EXPLORE THE KNOWLEDGE ON MIDWIFERY CARE AMONG NURSES

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EXPLORE THE KNOWLEDGE ON MIDWIFERY CARE AMONG NURSES IN ORDER TO DEVELOP A TEACHING

EXPLORE THE KNOWLEDGE ON MIDWIFERY CARE AMONG NURSES IN ORDER TO DEVELOP A TEACHING MODULE By Dr. MALLIKA RAJADURAI Professor College of Nursing, PIMS Puducherry, INDIA

PONDICHERRY INSTITUTE OF MEDICAL SCIENCES (A UNIT OF MADRAS MEDICAL MISSION) Puducherry – South

PONDICHERRY INSTITUTE OF MEDICAL SCIENCES (A UNIT OF MADRAS MEDICAL MISSION) Puducherry – South India

OUTLINE OF PRESENTATION �Introduction �Midwifery Education in India �Health care System in India �Statement

OUTLINE OF PRESENTATION �Introduction �Midwifery Education in India �Health care System in India �Statement of the Problem �Objectives �Methodology �Study Findings �Discussion �Teaching Module

A Midwife should have a & (Old Textbook on Midwifery- 18 th century)

A Midwife should have a & (Old Textbook on Midwifery- 18 th century)

INTRODUCTION • India has 27 Million births per year, which is the largest in

INTRODUCTION • India has 27 Million births per year, which is the largest in the world. • Maternal mortality : GLOBAL -300 -500 per 100, 000 births. • 50, 000 -75, 000 maternal deaths occur every year in India. • This is about 20% of the global burden.

MIDWIFERY EDUCATION IN INDIA • Auxiliary Nurse Midwives : Two-year training program with Maternal

MIDWIFERY EDUCATION IN INDIA • Auxiliary Nurse Midwives : Two-year training program with Maternal Health integrated in the curriculum. (ANMs). • They provide maternal and child health care services in the Periphery.

HEALTH CARE DELIVERY SYSTEM

HEALTH CARE DELIVERY SYSTEM

PRIMARY HEALTH CENTRE � Peripheral health units - rural women meet their Maternal health

PRIMARY HEALTH CENTRE � Peripheral health units - rural women meet their Maternal health needs. �Health personnel in Primary Health Centre : The staff nurses, Village Health Nurses (VHN) and Auxiliary Nurse Midwives �They conduct normal delivery handle Emergency Obstetric care. �The knowledge in maternity care essential for nurses to practice safe motherhood.

ANTENATAL CHECKUP IN PHC, INDIA

ANTENATAL CHECKUP IN PHC, INDIA

 • The Millennium Development Goal (MDG 5). • To improve maternal health in

• The Millennium Development Goal (MDG 5). • To improve maternal health in India • MMR was 437 / 1 L- live births 2009. • 167/1 L- live births in 2013 • TARGET : To reduce MMR to 109 by 2015

National Rural Health Mission (NRHM) Recommendation of NRHM – 2012 • Skilled birth attendants(SBA)-.

National Rural Health Mission (NRHM) Recommendation of NRHM – 2012 • Skilled birth attendants(SBA)-. ANM’s with additional 3 months training in Maternity care • To have Skilled Birth Attendant at every Birth. • 87. 1% of live births are attended by SBA in 2013.

Government of India Effort • Universal institutional delivery Delivery should occur only in government

Government of India Effort • Universal institutional delivery Delivery should occur only in government health centre, hospitals or in nursing homes where Skilled Birth Attendants are available.

NEED FOR SKILLED BIRTH ATTENDANT (STATISTICAL EVIDENCE) �Less than 50% of women in India

NEED FOR SKILLED BIRTH ATTENDANT (STATISTICAL EVIDENCE) �Less than 50% of women in India have SBA at birth. There exists Unsafe Motherhood in India indicating the following statistics. 1. Every 5 minute one women somewhere in India dies Of complications of child birth 2. 15% develop life threatening complications. 3. 65% of deliveries occur at home. 4. 41%have SBA at the time of delivery. 5. 60% of women die postnatally. � 1/37 in INDIA, 1/230 in Srilanka, 1/ 5000 in Singapore, 1/7300 in Norway

STATEMENT OF THE PROBLEM To Explore the knowledge on Maternity care in order to

STATEMENT OF THE PROBLEM To Explore the knowledge on Maternity care in order to develop a teaching module for Skilled Birth Attendants working at Primary Health centers of selected health unit districts in Tamil Nadu.

