors, among these anaemia is strongest risk factor.

A cross sectional study was conducted at the department of obstetrics and gynaecologyin Aga Khan university hospital Karachi (2004) to review apractice of massive primary PPH management and develop a protocol. They taken 5678smples taken randomly, the study shows 3% of women had PPH,near miss cases with blood loss>1500ml was encounter in 14.37%, 56% of the women who had massive PPH. Among most of these cases delivered vaginally only.11

A survey studyconducted atUSA in 2004,to find out the levels, timing and determinants of occurrence of postpartum care among women of reproductive age in developing countries. Health survey data taken from 30 developing countries. The study focusedon the post operative period up to six weeks after delivery. The results shows that about one half of all births in these countries continued to occur out side health institutions, seven in ten of these births did not receive postpartum care, women who are lived in wealthier were more likely to receive postpartum care. 9

Adescriptive study was conductedin Dhaka slums at Bangladesh (1995) ,to asses traditional practices of traditional birth attendants. This study describes association among delivery location, training of birth attendants, birthing practices and early postpartum morbidity of women.The interview method was used. Samples taken from 489 birth attendantsand checked 1506 women’s delivery record. After analyses this study revealed that greatest association found between maternal characteristics, birth practices, delivery location, training of birth attendants and early postpartum morbidity.12

6.3 STATEMENT OF PROBLEM

Effectiveness ofplanned teaching programme regarding prevention of postpartumhaemorrhage among JuniorHealth AssistantFemales of selected Primary Health Centres at Mangalore.

6.4 OBJECTIVES

The objectives of the study are:

  1. To determine the knowledge of Junior Health Assistant Femalesregarding prevention of postpartumhaemorrhageusingstructured knowledge questionnaire.
  2. To evaluate the effectiveness of planed teaching programme regardingprevention of postpartumhaemorrhage. among Junior Health Assistant females.
  3. To find out theassociation between pretest knowledge scores of Junior Health Assistant Females regarding prevention of postpartumhaemorrhage and selected demographic variables.

6.5:OPERATIONAL DEFINITIONS

  1. Effectiveness:In this study effectiveness refers to the extent to which planned teaching programme onprevention of postpartumhaemorrhage has achieved the desired effect.
  2. Planned Teaching Programme: It refers to planned events, series of studies or lectures in a view to improve knowledge. In this study, it refers to systematically developed teaching programme designed foragroup of Junior Health Assistant Females toprovide information on prevention of postpartumhaemorrhagewhich includes intelligent anticipation, skilled supervision, prompt detection and effective institution of therapy.
  3. Postpartum Haemorrhage: It refers to a loss of blood more than 500ml from the genital tract, withintwenty four hours of delivery.
  4. Junior Health Assistant Females: In this study, it refers to those whocompleted 18 months junior health assistanttraining programme and working in selected primary health centres at Mangalore.

6.6ASSUMPTIONS

  1. Junior Health Assistant Females will have some knowledge regarding prevention of postpartum haemorrhage.
  2. Awareness regarding role of prevention of postpartum haemorrhage is less among Junior Health Assistant Females.
  3. Junior Health Assistants Females will willingly participate in teaching programme.
  4. Planned teaching programme is an accepted teaching- learning strategy.

6.7HYPOTHESES

Hypothesis will be tested 0.05 level of significance

H1:There will be a significant mean difference between pre-test and post test knowledge scores of Junior Health Assistant Females regarding prevention of postpartum haemorrhage.

H2:There will be significant association between the pre-test mean knowledge score and selected demographic variables.

6.8DELIMITATION

This study delimited to:

  1. Junior Health Assistant Females who areworking inselected Primary Health Centres at Mangalore.

7MATERIALS AND METHODS:

7.1SOURCE OF DATA

The data will be collected from Junior Health Assistant Females working at selected Primary Health Centres ofMangalore.

7.1.1RESEARCH DESIGN

Pretest-posttest evaluatory research design will be selected for the study.