OBJECTIVES 1. To identify the knowledge level on maternity care among nurses working at

OBJECTIVES 1. To identify the knowledge level on maternity care among nurses working at Primary Health Centers of Thoothukudi Health Unit District. 2. To compare the level of knowledge on maternity care within groups. 3. To associate the knowledge level with demographic variables of nurses. 4. To develop teaching module for Skilled Birth attendant.

METHODOLOGY

METHODOLOGY

SCHEMATIC REPRESENTATION OF RESEARCH DESIGN Phase -1 Phase -2

SCHEMATIC REPRESENTATION OF RESEARCH DESIGN Phase -1 Phase -2

SETTING : THUTHUKUDI HUD Tuticorin HUD Thootikudi Karungulam Srivaikunda m Thiruchendur Sattankulam Alwarthirunagar Udankudi

SETTING : THUTHUKUDI HUD Tuticorin HUD Thootikudi Karungulam Srivaikunda m Thiruchendur Sattankulam Alwarthirunagar Udankudi : Upgraded PHC : Block PHC : PHC

RESEARCH TOOLS o Section: I- Questionnaire to collect demographic data. o Section: II Self

RESEARCH TOOLS o Section: I- Questionnaire to collect demographic data. o Section: II Self administered questionnaire to assess knowledge on midwifery care. o 50 multiple choice questions. o Under 6 domains Of maternity care.

Domains of Maternity Care o General maternity care (11 items), o Care during normal

Domains of Maternity Care o General maternity care (11 items), o Care during normal labour (6 items), o Management of complications during pregnancy (13 items) o Obstructed labour (5 items), o Obstetric complication (10 items) o Postpartum complications (5 items)

RESULTS

RESULTS

HIGH LIGHTS OF DEMOGRAPHIC VARIABLES MAT Exp 46. 3% Age <30 yrs 47. 3%

HIGH LIGHTS OF DEMOGRAPHIC VARIABLES MAT Exp 46. 3% Age <30 yrs 47. 3% Exp <10 yrs 50% SN 47% ANM 53% No SBA 53. 7%

FIGURE 3: PERCENTAGE DISTRIBUTION OF OVERALL KNOWLEDGE LEVEL ON MIDWIFERY CARE AMONG NURSES n=

FIGURE 3: PERCENTAGE DISTRIBUTION OF OVERALL KNOWLEDGE LEVEL ON MIDWIFERY CARE AMONG NURSES n= 300

DOMAINSVISE KNOWLEDGE LEVEL Adequate (71 -100%) 100% Moderately Adequate (51 - 70%) 94. 7%

DOMAINSVISE KNOWLEDGE LEVEL Adequate (71 -100%) 100% Moderately Adequate (51 - 70%) 94. 7% 87. 7% 80 70 60 50 36. 7% 36. 3% 15. 7% 4. 3% Domains 2. 3% 1. 7% Postpartum Complications 5. 3% 0% Obstetric Complications 0% 10% Obstructed Labor 0% Complications during Pregnancy 7. 3% Care During Normal Labor 10 0 82. 7% 59% 56. 3% General Midwifery Care Percentage 100 90 40 30 20 Inadequate (<50%)

FIGURE 4: DOMAIN WISE MEAN KNOWLEDGE ON MIDWIFERY CARE AMONG NURSES WORKING AT PRIMARY

FIGURE 4: DOMAIN WISE MEAN KNOWLEDGE ON MIDWIFERY CARE AMONG NURSES WORKING AT PRIMARY HEALTH CENTRE THOOTHUKUDI HUD

TABLE 3 : COMPARISON OF DOMAIN WISE KNOWLEDGE LEVEL ON MIDWIFERY CARE BETWEEN GROUPS.

TABLE 3 : COMPARISON OF DOMAIN WISE KNOWLEDGE LEVEL ON MIDWIFERY CARE BETWEEN GROUPS. (ANM, VHN , STAFF NURSES) S. No 1 2 DOMAINS General maternity care Care during normal labour F Value p Value 12. 5 0. 001 HS 0. 01 S 0. 0001 HS 04. 6 3 Care during complication of pregnancy 14. 3 4 Obstructed Labor 0. 358 0. 69 NS 5 Obstetric complication 0. 58 NS 6. Post partum Complication 2. 8 0. 05 S ANOVA test used, Significant at p<0. 05 Level.

INTERPRETATION OF FINDINGS • Both ANOVA and Post Hoc test was done to infer

INTERPRETATION OF FINDINGS • Both ANOVA and Post Hoc test was done to infer the comparison of Domain wise knowledge. • It was found to be statistically significant difference in the knowledge level between ANM, Staff Nurses and VHNS in the domains General maternity care, Care during normal labour, Care during complication of pregnancy and post partum complication.

ASSOCIATION Level of knowledge had association with the following demographic variables -SS at p<0.

ASSOCIATION Level of knowledge had association with the following demographic variables -SS at p<0. 01 o Age < 30 yrs o Married o Having children o Qualification –SSLC o ANM o > 10 yrs of experience in maternity

ASSOCIATION OF DOMAINSVISE LEVEL OF KNOWLEDGE o The following domain vise knowledge had association

ASSOCIATION OF DOMAINSVISE LEVEL OF KNOWLEDGE o The following domain vise knowledge had association with demographic variables -SS at p<0. 1. ØComplications during pregnancy ØObstructed labor ØObstetric complications ØPostpartum complications

DISCUSSION Level of knowledge on midwifery care among nurses • The overall knowledge level

DISCUSSION Level of knowledge on midwifery care among nurses • The overall knowledge level on Midwifery care among nurses working at Primary health centre were found to be inadequate 296 (98. 7%) and 4 (1. 3%) had moderately adequate knowledge

SUPPORTIVE STUDY Assessment of Nurse–Midwives' Knowledge and Practices toward Second Stage of Labor Ahrar

SUPPORTIVE STUDY Assessment of Nurse–Midwives' Knowledge and Practices toward Second Stage of Labor Ahrar M. Rasheid, and Rabea'a M. Ali, -Saudi Arabia 2010 had assessed the knowledge and practice on the management of second stage of labor. (75) Nurse-Midwives in (6) hospitals. There was a high mean of scores in' knowledge and a low mean scores for their practices. There was a significant association between nurses-midwives' practices and their educational level, and birth number average.

 • Comparison of Knowledge Level of on Midwifery Care Among Nurses within groups

• Comparison of Knowledge Level of on Midwifery Care Among Nurses within groups – There was significant difference in the knowledge level between age, marital Status, Having child, Qualification, work experience which also had significant association. Teaching Module can enhance the level of Knowledge - Quality Nursing care in Maternity

SUPPORTIVE STUDY • S. A. Harvey et al of Jamaica measured the competence of

SUPPORTIVE STUDY • S. A. Harvey et al of Jamaica measured the competence of Nurses by the Guidance of WHO using 49 MCQ covering 6 clinical areas. • The mean knowledge being 55. 8% among 166 Participants. • The study infer that - wide gap existed between the current Evidence Based standards and levels of provider Competence.

OUTCOME OF THE STUDY o Teaching Module on midwifery care for SBA Specific Objectives

OUTCOME OF THE STUDY o Teaching Module on midwifery care for SBA Specific Objectives of Module: o To gain knowledge on general midwifery care. o To apply the knowledge and practices of the same in normal maternity, newborn and obstetrics care.

CONCLUSION • Though the knowledge of nurses was inadequate the maternal mortality rate in

CONCLUSION • Though the knowledge of nurses was inadequate the maternal mortality rate in Thoothukkudi district is 0. 8, IMR is 1. 1 and birthrate is 15. 9 which denotes that the nurses practice is good. • State with low Maternal Mortality rate in India. 1 2