O1xO2

O1=pretest

X=treatment (planned teaching programme)

O2=Post test

7.1.2 SETTINGS

In this study the pretest and teaching programme conducted at selected Primary Health Centres during monthly meeting section. Post test will be conducted at their particular health centres after 7 days.

7.1.3 POPULATION

The population in this study comprised of Junior Health Assistant Females in selected Primary Health Centres, in Mangalore. There are total 370 Junior Health Assistant Females appointed in 67 Primary Health Centres in and around Mangalore.

7.2.METHODS OF DATA COLLECTION

7.2.1 SAMPLING PROCEDURE

The sample for the present study will be selected by Simple Random Sampling Technique.

7.2.2 SAMPLE SIZE

In this study sample size consists of 3O JuniorHealth Assistant Females.

7.2.3 INCLUSION CRITERIA FOR SAMPLING

  1. Junior Health Assistant Females who are willing to participate
  2. Junior Health Assistant Females who are present at the time of teaching programme.

7.2.4EXCLUSION CRITERIA:

  1. Junior Health Assistant Females are already exposed to training programme on prevention on postpartum haemorrhage.

7.2.5 INSTRUMENTS INTENDED TO BE USED:

The tool used for this studies are:-

  1. 1.Base line proforma
  2. 2Structured knowledge questionnaire

7.2.6 DATA COLLECTION METHOD

  1. Permission will be obtained from the District Health Office and medical officer of Primary Health Centres.
  2. Purpose and need for the study will be explained to the Junior Health Assistant Females.
  3. Consent will be obtained from Junior Health Assistant Females.
  4. Pre-test will be conducted on the day1st; planned teaching program will be given on same day and on 7th and 8th day post test will be conducted.

7.2.7 PLAN FOR DATA ANALYSIS

The data will be analysed using both descriptive (mean,median,mean percentage and standard deviation) and inferential statistical (chi square test) and (t test) .

7.3. DOES THE STUDY REQUIRE ANY INVESTIGATIONS OR INTERVENTION TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN ANIMALS?

Yes, in the present study investigator plan to use structured questionnaire to assess the knowledge of Junior Health Assistant Females regarding prevention of postpartumhaemorrhage.

7.4 HAS ETHICAL CLEARANCE BEEN OBTAINED FROM YOUR INSTITUTION IN CASE OF 7.3?

Yes, ethical clearance will be obtained from the research committee of this institution

LIST OF REFERENCE

  1. The international confederation of midwives, international federation of obstetrics and gynaecology,joint statement of the third stage of labour to prevent postpartumhaemorrhage.The Hague ICM.2003;
  2. Khan KS,Wojdyla D,Say L,Gulmezoglu AM,Van Look PF. WHO analysis of maternal death.2006;1066-1074
  3. United Nations.Millenium Development Goals,Newyork.UN.2000; 331:1147-98
  4. D C DUTTA.Text book of obsteritics. 2004;6:411-419
  5. NHS.Guildelines for the management of severe obsteritic haemorrhage. 2004;12:1011-1018
  6. Lars Hoj.Departement of epidemiology research statens serum Institute. 2001;21:234-345
  7. RJ Derman,B S Kodkany,SS Goudar,SE Gellar,VA Naik,.In preventing postpartumhaemorrhage in resource poor communities. 2006;368:1248-53
  8. RT Strant,F Da Silva, E Jangstent, postpartum haemorrhage,A prospective study in Anjola.2oo5;84 (3) :260-265
  9. Alfredo Fort,Monika Rothary,Noureddine,.postpartum care in developing countries.2004;14 (8) ;123-134
  10. Parvin A Khanum,M A Quaium,knowledge and use of essential obstetric care services in a rural NGO working area.2001;54:56-75
  11. 11.Lumen Sheikh,Nadeem Faiyaz,Javed H Rizwi, he department of OBG Aga Khan university.2006;56 (1) :26-31
  12. 12.N Fronczak,Afrifeen S F,AC Moral.dellivery practices of traditional birth attendants.1995;87 (5) :62-79

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